Treatment of refractory ventricular tachycardia with combination of alcohol ablation and radiofrequency ablation

The post-infarcted related ventricular tachycardia (VT) is considered associated with increase in mortality or sudden cardiac death (SCD). Implantable cardioverter defibrillation (ICD) has been the standard therapy for the first or second prevention of SCD after myocardial infarction (MI). Incessant VT, which has poor response to anti-arrhythmic drugs and can cause repetitive ICD shock, is usually a tough problem in clinical practice. According to the guideline, incessant infracted related VT could be treated with catheter ablation. Herein we reported a case of refractory scar-induced VT accompanied with thrombus in the left chamber, which was full with ups and downs during the therapy.  A 81-year-old male patient came to Drum Tower Hospital, Medical School of Nanjing University for “chest pain for nine years, palpitation for two years and recurrence for 12 h” on December 10, 2018. Nine years ago, the patient was diagnosed acute anterior MI due to persistent chest pain. He accepted primary percutaneous coronary intervention and left anterior descending artery was deployed with 2 stents. The ultrasound demonstrated left ventricular end-diastolic diameter (LVDd) 6.66 cm, left ventricular ejection fraction (LVEF) 31%, ventricular aneurysm formed. The patient rejected ICD at that time. In February 2016, the patient came to us due to paroxymal palpitation. Electrocardiogram (ECG) showed monomorphic VT with heart rate (HR) of 156 bpm. VT discontinued after admistration of aminodarone. Then ICD was therefore implanted. Thereafter, the patient experienced appropriate ICD shocks intermittently which were proven by device programming. Nevertheless, the aminodarone was not prescribed due to long QT interval. On December 10, 2018, the patient suffered