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CLINICAL STUDIES

Characteristics of electrograms recorded at reentry circuit sites and bystanders during ventricular tachycardia after myocardial infarction

Dusan Z. Kocovic, MD^*, Tomoo Harada, MD, Peter L. Friedman, MD, PhD and William G. Stevenson, MD

^* Cardiovascular Division, Department of Medicine, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
Division of Cardiology, Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, USA

Manuscript received March 24, 1998; revised manuscript received March 8, 1999, accepted April 19, 1999.

Reprint requests and correspondence: Dr. Dusan Z. Kocovic, Hospital of the University of Pennsylvania, Cardiovascular Division, 9 Founders Pavilion, 3400 Spruce Street, Philadelphia, Pennsylvania 19104
kocovic{at}mail.med.upenn.edu

OBJECTIVES

The purpose of this study was to determine the relation of isolated potentials (IPs) recorded during ventricular tachycardia (VT) to reentry circuit sites identified by entrainment.

BACKGROUND

Reentry circuits causing VT late after myocardial infarction are complex. Both IPs and entrainment have been useful for identifying successful ablation sites, but the relation of IPs to the location in the reentry circuit as determined by entrainment has not been completely defined.

METHODS

Data from catheter mapping of 70 monomorphic VTs in 36 patients with prior myocardial infarction were retrospectively analyzed. Entrainment followed by radiofrequency current (RF) ablation was performed at 384 sites. On the basis of entrainment, sites were classified as reentry circuit exit, central–proximal, inner or outer loop sites. Sites outside the circuit were divided into remote and adjacent bystanders.

RESULTS

Isolated potentials were recorded at 50% (51 of 101) of reentry circuit exit, central and proximal sites as compared with only 8% (11 of 146, p < 0.001) of inner loop and outer loop sites and only 1.8% (2 of 106) of remote bystander sites (p < 0.001). Isolated potentials were also present at 45% of adjacent bystander sites. At central and proximal sites the presence of an IP increased the incidence of tachycardia termination by RF to 47.5% from 24% (p = 0.05). At exit sites tachycardia termination occurred frequently regardless of the presence or absence of IPs (45% vs. 48%, p = NS). Isolated potentials at exit, central and proximal sites had a shorter duration at sites where ablation terminated VT than at sites without termination (20.9 ± 9.6 ms vs. 35.7 ± 15.3 ms, p < 0.001).

CONCLUSIONS

Isolated potentials are a useful guide to sites in the central–proximal region of the reentry circuit, but often fail to identify exit sites where ablation is successful. Entrainment and analysis of electrograms provide complementary information during mapping of VT.

Abbreviations and Acronyms   CL = cycle length   EG-QRS = electrogram to QRS interval   IP = isolated potential   PPI = postpacing interval   RF = radiofrequency current   VT = ventricular tachycardia

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