Radiofrequency catheter ablation of postinfarction ventricular tachycardia from the proximal coronary sinus.

Optimum strategy for radiofrequency (RF) catheter ablation of ventricular tachycardia (VT) after inferior wall myocardial infarction (MI) that originates from the posteroseptal process of the left ventricle is not known. We describe a case report of a 57-year-old man who developed recurrent post-MI VT with ECG morphology consistent with this type of VT (i.e., left bundle branch block pattern with predominant R waves from V2 to V6 and left-axis deviation). Endocardial mapping and entrainment during VT demonstrated a critical isthmus of the reentrant circuit in the proximal coronary sinus. RF application terminated VT and rendered it noninducible.