The ‘Bermuda triangle’ of the heart
Although premature ventricular complexes and ventricular tachycardia (VT) from outflow tracts are easy to map and ablate, some foci create the greatest challenges for the electrophysiologist. One such example is the ‘Bermuda triangle’ of the heart.

In this case paper, the authors describe the rarely used but acceptable approach to the ‘Bermudian’ focus. Published in the European Journal of Heart Case Reports, the authors present a case of a 38-year-old male patient with sustained monomorphic VT, who underwent radiofrequency ablation of arrhythmogenic myocardium.

After unsuccessful ablation through the posterior right ventricular outflow tract (RVOT), left coronary cusp (LCC), and distal coronary sinus, tachycardia was eliminated from the left atrial appendage (LAA). Complaints such as palpitations and weakness disappeared after the procedure.

Learning points
• Radiofrequency ablation of the ventricular tachycardia may be performed using the left atrial appendage (LAA). This approach is used when epicardial location of arrhythmia-causing tissue is suspected and ablation through the right ventricular outflow tract, left coronary cusp, and great cardiac vein fails.

• Catheter manipulations in the LAA might be feasible and future researches are needed.

Read in detail about the case here:
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