Случай успешного картирования эпикардиальной поверхности базального отдела левого желудочка во время процедуры радиочастотной аблации желудочковой тахиаритмии

16-year old patient, admitted to the hospital in June, 2011 had complains of cardiac disorders, frequent unrhythmical heartbeating, dyspne a and fatigue after physical exercise. There were 22 437 monomorphic ventricular extrasystoles according to Holter ECG monitoring. The patien t underwent combined endocardial and epicardial mapping and radiofrequency ablation of ventricular arrhythmias with convection and irriga ble electrodes, produced by Biosense, Webster and Medtronic. “Cold” and convection exposures in ectopic ventricular activity for anteroseptal zone of exit sites of the right ventricle and for the left sinus o f Valsalva with partial positive effect were made. Also, epicardial mapping of basal left ventricle to detect the point of the early excitement wa s performed. The point was at 3–5 mm from bifurcation of the trunk of the left coronary artery. Thus, radiofrequency ablation was discontinue d to avoid fatal complications, connected with coronary artery injury. In postoperative period, the patient`s complains disappeared and cardia c disorders were reduced. Certainly, positive effect of epicardial mapping is the access to the surface of heart to reach necessary sites of electrodes` positioning to get mor e exact results for mapping and ablation with increase of survival of sinus rhythm and complete elimination of symptomatic ventricular tach yarrhythmiae. Disadvantages of this procedure: possible complications (hemopericardium, precordialgiae, acute myocardial infarction), absence of 100% possibility to use radiofrequency ablation because of supposed arrhythmogenic area of coronary arteries and epicardial bod y fat; besides, there are the cases of intramyocardial position of ectopic activity.