Epicardial Ablation of Ventricular Tachycardia with Manual Controlled External Irrigation in a Patient with Nonischemic Cardiomyopathy

We describe a patient with nonischemic cardiomyopathy who underwent radiofrequency (RF) catheter ablation for a drug-refractory ventricular tachycardia (VT). RF ablation from a left ventricular (LV) endocardial site failed to eliminate the VT. Using a conventional ablation catheter with the temperature-controlled mode, RF ablation from the LV epicardium resulted in failed ablation because of low power due to a temperature limitation function. However, by using a pericardial pigtail catheter for manual infusion and removal of saline within the pericardial space, adequate energy could be delivered, and the ablation overlying the lowvoltage area successfully eliminated the VT.