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CLINICAL STUDY

Noncontact mapping to guide ablation of right ventricular outflow tract tachycardia

Paul A. Friedman, MD, FACC^*,*, Samuel J. Asirvatham, MD^*, Suellen Grice, RN^*, Michael Glikson, MD, Thomas M. Munger, MD, FACC^*, Robert F. Rea, MD, FACC^*, Win K. Shen, MD, FACC^*, Arshad Jahanghir, MD^*, Douglas L. Packer, MD, FACC^* and Stephen C. Hammill, MD, FACC^*

^* Division of Cardiovascular Disease, Mayo Clinic, Rochester, Minnesota, USA
Sheba Medical Center, Tel Hashomer, Israel

Manuscript received October 17, 2001; revised manuscript received February 25, 2002, accepted February 28, 2002.

^* Reprint requests and correspondence: Dr. Paul A. Friedman, Division of Cardiovascular Diseases, Mayo Clinic, 200 First Street Southwest, Rochester, Minnesota 55905.
pfriedman{at}mayo.edu

OBJECTIVES: The aim of this study was to determine whether noncontact mapping is feasible in the right ventricle and assess its utility in guiding ablation of difficult-to-treat right ventricular outflow tract (RVOT) ventricular tachycardia (VT).

BACKGROUND: In patients without inducible arrhythmia, RVOT VT may be difficult to ablate. Noncontact mapping permits ablation guided by a single tachycardia complex, which may facilitate ablation of difficult cases. However, the mapping system may be geometry-dependent, and it has not been validated in the unique geometry of the RVOT.

METHODS: Ten patients with left bundle inferior axis VT, no history of myocardial infarction and normal left ventricular function underwent noncontact guided ablation; seven had failed previous ablation and three had received a defibrillator. All noncontact maps were analyzed by a blinded reviewer to determine whether the arrhythmia focus was epicardial and to predict on the basis of the map whether arrhythmia would recur.

RESULTS: The procedure was acutely successful in 9 of 10 patients. During a mean follow-up of 11 months, 7 of 9 patients remained arrhythmia-free. Both patients in whom the blinded reviewer predicted failure had arrhythmia recurrence: one due to epicardial origin with multiple endocardial exit sites and one due to discordance between site of lesion placement and earliest activation on noncontact map.

CONCLUSIONS: Mechanisms of ablation failure in RVOT VT include absence of sustained arrhythmia, difficulty with substrate localization and epicardial origin of arrhythmia. In this study, noncontact mapping was safely and effectively used to guide ablation of patients with difficult-to-treat RVOT VT.

Abbreviations and Acronyms   3-D   three-dimensional   ECG   electrocardiogram   ICD   implantable cardioverter defibrillator   MEA   multiple electrode array   RF   radiofrequency   RV   right ventricle/ventricular   RVOT   right ventricular outflow tract   VT   ventricular tachycardia

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