Endo-Epicardial ablation of incessant slow monomorphic ventricular tachycardia originating from the left ventricular summit in a patient with cardiac resynchronization therapy defibrillator

Slow ventricular tachycardia (VT) in patients with ICDs is uncommon, and its impact is considered minor. However, understanding its long-term risk is crucial since high-risk patients might benefit from prophylactic ablation and device programming to reduce inappropriate ICD therapies. We present the case of a 69-year-old man with a history of acute myocardial infarction and aborted sudden cardiac death in 2002 underwent angioplasty with stent placement in the anterior descending artery and implantation of a CRT-D. He remained in NYHA functional class I. In 2019, he experienced two appropriate shocks for ventricular tachycardia (VT), and in 2021, three sustained VT events within 24 hours. A catheter ablation was decided to treat the VT, with a successful endo-epicardial approach. After 48 hours without VT recurrence, he was discharged. In the presented case of ischemic cardiomyopathy, an endo-epicardial approach was crucial for successful ablation of VT originating from the left ventricular summit. This case emphasizes the need for individualized ablation strategies in patients with incessant slow VT and ICDs.