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Radiofrequency (RF) ablation of ventricular tachycardia (VT) poses numerous challenges that can limit acute and long-term success. A large percentage of clinical and induced VTs are not hemodynamically tolerated. Various techniques for hemodynamic support have been utilized, including intraaortic balloon pumps and percutaneous left ventricular (LV) assist devices. However, venoarterial extracorporeal membrane oxygenation (VA-ECMO) is gaining interest in the field, as it provides superior hemodynamic support during mapping and ablation of VT. Midmyocardial substrates are a major limitation of currently available RF ablation technology. These substrates are frequently seen in the interventricular septum and LV summit. Catheter-based technology continues to advance, but a major limitation is the depth of lesions that can be produced, which has led to an interest in bipolar ablation. Bipolar ablation delivers energy between 2 catheters placed across from each other, as opposed to between the ablation catheter and a grounding pad in standard unipolar ablation. This method allows for a targeted energy delivery with a larger lesion size. We present a case of a patient with incessant VT and recurrent cardiac arrest in the setting of cardiomyopathy, who required ECMO support and in whom the clinical VT remained easily inducible until bipolar ablationwas performed across the interventricular septum. To the best of our knowledge, this is thefirst reported case of successful bipolar ablation

Incessant intraseptal ventricular tachycardia ablated utilizing extracorporeal membrane oxygenation and bipolar ablation