Successful Application of Stereotactic Body Radiation Therapy for Ventricular Tachycardia Substrate in a Patient With Nonischemic Cardiomyopathy.

Cardiac stereotactic body radiotherapy (SBRT) has been gaining attention as a potential treatment for patients with ventricular tachycardia (VT). Here, we describe a nonischemic patient with severe heart failure and VTs originating from the deep anteroseptal substrate that was refractory to standard and bipolar catheter ablations, and was successfully managed with SBRT. In conclusion, anteroseptal VTs resistant to catheter ablation in severe nonischemic heart failure might be an indication for cardiac SBRT as palliative therapy.

Dual countertraction for extraction of abandoned leads with severe lead-to-lead adhesion.

Note that firm adhesion between the atrial lead near the proximal electrode and the ventricular lead is present. Simultaneous application of countertraction from the femoral and jugular workstation, i.e. dual countertraction, liberated the two leads from the adhesion.

A single premature stimulation from the para-Hisian region unmasked negative involvement of the left anterior fascicle in the verapamil-sensitive ventricular tachycardia with a right bundle branch block and right-axis deviation.

A 33-year-old man had verapamil-sensitive ventricular tachycardia (VT) with a right bundle branch block (RBBB) and right axis deviation. Programmed stimulation from the para-Hisian region induced ventricular tachycardias (VT1 or VT2). VT1 was entrained during pacing from the para-Hisian region. A single para-Hisian stimulation antidromically captured the proximal portion of the left anterior fascicle (LAF), but the cycle length of VT2 remained unchanged. This observation indicated that the upper limb of the LAF was a bystander of the reentry circuit. We have clarified this mechanism with applying a single premature stimulation from the para-Hisian region.