Catheter ablation of ventricular tachycardia associated with cardiac sarcoidosis: Targeting a low-voltage area with strict voltage criteria.

The usefulness of voltage mapping with strict voltage criteria for catheter ablation of postinfarction ventricular tachycardia (VT) has been reported but not for VT associated with cardiac sarcoidosis (CS). A 62-year-old man with CS was referred for catheter ablation of VT refractory to antiarrhythmic and immunosuppressive therapy. Voltage mapping during sinus rhythm using strict voltage criteria with an upper limit of the low-voltage area (LVA) of ≤0.8 mV revealed an LVA on the posterior side of the interventricular septum, and a narrow isthmus was observed in the LVA. Concealed entrainment was observed at the narrow isthmus during the VT. The VT was eliminated and was no longer inducible after a focal radiofrequency application targeting the narrow isthmus. As with postinfarction VT, targeting the LVA with strict voltage criteria might be a feasible method for the catheter ablation of VT associated with CS. <Learning objective: The activation mapping strategy during ongoing ventricular tachycardia is sometimes difficult to illustrate a complete map. Adjusting the voltage limits of the bipolar maps with strict voltage criteria for identifying the critical isthmus of the macroreentrant circuits during sinus rhythm might be a feasible method to eliminate ventricular tachycardia associated with not only myocardial infarctions, but also cardiac sarcoidosis.>.