Case Study: EV-ICD and Epicardial Ablation in a 40-Year-Old Patient

A 40-year-old man presented with palpitations and dizziness that had been ongoing for several days. EMS found that he was in sustained monomorphic ventricular tachycardia and performed cardioversion to restore regular heart rhythm. In conversation with care providers, the patient recalled a prior episode of chest pain that had lasted for several days. He was brought to Temple Health for further care.

By
June 4, 2025
3 min

Temple Health

At a Glance

Category	Detail
Condition	Ventricular Tachycardia (VT) due to prior myocardial infarction
Key Mechanisms	Use of EV-ICD for anti-tachycardia pacing and epicardial ablation for VT management
Target Population	Patients with a history of myocardial infarction and ventricular tachycardia
Care Setting	Cardiology, specifically electrophysiology

Key Highlights

Patient presented with sustained monomorphic VT and poor LV function due to anterior myocardial infarction.
EV-ICD offers lower infection risk and avoids venous complications compared to traditional ICDs.
Epicardial ablation was successfully performed despite the presence of LV thrombus.
Patient has not experienced further VT episodes six months post-procedure.
Combination of EV-ICD and epicardial ablation is a novel approach in the U.S.

Guideline-Based Recommendations

Diagnosis

Assess history of myocardial infarction and symptoms of VT.
Utilize ECG and echocardiogram for diagnosis confirmation.

Management

Consider EV-ICD for patients with a history of VT and prior myocardial infarction.
Use antiarrhythmic drug therapy and neuromodulation as adjuncts.

Monitoring & Follow-up

Regular follow-up to monitor for VT episodes and device function.
Assess for potential complications related to the EV-ICD.

Risks

Contraindications include prior sternotomy.
Potential for thrombus-related complications during ablation.

Patient & Prescribing Data

Patients with ventricular tachycardia and prior myocardial infarction.

EV-ICD is suitable for younger patients and those with infection risks.

Clinical Best Practices

Evaluate candidates for EV-ICD based on individual risk factors.
Consider epicardial ablation in cases with LV thrombus where conventional ablation is not feasible.
Ensure multidisciplinary expertise for combined procedures.