Mitral isthmus pathology of re-entrant ventricular tachycardia in a patient with idiopathic dilated cardiomyopathy

Histopathological verification for successful ablation of mitral isthmus ventricular tachycardia complicated with cardiac sarcoidosis

A 68-year-old man died a few days after catheter ablation of drug-resistant, monomorphic ventricular tachycardia (VT) complicated with cardiac sarcoidosis. The diagnosis of mitral isthmus VT was made from electrophysiological observations, including electro-anatomical activation and voltage map, pace-mapping, entrainment mapping and ablation outcome. On autopsy of the heart, sarcoidic lesion with scattered fibrous tissue in the mitral isthmus was non-transmural, and the surviving myocardium serving as the reentry circuit in the endomyocardium was isolated from the adjacent viable epimyocardium, enabling the sustenance of macroreentry across the mitral isthmus. Non-transmural lesions produced by RF delivery created a barrier sufficient to interrupt the myocardial bundles located in the mitral isthmus, eliminating the mitral isthmus VT.