High-density mapping and ablation of an incessant ventricular tachycardia with endo-epicardial involvement in a patient with situs inversus totalis and left ventricular noncompaction

The association of situs inversus totalis and left ventricular noncompaction is very rare and poses several and unique challenges if endo-epicardial ablation has to be performed, both for anatomical access to the target area and for arrhythmia complexity. We report a case of incessant ventricular tachycardia with endo-epicardial involvement that required ablation in both surfaces to obtain final noninducibility.