Focal origin of ventricular fibrillation in a patient with ischemic cardiomyopathy.

A 65-year-old patient with history of ischemic cardiomyopathy admitted to the hospital for chest pain and subsequently experienced incessant ventricular fibrillation (VF), requiring repeated defibrillation. Coronary angiogram was unchanged, compared to a study a year before, and acute ischemia was not considered to be the etiology of the VF. A particular premature ventricular contraction morphology was noted on telemetry prior to each episode of VF. The patient subsequently underwent successful radiofrequency ablation of a focus in the left ventricular free wall. Careful examination of initiating foci of VF or polymorphic ventricular tachycardia, with radiofrequency ablation in appropriate cases, could be potentially life-saving.