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J Am Coll Cardiol, 2003; 41:2228-2236, doi:10.1016/S0735-1097(03)00492-3 © 2003 by the American College of Cardiology Foundation |
* Cardiac Arrhythmia Service, Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
Electrophysiology Section, Cardiology Division, Na Homolce Hospital, Prague, Czech Republic
Manuscript received March 30, 2001; revised manuscript received January 29, 2003, accepted February 6, 2003.
* Reprints requests and correspondence: Dr. Vivek Y. Reddy, Cardiac Arrhythmia Service, Massachusetts General Hospital, 32 Fruit St., Gray-Bigelow 109, Boston, Massachusetts 02114, USA.
vreddy{at}partners.org
OBJECTIVES: We evaluated the safety and acute procedural efficacy of a combined electrophysiologic and anatomic approach to ablation of all inducible ventricular tachycardias (VT) during sinus rhythm using an irrigated radiofrequency (RF) ablation catheter.
BACKGROUND: Ventricular tachycardia associated with chronic myocardial infarction (MI) is frequently hemodynamically intolerable and associated with multiple electrocardiographic morphologies. Because traditional mapping techniques are contingent on hemodynamic stability for adequate VT mapping, VT ablation therapy for many patients has been disappointing.
METHODS: High-density electroanatomic mapping was performed during either sinus rhythm in 11 consecutive patients with a history of MI and ventricular arrhythmias. The RF ablation was performed using an irrigated-tip ablation catheter. All inducible VTs were targeted for catheter ablation during sinus rhythm.
RESULTS: The RF ablation lesions were placed in a linear fashion traversing the border zones of infarcted and normal tissue (mean of 3.4 linear lesions/patient). With this strategy, the target VT was eliminated in 9 of 11 patients (82%). Furthermore, when targeting all inducible monomorphic VTs, complete procedural success was achieved in 7 of 11 patients (64%). During the follow-up period (mean 13.1 ± 1.9 weeks), spontaneous VT was only noted in the two patients with no acute procedural benefit.
CONCLUSIONS: By identifying potentially arrhythmogenic tissue during sinus rhythm, substrate mapping can guide the ablation of a majority of inducible VTs using an irrigated RF ablation catheter. This emerging therapeutic paradigm may be considered in the management of patients with multiple hemodynamically unstable monomorphic VTs.
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