Evidence of Late Septal Coronary Involvement After Bipolar Radiofrequency Ablation in a Patient With Lamin A/C Cardiomyopathy

Background: Bipolar radiofrequency ablation has been increasingly used in cases with deep intramyocardial circuits refractory to unipolar ablation. Patients with Lamin A/C cardiomyopathy frequently exhibit VT arrhythmia originating from deep in the interventricular septum. Methods and Results: We describe our use of bipolar ablation in a patient with nonischemic cardiomyopathy and Lamin A/C mutation for the treatment of a septal VT substrate with particular attention to pathology findings at 3 months. Conclusions: Bipolar ablation with catheters across the septum and in the presence of a microcatheter in a septal branch of the anterior interventricular vein was effective in controlling ventricular arrhythmia. Resultant ablation resulted in extensive myocardial injury and fibrosis. Neointimal hyperplasia of intervening coronary arteries may play a role in subsequent effects of initial ablation lesions.