[Verse 1] Talk about the muscle, stretched and worn thin, Old ventriculotomy scar still living within, Patch across the VSD, holding the hole, But it's paving a detour for the current to stroll, RV dilates, the wall drags like a limp, QRS spreading wide, read it off the blip, Gatzoulis, two-thousand, Lancet in print, One-eighty milliseconds, that's the fingerprint, Cross that number, the risk starts to spike, Ventricular tachycardia riding shotgun alike, Not a guess, not a hunch, it's a measured design, Every extra millisecond stretching that line. [Chorus] One-eighty's the number, circle it twice, Scar meets dilation, that's the ventricular vice, Four walls build the maze where the current can hide, Tricuspid, patch, patch, pulmonary — pick your side, Watch the QRS, let the rhythm confide, One-eighty's the number, don't let it slide. [Verse 2] Now follow the circuit, macro-reentry style, Current running loops like it's stuck on a dial, Four landmarks fence in the isthmus terrain, Tricuspid annulus first, fibrous and plain, Next the ventriculotomy, or the RVOT patch, A scarred surgical seam the current can't scratch, Third is the VSD patch, stitched years before, Fourth, pulmonary annulus or conduit — there's the door, Between those borders a hallway stays slow, Slow conduction's the spark that lets reentry grow, Map the isthmus, burn the gap shut tight, Four walls, one corridor — that's the fight. [Verse 3] Meanwhile the atrium's carrying weight, Tricuspid regurgitation keeps stretching the gate, Right atrium balloons, its fibers pulled apart, Flutter circuits spinning a second dark art, Intra-atrial reentry joins the fray, An early whisper that function's giving way, Don't just watch the ventricle, mind the top floor, Atrial static's knocking soft at the door, Flutter isn't quiet, it's a herald in disguise, Hemodynamic trouble hiding behind its eyes. [Bridge] Unload the volume, shrink the chamber down, QRS steadies, settles its crown, But the scar's still scar, the isthmus still there, Substrate won't vanish just from pressure care, That's why Part Five brings the cold probe near, Freeze the corridor, make the message clear, Surgery alone can't erase the trace, Concomitant cryoablation seals the space. [Chorus] One-eighty's the number, circle it twice, Scar meets dilation, that's the ventricular vice, Four walls build the maze where the current can hide, Tricuspid, patch, patch, pulmonary — pick your side, Watch the QRS, let the rhythm confide, One-eighty's the number, don't let it slide. [Outro] Scar, stretch, and circuit, that's the electrical tale, Measure the milliseconds, don't let the warning fail, Four borders, one lesson, trace where the current flows, Freeze the substrate quiet before the danger grows.
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