Mapping System–Assisted Bipolar Radiofrequency Ablation for the Treatment of Ventricular Tachycardia Associated With Ventricular Aneurysm

BACKGROUND: The management of malignant ventricular tachycardia (VT) in the aftermath of a myocardial infarction is a complex undertaking, particularly in cases accompanied by left ventricular aneurysm (LVA). It is frequently the case that conventional unipolar radiofrequency catheter ablation (RFCA) is inadequate. CASE SUMMARY: A 50-year-old male patient with a medical history of myocardial infarction presented with recurrent VT due to a LVA. Initial unipolar RFCA proved to be an ineffective treatment. Bipolar RFCA guided by CARTO mapping during coronary artery bypass grafting has been demonstrated to successfully ablate the LVA. Subsequent postoperative follow-up revealed no recurrence of VT and sustained cardiac function over a 2-year period. DISCUSSION: Refractory VT due to LVA poses significant treatment challenges. Bipolar RFCA, guided by CARTO mapping, has been shown to offer an effective solution, overcoming the limitations of unipolar RFCA by targeting both epicardial and endocardial arrhythmogenic substrates. This case demonstrates a surgical approach with the potential to yield favorable outcomes.