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Techniques for catheter ablation have evolved to effectively treat a range of ventricular arrhythmias. Pre-operative electrocardiographic and cardiac imaging data are very useful in understanding the arrhythmogenic substrate and can guide mapping and ablation. In this review, we focus on best practices for catheter ablation, with emphasis on tailoring ablation strategies, based on the presence or absence of structural heart disease, underlying clinical status, and hemodynamic stability of the ventricular arrhythmia. We discuss steps to make ablation safe and prevent complications, and techniques to improve the efficacy of ablation, including optimal use of electroanatomical mapping algorithms, energy delivery, intracardiac echocardiography, and selective use of mechanical circulatory support.

A 17-year-old boy was admitted for management of ventricular fibrillation (VF) with intermittent Brugada pattern on ECG. On evaluation, cardiac MRI revealed myocardial scar and mediastinal lymphadenopathy. 18-Fluorodeoxyglucose positron emission tomography scan showed inflammation in the heart, lungs, and lymph nodes. He was diagnosed as a case of cardiac sarcoidosis (CS) and treated with steroids. However, there was a reactivation of cardiac inflammation and the development of a second VF storm. Following catheter ablation, the patient's arrhythmia improved. This report highlights the inflammation due to CS mimicking channelopathic features.

Introduction Cardiac resynchronization therapy (CRT) by biventricular pacing (BiV) may worsen indices of ventricular repolarization. The impact of His bundle pacing (HBP) on repolarization is not well studied in patients with left ventricular systolic dysfunction. The aim of the study is to compare the repolarization parameters in ECG between these two pacing modalities. Methods Baseline and post implant parameters of 20 patients who had undergone HBP were compared with 18 patients who underwent CRT implantation. Repolarization parameters were monitored before implantation, 24 h and 6 weeks after implantation. Patients were followed up for 6 months with clinical and echocardiographic parameters. Result Baseline clinical, electrocardiographic and echocardiographic parameters were similar. Significant differences were noted in QTc, Tp-e and Tp-e/QTc between HBP and CRT groups both immediate post implant and after 6 weeks of implantation. Compared to pre-implantation, Tp-e and Tp-e/QTc shorten significantly immediate (90.54 ± 24.35 vs 69.62 ± 12.92, p Conclusion HBP is associated with significant reduction of Tp-e and Tp-e/QTc compared to CRT patients. Further evaluation is needed to determine whether this improvement in indices of repolarization is associated with reduction in clinical arrhythmic events.

Objectives This study identified predictors of clinical (CR) and echocardiographic response (ER) following immunosuppressive therapy (IST) in patients with cardiac sarcoidosis (CS). Backgr...

Implantable cardioverter-defibrillators are the mainstay of therapy for prevention of sudden cardiac death in high-risk patients with hypertrophic cardiomyopathy (HCM). Catheter ablation is a useful option for patients with recurrent, drug refractory monomorphic ventricular tachycardia (VT), and device therapy. Compared with other nonischemic substrates, there are limited data on the role and outcomes of catheter ablation in HCM. The challenges of VT ablation in HCM patients include deep intramural and epicardial substrates, suboptimal power delivery, and higher recurrence due to progression of disease. Patient selection, using cardiac MRI scar localization, and optimizing ablation techniques can improve outcomes in these patients.

Introduction The epidemiology of atrial fibrillation (AF) in India has not been studied systematically in large scale population based surveys. Stroke is one of the leading causes of death and disability in India. As AF is a major contributor of stroke, it is important to know the burden of AF and stroke risk in the population. The Andhra Pradesh Atrial Fibrillation (AP-AF) study aims to assess the prevalence, etiology, risk factors and stroke risk among the rural population in Andhra Pradesh, India. Methods This is a cross-sectional survey done using a two-stage sampling process. Adults (≥18years) from villages in East and West Godavari districts were sampled. Field investigators used a structured questionnaire to collect information on basic demographics, cardiovascular risk factors and medical history. Anthropometric measurements were performed, blood pressure measured and fasting capillary blood glucose was assessed. Electrocardiogram was done using a hand-held mobile ECG device-KardioMobile. ECGs were interpreted by study cardiologists. Participants diagnosed to have AF were invited to participate in a camp conducted by cardiologists where echocardiogram was done and also a focused history related to AF was collected. Along with age and sex stratified prevalence of AF, descriptive statistics will be used to present demographics, clinical profile, and cardiovascular risk factors. Stroke risk will be calculated using CHA 2 DS 2 -Vasc score. Conclusion The AP-AF study is expected to provide important information on AF epidemiology in rural India. The information may help improve health care policies in preventing stroke and other complications of AF.

Implantable cardioverter defibrillator (ICD) is often advised for secondary prevention of sudden cardiac death. Inappropriate shocks from ICD is uncommon but can seriously affect the quality of life. One of the reasons for inappropriate ICD shock is loose set screw, which may remain undetected by device interrogation and/or fluoroscopy. A 55-year lady presented with multiple inappropriate shocks few hours after an ICD implantation. The discrepancy between near field (NF, tip to ring) and far field (FF, Can to RV coil) signals helped us to suspect noise related to loose set screw, as the underlying problem. Re-exploration of the pocket had to be performed as the last resort to confirm the diagnosis and rectify the problem.

The objective of this study was to evaluate the effects of sodium glucose co-transporter 2 inhibitors (SGLT2i) on functional capacity and diastolic function in patients with diabetes with nonobstructive hypertrophic cardiomyopathy (nHCM) and preserved left ventricular (LV) function. From January 2019 to October 2020, a prospective open-label study was performed on patients with type 2 diabetes mellitus and nHCM with New York Heart Association class II-III symptoms. Patients with a LV ejection fraction50% were excluded. Patients were recruited from January 2019 to November 2019 to the SGLT2i arm and from November 2019 to October 2020 to the control arm. The primary composite end point was defined as achieving an improvement of at least 1.5 in E/e' and a reduction of ≥1 New York Heart Association functional class after 6 months of therapy. At baseline, there were no significant differences between the SGLT2i (n = 24) and control arms (n = 24). More patients in the SGLT2i arm achieved the primary end point than the patients in the control arm (70.8% vs 4.2%, p0.001). After 6 months of therapy, patients in the SGLT2i arm showed a significant improvement in all diastolic function parameters (E/e' 16.3 ± 1.9 vs 13.3 ± 1.6, p0.001; E/A 2.8 ± 0.1 vs 2.4 ± 0.1, p0.001; left atrial volume 45.6 ± 5.2 vs 40.8 ± 4.9 ml/m

We describe a 56-year old man with medically refractory ventricular tachycardia (VT) who was referred for catheter ablation. His examination revealed features suggestive of acromegaly. The diagnosis was confirmed by elevated levels of insulin like growth factor-1 and the presence of a pituitary adenoma. Following trans-sphenoidal surgery, there was a reduction in PVC burden and no recurrence of VT.

We present an unusual intracardiac mass posing a diagnostic dilemma. A middle-aged male patient was referred for workup of a symptomatic cardiac mass involving the mitral valve. Multimodality imaging consisting of cardiac magnetic resonance (CMR) imaging and 18F-fluorodeoxyglucose positron emission computerized tomography (18FDG-PET) scan was utilized to further characterize the mass after initial echocardiographic identification. CMR imaging identified extent of valvular mass into the interatrial septum and basal portion of the interventricular septum. On 18FDG-PET scan, the intracardiac mass was found to be metabolically active. It also revealed the presence of FDG avid lymph nodes in the abdomen. Histology of the lymph node revealed active granulomatous inflammation suggestive of tuberculosis. Treatment with antitubercular therapy resulted in resolution of the mass and mitral regurgitation, avoiding surgery.

Introduction Ventricular arrhythmias (VAs) have been successfully ablated from the pulmonary sinus cusps establishing pulmonary artery (PA) as a distinct site of arrhythmic foci. The aim of the present study was to determine the clinical presentation, electrocardiographic, and ablation characteristics of PA‐VAs. Methods Thirty consecutive patients with right ventricular outflow tract (RVOT)‐type VAs were included in this retrospective study. Three‐dimensional electroanatomic mapping was performed in all patients. Mapping was performed initially in RVOT, and later within the PA. Mapping was performed in the PA if there was no early activation, unsatisfactory pace‐map, or ablation in RVOT were unsuccessful. All PA‐VAs were mapped and ablated by looping the catheter in a reverse U fashion. Results Among 30 patients, 8 (26.6%) patients VAs were successfully ablated within PA. Electrocardiography (ECG) revealed that the QRS duration was significantly wider in the PA‐VAs group compared to the RVOT‐VAs group (155 ± 14.14 vs 142.40 ± 8.12 ms, P, Pulmonary artery is an important site of ventricular arrhythmic foci. Presence of an isolated prepotential in pulmonary cusp helps to identify the successful ablation site. We found mapping utilizing the reversed U method can help in localization and ablation of pulmonary artery derived ventricular arrhythmia.

Background Implantable cardioverter defibrillator (ICD) is recommended for patients with ventricular tachycardia (VT) due to cardiac sarcoidosis (CS). Programming supraventricular tachycardia (SVT) discriminators (onset, stability, and morphology/template match) is generally recommended to minimize inappropriate therapies. However, VT in patients with CS is known to show cycle length variability (CLV) and pleomorphism. Objective To determine whether the stability criterion, designed to prevent inappropriate therapy during atrial fibrillation with rapid ventricular rates, could potentially lead to incorrect classification of VT as SVT and inappropriately delay or inhibit ICD therapy. Methods Cases of biopsy-proven CS with VT were analyzed. For patients with implanted devices, all recorded electrograms of tachycardia episodes and ICD therapies were analyzed at last follow up. Results A total of 142 patients were included (mean age 38 years, 87 males). One hundred and three of 142 patients had implanted devices (ICD or CRT-D). Thirty eight of 103 (36.9%) patients received appropriate ICD therapies over 3 ± 2.2 years follow up. Four of 38 (10.5%) of patients experienced delayed-detection or underdetection of VT related to CLV, resulting in VT counters being repeatedly "reset" (classified as "unstable" rhythms). Retrospective analysis of other VT episodes in 70 of 103 (68%) patients revealed that 25 of 80 (31.3%) episodes had > 50 ms cycle length oscillations. Conclusion Among CS patients with VT, CLV is a common occurrence seen in two-thirds of VT episodes. Routine programming of the stability criterion may result in underdetection of VT in a subset of such patients. We recommend that the stability criterion should be programmed "OFF" for patients with CS, unless the patient has documented atrial fibrillation.

Background: Patients with outflow tract ventricular tachycardia (OTVT) with normal echocardiogram are labeled as idiopathic VT (IVT). However, a subset of these patients is subsequently diagnosed with underlying cardiac sarcoidosis (CS). Objective:Whether electrocardiogram (ECG) abnormalities in sinus rhythm (SR) can differentiate underlying CS from IVT. Methods: We retrospectively analyzed the SR-ECGs of 42 patients with OTVT/premature ventricular complexes (PVC) and normal echocardiography. All underwent advanced imaging with cardiac magnetic resonance (CMR)/18FDG PET-CT for screening of CS. Twenty-two patients had significant abnormalities in cardiac imaging and subsequently had biopsy-proven CS (Cases). Twenty patients had normal imaging and were categorized as IVT (Controls). SR-ECGs of all patients were analyzed by 2 independent, blinded observers. Results: Baseline characteristics were comparable. Among the ECG features analyzed – fascicular (FB) or bundle branch block (BBB) was seen in 9/22 Cases vs. 1/20 controls (p = 0.01). Among patients without FB or BBB, fragmented QRS (fQRS) was present in 9/13 cases but in none of the controls (p

Detection of high rate episodes can potentially result from oversensing of physiological or nonphysiological signals. Assessment of lead integrity, lead connection and analysis of noise characteristics on electrograms are decisive steps in the evaluation of oversensing. We report a case of high atrial and ventricular rate episodes due to minute ventilation oversensing in the presence of lead connector issues.

The burden of atrial fibrillation (AF) is increasing worldwide. It is often asymptomatic, with stroke being the first manifestation in some. AF burden in the community and the practice of stroke prophylaxis has not been studied in India. The problem might be higher in rural regions due to poor health awareness and challenges to healthcare access. This study aimed to estimate the prevalence of AF, clinical profile and stroke risk in rural India.This is a community-based cross-sectional study done in rural Andhra Pradesh (AP). Adults from 40 villages formed the study population. We did a door-to door survey to collect information on demographics, and medical history. Electrocardiogram was recorded using a smart phone based Alivecor device. Participants diagnosed with AF underwent echocardiogram. Study cardiologists assessed the cardiovascular risk profile and collected detailed medical history.Fourteen of the 4281 individuals screened had AF (0.3%). The mean age of the sampled population was 44 ± 16.5 years with 56% women. The mean age of participants with AF was 71 ±7.8 years; males were 71%. Except for one, all were non-valvular AF. Majority had a CHAThe prevalence of AF is lower in this study compared to studies from the developed countries. Non-rheumatic cardiovascular risk factors were primary causes for AF. Non-adherence to stroke prophylaxis is a major threat that needs to be addressed.

Cardiac sarcoidosis (CS) can present as ventricular tachycardia (VT). Management of VT in CS is difficult and includes disease-specific agents, including steroids, antiarrhythmic drugs (AADs), and implantation of an implantable cardioverter-defibrillator (ICD). In patients with steroid-resistant CS presenting with VT storm / incessant VT, radiofrequency (RF) catheter ablation is usually attempted. Patients with refractory VT and left ventricular (LV) dysfunction are referred for heart transplant. We report a case of steroid-resistant CS presenting with incessant VT and tachycardiomyopathy, in which the patient failed to respond to all the multimodal approaches and was worked up for heart transplantation. Use of a biological agent—adalimumab in this patient—resulted in termination of VT, followed by improvement in cardiac function.

This study identified predictors of clinical (CR) and echocardiographic response (ER) following immunosuppressive therapy (IST) in patients with cardiac sarcoidosis (CS).IST has been the cornerstone of treatment for patients with CS and active myocardial inflammation. However, there are little data to explain the variable response to IST in CS.Data of 96 consecutive patients with CS from the Granulomatous Myocarditis Registry were analyzed. All patients underwent aAmong 91 patients included in the final analysis, 54.9%, 20.9%, and 24.2% of patients were classified as complete and partial responders and nonresponders, respectively. Cox regression analysis (all responders vs. nonresponders) identified the following as independent predictors of response following immunosuppression: LVEF40% (hazard ratio: 1.61; 95% confidence interval: 1.06 to 7.69; p = 0.031) and myocardial UI30 (hazard ratio: 1.28; 95% confidence interval: 1.05 to 6.12; p = 0.010). The final model had a good discriminative power (area under the curve [AUC]: 0.85) and predictive accuracy (sensitivity: 85.5%; specificity: 86.4%). Pre-treatment myocardial UI had a strong positive correlation with change in LVEF following immunosuppression.Pre-treatment

BACKGROUND: Fetal arrhythmias constitute 10 to 20% of the total referrals to fetal cardiology unit. Ventricular tachycardia (VT) is a rare form of fetal tachyarrhythmia. MATERIALS AND METHODS: This report describes the clinical presentation, diagnostic features, and successful management of VT in a fetus at 32 weeks of gestation. Transplacental therapy with sotalol resulted in the termination of tachyarrhythmia in 48 h, followed by good postnatal outcome. CONCLUSION: Fetal m-mode showing ventricular rate higher than atrial rate with atrio-ventricular dissociation is suggestive of VT. Early diagnosis and institution of transplacental therapy prior to development of hydrops seem to carry a good prognosis even in malignant fetal arrhythmias like VT.

Background The cause of atrioventricular conduction block (AVB) remains unexplained in a significant number of patients. Granulomatous myocarditis is an uncommon but important cause of AVB. Fluorine-18 fluoro-2-deoxyglucose positron emission computed tomography (18-FDG PET) scan has emerged as a sensitive tool for diagnosing granulomatous myocarditis. Objective The purpose of this study was to evaluate the prognostic value of 18-FDG PET scan in patients with unexplained AVB. Methods Patients age 18–55 years presenting with unexplained AVB and requiring a permanent pacemaker were evaluated with a fasting 18-FDG PET scan. Transthoracic echocardiography was performed at baseline and at follow-up. Major adverse cardiac events (ventricular tachycardia, heart failure, cardiac death) were noted during follow-up. Results Over a period of 3 years, 35 patients (20 females, 15 males; mean age 43.67 ± 11.21 years) were included in the study. Abnormal myocardial FDG uptake was noted in 15 patients (42.8%). Four patients consented for biopsy of paracardiac FDG avid lymph nodes, which revealed granulomatous inflammation (one of which grew Mycobacterium tuberculosis in culture). Mean follow-up period was 24 months. Major adverse cardiac events were significantly higher in the patients with abnormal PET uptake ( P Conclusion Patients with high-degree AVB and abnormal myocardial 18-FDG PET uptake have more adverse cardiac events and worse outcomes. Early screening for myocardial inflammation and appropriate treatment may prevent these complications. Tuberculosis may be an important cause of unexplained AVB, apart from sarcoidosis, in developing countries such as India.

Left ventricular (LV) systolic dysfunction leading to heart failure (HF) is known to occur after permanent pacemaker implantation (PPI) in a subset of patients. They are often treated by upgradation of the pacemaker to cardiac resynchronisation therapy (CRT). We report a case of progressive LV dysfunction and HF after PPI. Cardiac 18FDG-PET-CT scan revealed abnormal myocardial FDG uptake suggestive of cardiac sarcoidosis (CS). Biopsy from FDG avid lymph node demonstrated non-caseating granuloma. Therapy with steroids resulted in resolution of HF symptoms accompanied by a significant improvement in LV function. Keywords: CRT upgradation, Cardiac sarcoidosis, Pacemaker induced LV dysfunction, Steroids

In this report, we describe complete disappearance of LBBB with normalization of LV function in two patients with cardiac sarcoidosis (CS) after immunosuppressive therapy. Both of these patients were ideal Class IA candidates for CRT (Complete LBBB, QRS ≥ 150 ms, EF, Highlights • There was disappearance of LBBB and normalization of LVEF in two patients with cardiac sarcoidosis after immunosuppression. • Both patients were initially candidates for CRT implantation. • LBBB may be reversible in a subset of patients with CS, if immunosuppression is initiated in a timely manner.

Background: Brugada syndrome (BrS) is known to cause malignant ventricular arrhythmia (VA) and sudden cardiac death (SCD). Patients with implantable cardioverter defibrillator (ICD) may experience recurrent shocks from ICD. Recent reports indicate that radiofrequency ablation (RFA) in BrS is feasible, and effective. Catheter ablation of premature ventricular complexes (PVCs) triggering VA and substrate modification of right ventricular outflow tract (RVOT) has been described. Methods and results: Five patients (4 males, age-23 to 32 years) with BrS and electrical storm (ES) despite being on isoprenaline infusion and cilostazol (phosphodiestrase-3 inhibitor) underwent 3 dimensional electroanatomic mapping and RFA. Ventricular fibrillation was easily inducible in two patients. Voltage map of right ventricle was created in sinus rhythm in all patients. Substrate modification of RVOT was performed endocardially in one patient, both endocardial and epicardial in three and only epicardially in one patient. Brugada pattern gradually resolved over one week in all patients post procedure. These patients completed follow up of median 40 months (1.5–70). One patient had inappropriate shock due to atrial fibrillation, one had an episode of VF and appropriate shock 24 months after the RFA. The remaining four patients had no device therapy or VA in device log on follow up. Conclusion: Abnormal myocardial substrate is observed in RVOT among patients with BrS. Substrate modification in these patients may abolish Brugada pattern on the ECG and prevents spontaneous VAs on long term follow up. Keywords: Brugada syndrome, Electrical storm, Catheter ablation

Introduction Treating ventricular tachycardia (VT) in patients with cardiac sarcoidosis (CS) is challenging as patients present in different phase of the disease (inflammatory, scar, or sometimes both). A customized approach to treatment is required for better outcomes. We describe our experience in the management of VT in CS based on the phase of the disease. Methods and results Patients were considered to have myocardial inflammation if there was an increased myocardial 18fluorodeoxy glucose (FDG) uptake in PET-CT scan of the chest (n = 14). These patients were treated with antiarrhythmic drugs (AADs) and immunosuppression. Patients with scar related VT (without active inflammation) were managed with AADs and underwent radiofrequency ablation (RFA) if unresponsive to drug therapy (n = 4). Patients previously treated for CS who presented with VT and evidence of reactivation (abnormal FDG uptake) after a quiescent period of 6 months were treated with intensified immunosuppression alongside AADs (n = 3/14). Patients with myocardial inflammation responded well to immunosuppression. Patients with drug resistant VT in the scar phase responded well to RFA. Four patients in the inflammatory group had recurrence of VT during follow-up of whom 3 were found to have disease reactivation. Intensified immunosuppression suppressed VT in all 3 patients. In 1 patient, VT recurrence was found to be scar related and required RFA for control. Conclusion Tailoring therapy for VT in CS according to the phase of disease results in good clinical outcome and avoids unnecessary immunosuppression.

A 48-year-old man who was previously a responder to cardiac resynchronization therapy (CRT) presented with worsening of heart failure and reduction in the percentage biventricular (BiV) pacing. Device interrogation revealed T-wave oversensing that was eliminated by optimizing the interventricular (VV) delay. Compared to simultaneous BiV pacing, both sequential left ventricle-right ventricle (LV-RV) and univentricular LV pacing shortened the QTc, T peak-end intervals and reduced the T wave amplitude. Modification of VV delays can result in changes in wavefront of activation and thereby affect ventricular repolarization patterns.

Background and objectives: Cardiovascular implantable electronic devices (CIED) are frequently implanted in patients on anti-thrombotic agents. Pocket hematomas are more likely to occur in these patients. The use of a sterile surgical drain in the pulse generator pocket site could prevent hematomas, but fear of infection precludes its use. The objective of the present study is to study the safety and efficacy of surgical drain in patients on antithrombotics undergoing CIED implantations. Methods: This is a single-centre, retrospective study involving patients undergoing CIED implantations on antithrombotics (antiplatelets and anticoagulants) from August 2013 to July 2016. Patients with high risk of thromboembolism were continued on oral antithrombotics or were bridged with heparin after stopping oral antithrombotics. A sterile close wound suction drain was placed in device pockets following CIED implantations. Post procedure, pressure dressing was applied and removed after 12 h once the drain volume was less than 10 ml in 24 h. Results: Sixty seven patients required surgical drain implantation. Major indications for antithrombotic use were presence of intracoronary stent, atrial fibrillation and mechanical valve replacements. The mean post-procedural hospital stay was 3 ± 0.9 days and mean overall drain was 16.6 ± 8.2 ml. At a mean follow up of 17.6 ± 8.2 months, one patient (1.4%) had pocket hematoma. There were no infections. Conclusion: The use of a surgical drain in CIED implantation significantly reduces the risk of hematoma formation without increasing the risk of infection. Antithrombotic drugs can be safely continued at the time of implantation of cardiac devices. Keywords: Pocket hematoma, Antithrombotic treatment, Device implantation, Anticoagulation, Antiplatelets, Surgical drain

Background Electrical storm (ES) due to drug refractory ventricular tachycardia (VT) occurring within first few weeks of acute myocardial infarction (MI) has poor prognosis. Catheter ablation has been proposed for treating VT occurring late after MI, but there is limited data on catheter ablation in VT within first few weeks of MI. Methods and Results Five patients (4 males, mean age 54.2 ± 12.11 years) between June 2008 to July 2012, referred for VT presenting as ES refractory to antiarrhythmic drugs in the early post infarction period (six weeks following MI) despite revascularization. Three patients had anterior wall MI and two inferior wall MI with left ventricular ejection fraction ranging from 26 to 35%.All underwent catheter ablation within 48 hours of being in VT except one who presented late. Clinical VT was induced in all five patients. Total number of VTs induced were 11 (2.2 ± 1.09 per patient). Two patients needed epicardial ablation via pericardial puncture. Though acute success was 100%, one patient had recurrence of clinical VT the next day of procedure.One patient succumbed to sepsis with multiple organ failure. The remaining four patients are doing well without further clinical recurrence of VT over a period of 3.7 years of follow-up. Conclusion Catheter ablation can be a useful adjunctive therapy for patients with recurrent VT in the early post infarction period. This procedure appears to be safe with acceptable success rate.

A 55 year old male presented with recurrent implantable cardioverter defibrillator (ICD) shocks due to polymorphic ventricular tachycardia (PMVT). He had undergone prior catheter ablation for VT three years ago. During the prior attempt he underwent voltage guided substrate ablation. With programmed ventricular extrastimulation (PVES), PMVT was repeatedly induced requiring DC shock. Intravenous procainamide was administered and PVES was repeated which induced sustained monomorphic ventricular tachycardia (MMVT). This VT had pseudo delta waves with maximum deflection index of 0.68, suggestive of epicardial origin. Activation mapping was performed epicardially. Presystolic potentials were recorded in mid anterolateral wall of left ventricular epicardial region. Radiofrequency (RF) ablation at this site terminated the VT. Post ablation there was no inducible tachycardia and patient is free of arrhythmias during 2 years of follow-up.