Abstract
A 70-year-old man, who had suffered from myocardial infarction 25 years ago, admitted with- ventricular tachycardia (VT) . Upon further examination, he was found to have 2 vessel disease including total occlusion of the left anterior descending artery and the left ventricular apical aneurysm with multiple thrombi. He needed coronary bypass grafting and removal of the thrombi. We planned to treat VT during the operation. After Off-pump coronary artery bypass grafting, cardio-pulmonary bypass was started. Apical thrombi were removed through the incision of the aneurysm, and the heart was restarted by cardioversion. After rewarming to normal body temperature, VTs were induced by left ventricular extrastimulation. By endocardial mapping with a 20-electrode ring catheter, the earliest activation sites and the neighbor area, where diastolic potentials were recorded, were marked by a color marker. Linear ablations by a monopolar radiofrequency device were performed at the marked area 3 times at a setting of 70 degrees centigrade for 60 seconds. After the procedure, VT could not be induced by extra- and burst-cardiac stimulation. Finally, left ventriculoplasty was performed. VT has not recurred in the 20 months since the surgery.
