Ablation of Ventricular Fibrillation in an Orthotopic Heart Lung Transplant

Arrhythmia is well described following cardiac transplantation. We report a case of recurrent ventricular fibrillation (VF) originating from an orthotopic cardiac allograft. VF was consistently initiated on each occasion by a relatively early-coupled monomorphic ventricular ectopic. Antiarrhythmic agents failed to suppress the arrhythmia. Electrophysiological testing with noncontact mapping showed a high-frequency potential at the earliest activation site. Radiofrequency ablation resulted in abolition of ventricular ectopy with no further VF recurrence. Although there is substantial experience with ablation of atrial tachycardias in this setting, experience with ablation for ventricular arrhythmias is limited and ablation of VF not described. PACE 2012; 35:e102–e104)