A case of incessant VT from an intramural septal focus: Ethanol or bipolar ablation?

Introduction Substrate-based radiofrequency (RF) ablation of scar-related ventricular tachycardia (VT) has become standard practice, often in addition to an intracardiac cardioverter-defibrillator. VT procedures without identified substrate are particularly challenging cases, especially when VT is noninducible. An intramural focus is often challenging to ablate using conventional RF ablation, and different options are or will be possible such as high-power unipolar ablation, bipolar ablation, irrigated needle ablation, or selective coronary ethanol injection. The following case is used to illustrate a patient-tailored approach to choose between bipolar and ethanol ablation after a failed RF attempt, since needle ablation is not approved yet for human use.