Malignant Ventricular Tachycardia, Ventricular Wall Ablation, and Orthotopic Heart Transplantation

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Described herein are three patients with refractory ventricular tachycardia and one or more unsuccessful ablation procedures finally leading to orthotropic heart transplantation (OHT). The latter procedure allowed examination of the ventricular ablation sites, an unusual opportunity reported previously in few patients (all case reports). The acute ablation lesions are unique, with necrosis of the myocardial fibers adjacent to the endocardium and encircled by layers of extravasated erythrocytes in the deeper myocardial wall. All 3 patients returned to normal activities following the OHT.

Section snippets

Case #1

A 51-year-old obese, former truck driver, who was born in July 1963, had been well until age 49 (July 2012) when she had an acute myocardial infarct and received several coronary stents. Thereafter, she was in chronic heart failure and had several episodes of VT and an implantable cardioverter defibrillator (ICD) was inserted (2013). During the next several months she had a number of VT episodes and ICD shocks. As a consequence, an ablation procedure was done in August 2014. Nevertheless, the

Discussion

Described herein are 3 patients who had recurrent episodes of VT not eliminated by ablation procedures leading to OHT in each. The OHT provided the opportunity to study morphologically the cardiac ventricular ablation sites, something infrequently available in humans. In each patient the ablation sites were clearly distinguishable presumably because the intervals between the last ablation procedure and the OHT were short (15 days in case #1, 2 days in case # 2, and 14 days in case # 3). The

Conflict of Interests

The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

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Present address: Baylor University, Waco Texas.

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