Successful radiofrequency catheter ablation of idiopathic left ventricular tachycardia using both retrograde and transeptal approach

Idiopathic left ventricular tachycardia (ILVT) has become more popular among the Oriental young population. We report our experience with catheter ablation of this arrhythmia. Two women and 4 men, their age ranged from 13 to 32 years-old (mean 22.3 years) had recurrent VT for 3 to 6 years with mean frequency of 4 ± 3 years episode per year. No structural heart disease was identified. The tachycardia was easily induced by both ventricular and atrial stimulation. All can be terminated by iv verapamil administration. Our approach was using two electrods at the ventricle, one from retrograde aortic and the other from transeptal approach. The VT location was confirmed by earliest endocardial activation and/or pace mapping technique and the sites were uniformly from the inferoapical left ventricle. Purkinje potential could be recorded in the two patients and the radio frequency (RF) current was delivered at the site, while for the remainder the earliest electrical activation was the site of RF catheter ablation. All successful RF ablation were performed through retrograde aortic catheter. No complication was reported. During the follow up of 3 to 20 months, all patients were free from any tachycardia without medication. In conclusion, ILVT can be effectively and safely treated using catheter ablation. Additional transeptal while using retrograde aortic approach may be helpful for activation mapping technique.