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CLINICAL RESEARCH: HEART RHYTHM DISORDER

Isolated Potentials During Sinus Rhythm and Pace-Mapping Within Scars as Guides for Ablation of Post-Infarction Ventricular Tachycardia

University of Michigan Medical Center, Ann Arbor, Michigan.

Manuscript received September 19, 2005; revised manuscript received November 4, 2005, accepted December 5, 2005.

^_* Reprint requests and correspondence: Dr. Frank Bogun, Division of Cardiology, University of Michigan Health System, TC B1 140, 1500 East Medical Center Drive, Ann Arbor, Michigan 48109-0366. (Email: fbogun{at}umich.edu).

OBJECTIVES: The purpose of this study was to identify ventricular tachycardia (VT) isthmus sites by pace-mapping within scar tissue and to identify electrogram characteristics that are helpful in identifying VT isthmus sites during sinus rhythm (SR).

BACKGROUND: Pace-mapping has been used in the scar border zone to identify the exit site of post-infarction VT.

METHODS: In 19 consecutive patients (18 men, mean age 66 ± 9 years, mean ejection fraction 0.24 ± 0.12) with post-infarction VT, a left ventricular voltage map was generated during SR. Pace-mapping was performed at sites with abnormal electrograms or isolated potentials. Radiofrequency ablation was performed at isthmus sites as defined by pace-mapping (perfect pace-map = 12/12 matching electrocardiogram leads; good pace-map = 10/12 to 11/12 matching electrocardiogram leads) and/or entrainment mapping.

RESULTS: A total of 81 VTs (mean cycle length 396 ± 124 ms) were inducible. In 16 of the 19 patients, a total of 41 distinct isthmus areas of 41 distinct VTs were identified and successfully ablated. All but one displayed isolated potentials during SR. Furthermore, 22 of the 81 VTs (27%) for which no isthmus was identified became noninducible after ablation of a targeted VT. The 16 patients in whom 1 isthmus was identified and ablated were free of arrhythmic events during a mean follow-up of 10 months.

CONCLUSIONS: During SR, excellent or good pace-maps at sites of isolated potentials within areas of scar identify areas of fixed block that are protected and part of the critical isthmus of post-infarction VT. Shared common pathways might explain why non-targeted VTs might become noninducible after ablation of other VTs.

Abbreviations and Acronyms   ICD = implantable cardioverter-defibrillator   SR = sinus rhythm   VT = ventricular tachycardia

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