1. 50 yr old man Recurrent tachy episodes since a few years
Normal echo
Inputs from Chandrashekhar and Tahmeed

2. Basal ECG- normal

3. Any D/D. – No. Clearly MMVT, note the slow downstroke of QRS in V1
Any D/D? – No. Clearly MMVT, note the slow downstroke of QRS in V1. Likely AV dissociation (note the changing T waves in V2)

4. And now? RF unipolar signal looks good with early QS deflection  What next?

5. Use a smaller French size, small curve, easily deflectable catheter
It was difficult to manipulate the mapping catheter in the area of interest-options?
Use a smaller French size, small curve, easily deflectable catheter

6. Comment on the RF signal- Fragmented bipolar signal, remarkably early
55 ms

7. RF energy- clean VT termination

8. RF site- LAO 40. Note the double curve needed in the ablation catheter to reach the desired site at the septal-free wall interface in the RVOT. A 6F small (A) curve mapping catheter was used.

9. RF site- RAO 30

10. After ablation-comment: No tachy induced with rapid atrial pacing; no inducible tachy with V pacing