Ablation of recurrent idiopathic left bundle branch block inferior-axis ventricular tachycardia was performed in a 50-year-old patient. After unsuccessful ablation attempts with an irrigated-tip catheter from the left ventricle (LV) and an anterolateral branch of the coronary sinus at the site of earliest activation, epicardial access and map were obtained. Phrenic nerve stimulation could be induced at the earliest site at the epicardium. To prevent phrenic nerve capture, a stepwise bolus of air (250 mL total) was injected into the pericardial space to separate the epicardium from the nerve, but without success. Air then was removed, and normal saline solution (300 mL) was dripped in the pericardium until blood pressure dropped below 60 mmHg. Because diaphragmatic stimulation still was present, 100 mL of normal saline was removed, and new boluses of air (250 mL total) were added in the pericardial space until no stimulation could be reproduced. Ablation was completed without complications (Figure 1. The arrows in the figure point to the air-saline corridor in the pericardial space).
展开▼
