(Circulation. 1999;99:2283-2289.)
© 1999 American Heart Association, Inc.
Clinical Investigation and Reports |
Entrainment/Mapping Criteria for the Prediction of Termination of Ventricular Tachycardia by Single Radiofrequency Lesion in Patients With Coronary Artery Disease
From the National Heart Institute, Inaba, Cairo, Egypt (A.E.-S.); Montreal General Hospital, Montreal, Quebec, Canada (T.H.); and the Clinical Cardiac Electrophysiology Laboratories of the Harvard Thorndike Electrophysiology Institute and Arrhythmia Services at Beth Israel Deaconess Medical Center, Boston, Mass (P.P., K.M., L.E., M.E.J.).
Correspondence to Mark E. Josephson, MD, Director of the Harvard Thorndike Electrophysiology Institute, Beth Israel Deaconess Medical Center, 330 Brookline Ave RW453, Boston, MA 02215. E-mail mjoseph2{at}bidmc.harvard.edu
Background-A variety of mapping criteria have been proposed to localize critical sites at which radiofrequency (RF) can predictably terminate reentrant ventricular tachycardia (VT) caused by coronary artery disease. The purpose of this study was to determine the accuracy of using a combination of 3 mapping criteria in predicting termination of VT by a single RF lesion.
Methods and Results-Fifteen consecutive patients with
coronary artery disease and recurrent sustained VT underwent an
attempted RF ablation of 20 monomorphic VTs. Successful termination of
VT by a single RF lesion was predicted if all the following mapping
criteria were met: (1) an exact QRS match in the 12-lead ECG during
entrainment; (2) a return cycle length 
10 ms of the VT cycle length;
(3) presystolic potentials (<70% of VT cycle length) with an
activation time to the QRS within 10 ms of the stimulus to QRS.
Inability to meet these 3 criteria was considered to predict failure of
VT termination by RF energy at that site. RF ablation was applied to 44
left ventricular sites in 20 VTs at which at least 1 of the
mapping criteria was met. VT was terminated with a single RF lesion in
19 of 19 sites meeting all criteria; RF failed to terminate VT at 24 of
25 sites at which all 3 criteria were not met
(P<0.0005).
Conclusions-To maximize success and minimize the number of RF lesions in patients with infarct-related VT, all the above 3 mapping criteria should be met before the application of RF energy.
Key Words: catheter ablation • tachycardia • mapping • coronary artery disease
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