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Circulation. 2000;101:1288-1296

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(Circulation. 2000;101:1288.)
© 2000 American Heart Association, Inc.


Clinical Investigation and Reports

Linear Ablation Lesions for Control of Unmappable Ventricular Tachycardia in Patients With Ischemic and Nonischemic Cardiomyopathy

Francis E. Marchlinski, MD; David J. Callans, MD; Charles D. Gottlieb, MD; Erica Zado, PA-C

From Allegheny University Hospitals–Medical College of Pennsylvania Division and the University of Pennsylvania Health System, Philadelphia, Pa.

Correspondence to Francis E. Marchlinski, MD, Hospital of the University of Pennsylvania, 9th Floor Founders—Cardiology, 3400 Spruce Street, Philadelphia, Pa 19104. E-mail: fmphilapa{at}home.com


*    Abstract
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Background—Conventional activation mapping is difficult without inducible, stable ventricular tachycardia (VT).

Methods and Results—We evaluated 16 patients with drug refractory, unimorphic, unmappable VT. Nine patients had ischemic and 7 had nonischemic cardiomyopathy. All patients had implantable defibrillators and had experienced 6 to 55 VT episodes during the month before treatment. Patients underwent bipolar catheter mapping during baseline rhythm. The amount of endocardium with an abnormal electrogram amplitude was estimated using fluoroscopy in 3 patients and a magnetic mapping system (CARTO) in 13 patients. For the magnetic mapping, normal endocardium was defined by an amplitude >1.5 mV; this measurement was based on sinus rhythm maps in 6 patients who did not have structural heart disease. Radiofrequency point lesions extended linearly from the "dense scar," which had a voltage amplitude <0.5 mV, to anatomic boundaries or normal endocardium. To limit radiofrequency applications, 12-lead ECG during VT and pacemapping guided placement of linear lesions. No new antiarrhythmic drug therapy was added. The amount of endocardium demonstrating an abnormal electrogram amplitude ranged from 25 to 127 cm2. A total of 8 to 87 radiofrequency lesions (mean, 55) produced a median of 4 linear lesions that had an average length of 3.9 cm (range, 1.4 to 9.4 cm). Twelve patients (75%) have been free of VT during 3 to 36 months of follow-up (median, 8 months); 4 patients had VT episodes at 1, 3, 9, and 13 months, respectively. Only one of these patient had frequent VT.

Conclusions—Radiofrequency linear endocardial lesions extending from the dense scar to the normal myocardium or anatomic boundary seem effective in controlling unmappable VT.


Key Words: tachycardia • ablation • defibrillators, implantable


*    Introduction
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The presence of multiple morphologies, hemodynamic intolerance, and noninducibile ventricular tachycardia (VT) have limited the widespread applicability of catheter ablative therapy.1 2 3 An anatomically based approach deployed in sinus rhythm might eliminate the requirement for mapping all ventricular arrhythmias and extend the applicability of ablative therapy.

On the basis of prior experience with sinus rhythm electrogram mapping and surgical ablative therapy, we hypothesized that in patients with unmappable, unimorphic VT, (1) the abnormal endocardium can be defined using detailed sinus rhythm voltage mapping, and (2) linear ablation lesions that repeatedly and/or selectively interrupt the border zone of abnormal endocardium could control VT.


*    Methods
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Patient Population
This study included 12 men and 4 women who had recurrent VT that induced shocks from their implantable defibrillator. Nine patients had coronary disease and a prior infarction, and 7 patients had nonischemic cardiomyopathy. Four of the 7 patients had primarily right ventricular (RV) involvement, with marked RV dilatation and marginally depressed left ventricular (LV) systolic function (Table 1Down). Two patients had idiopathic cardiomyopathy, with dilatation of both ventricles. The last patient with nonischemic cardiomyopathy had biventricular involvement in the setting of rheumatic valvular disease. Despite drug therapy, all patients had frequent VT, which was documented by electrograms stored in the implantable defibrillator (Table 1Down). Thirteen of the 16 patients had received long-term (>2 months) therapy with amiodarone, and 6 had prior ablation attempts. Most patients had evidence of multiple VT morphologies, as based on 12-lead ECG or stored electrograms. All documented, spontaneous VT was unimorphic. The 16 patients came from a pool of 48 patients who were referred to our hospital for catheter ablation.


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Table 1. Patient Characteristics

The study patients were evaluated after informed consent was obtained. All procedures were done following the institutional guidelines of the Allegheny University of the Health Sciences. A total of 15 patients were also treated with antiarrhythmic agents during the study (Table 1Up). Antiarrhythmic agents were not withdrawn because (1) 14 patients were being treated with amiodarone and (2) all patients were experiencing recurrent VT. All patients underwent programmed stimulation through triple extrastimuli at 2 RV sites to document the mode of induction, the cycle length, and the configuration of the induced VT (Table 1Up). At the time of evaluation, VT was not mappable because of hemodynamic collapse with VT, changes in QRS morphology with attempted mapping, or the inability to induce sustained VT (Table 1Up).

Sinus Rhythm Mapping
Detailed endocardial mapping was performed during supraventricular rhythm (14 patients) or, if the patients were pacemaker-dependent, paced rhythm (2 patients). A total of 72 to 430 sites were recorded per chamber. Only the LV was mapped in patients with coronary disease. In patients with nonischemic cardiomyopathy, both ventricles were mapped. Access to the LV was via a retrograde aortic approach in 14 patients and a transseptal approach in 2 patients. During all LV mapping and ablation, heparin was administered to achieve and maintain an activated coagulation time >250 s.

Reference Values for Sinus Rhythm Bipolar Electrogram Mapping
In the first 3 patients, all mapping and ablation was performed using a 7-F extended-curve thermistor catheter (SteeroCath-T, Electrophysiology Technologies, Inc) that had a 4-mm tip electrode. The catheter provided temperature and impedance monitoring during energy delivery, as well as bidirectional steerability. All recordings were bipolar, with an interelectrode distance of 2 mm. Signals were filtered at 30 to 500 Hz and were displayed at 100 to 200 mm/s on a physiological recording system (Prucka, Inc). Electrogram amplitudes were measured with electronic calipers. Sites with an electrogram amplitude <3.0 V were considered abnormal.4

In the next 13 patients, we used the CARTO (Biosense, Inc) magnetic mapping system with the Navistar catheter.5 6 Navistar catheters were 7 or 8 Fr, unidirectionally deflectable, and provided impedance but not temperature monitoring. The Navistar bipole consists of a 4 mm-tip electrode and a 2 mm-ring electrode separated by 1 mm of spacing. Electrograms were filtered at 10 to 400 Hz and displayed at 100 mm/s; peak-to-peak amplitude was measured automatically.

Reference values for distinguishing normal and abnormal electrograms with this system were established by mapping the RV (4 patients) and/or LV (4 patients) in 6 patients who did not have structural heart disease. A total of 71 to 168 sites were recorded per normal ventricle. None of these subjects was taking cardioactive drugs. Five of these subjects were men, and their mean age was 37±12 years.

Reference Values of Magnetic Mapping System
The mean bipolar electrogram amplitude recorded from the normal RV was 3.7±1.7 mV (range, 0.4 to 11.5 mV). Of note, 95% of all bipolar electrogram signals recorded from the RV were >1.44 mV. The mean bipolar electrogram amplitude recorded from the LV was 4.8±3.1 mV (range, 0.6 to 20.5 mV). Of note, 95% of all LV electrograms were >1.55 mV. Using these data, we defined normal endocardium using the CARTO-Biosense system as that demonstrating a bipolar electrogram of >1.5 mV. On the basis of our previous experience with catheter and intraoperative mapping, we then arbitrarily designated a value of <0.5 mV as consistent with "densely scarred" endocardium.7 8

Voltage Map Color Display and Technique for Estimating Extent of Abnormal Endocardium
The magnetic mapping system includes a magnetic sensor in the catheter tip that can be localized in 3D space using the ultralow magnetic field generators placed under the fluoroscopic table. The electrogram amplitude recorded from the catheter at different endocardial locations can be shown on a computer display as a voltage map. The color display for illustrating abnormal myocardium was set with a color range of 0.5 to 1.5 mV to highlight the border zone (Figures 1 through 6DownDownDownDownDownDown). The CARTO system can also calculate the anatomic distance between any 2 designated points.5 6 Thus, by assuming a rectangular or trapezoidal shape of any abnormal segment, the extent of the endocardium demonstrating abnormal (<1.5 mV) and densely scarred (<0.5 mV) voltage amplitudes could be estimated (Tables 2Down and 3Down).



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Figure 1. Voltage maps of RV in anterior (AP) and posterior (PA) views. Color range for bipolar electrogram maps is identical for all subsequent figures. Purple represents normal endocardium (amplitude >=1.5 mV); red, dense scar (amplitude <=0.5 mV); and range between purple and red, border zone (signal amplitudes between 0.5 and 1.5 mV). Top, RV map from patient without heart disease is represented almost entirely by color purple. Bottom, RV map from patient with VT and RV cardiomyopathy with abnormal endocardium over superior RV free wall and septum. Linear ablation lesions, identified by contiguous dark circles, extend from dense scar to normal endocardium. APEX indicates location of RV apex.



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Figure 2. Voltage maps of LV in right and left anterior oblique (RAO and LAO) views. Color range is as described in Figure 1Up. Top, LV map from patient without heart disease is represented by color purple. Bottom, LV map from patient with VT and coronary disease shows apical dense scar, as indicated by color red, and border zone that extends over septum and anterior LV. Linear ablation lesions, identified by contiguous dark circles, extend across border zone.



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Figure 3. Electrocardiograms of VT and pacemap (PACE) identifying appropriate region for linear ablation in patient with RV cardiomyopathy. A, VT morphologies are mimicked by pacemapping at RV free wall sites, as indicated on mesh silhouette of RV. B, Color voltage map of RV in anteroposterior view, coupled with mesh figure, as in A. The 12-lead ECG during VT and pacemap directed linear lesions to RV free wall. Linear lesions, identified by contiguous dark circles, extend from dense scar (red) and cross border zone sites showing best pacemaps. APEX indicates location of RV apex.



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Figure 4. Electrocardiograms of VT and pacemap identifying appropriate regions for linear ablation in patient with coronary disease. A, Left bundle-branch block VT mimicked during pacing from LV septum (pacing site 2-3).9 10 Inset shows location of linear lesion that crossed site of pacemap. Two other left bundle VT morphologies were present; thus, additional septal linear lesions existed. B, Two additional right bundle VT morphologies mimicked by pacemapping. Mesh figure of LV in left anterior oblique (LAD) projection shows relationship of pacemap sites to nonseptal linear lesions. C, Voltage maps projected to display septal, inferior, and anterolateral LV to show all linear lesions crossing border zones, with mesh figure as in B. Linear nature of multiple point lesions is emphasized by solid lines.



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Figure 5. Linear lesions crossing all aspects of border zone of inferior infarction in patient with multiple unmappable VTs. Voltage maps projected display septal, inferior, and lateral LV and show extent of abnormal recordings and linear lesions. Voltage map color range is as defined in Figure 1Up. Seven linear ablation lines interrupt border zone. Twelve-lead ECGs were not available for spontaneous VTs warranting a more extensive, nonguided approach.



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Figure 6. Bipolar electrogram voltage maps (BIPOLAR) in anterior (AP), posterior (PA), and left anterior oblique (LAO) views from patient with RV cardiomyopathy. Color range is as in Figure 1Up. Abnormal electrograms were recorded over most of RV free wall. Patient had multiple left bundle VT morphologies. Linear lesions, guided by pacemapping and voltage map, connect dense scar to normal endocardium along RV free wall. APEX indicates location of RV apex; large circle, location of tricuspid valve orifice.


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Table 2. Mapping and Ablation Characteristics in Patients With Coronary Artery Disease


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Table 3. Mapping and Ablation Characteristics in Patients with Nonischemic Cardiomyopathy

Ablation Technique and Location of Linear Lesions
Linear lesions were placed using 3 guiding principles. (1) Lesions would extend across the borders of the endocardium that demonstrated abnormal bipolar electrogram voltage. (2) Lesions would typically extend from the areas demonstrating the lowest amplitude signals (<0.5 mV) to areas demonstrating a distinctly normal signal (>3 mV for the first 3 patients and >1.5 to 2.0 mV for the last 13 patients) or to a valve continuity. (3) Lesions would cross through the border zones at sites where mapping approximated the QRS morphology of VT. Twelve-lead ECG recordings of spontaneous and induced VT were analyzed to regionalize the site of origin of the VT using standard criteria.9 10 The mapping catheter was then placed along the appropriate border of the scar, and pacemapping was performed to create a 12-lead ECG that approximated the VT (Figures 3Up and 4Up). This modification to a purely anatomic ablation approach was essential because (1) the extent of electrogram abnormalities was large (Tables 2Up and 3Up) and (2) the size and 3D character of the VT circuit was not established. In 5 of the 16 patients, the electrograms stored in the defibrillator did not match the electrograms of induced VT, and 12-lead ECGs of spontaneous VT were unavailable. In these patients, linear lesions were created at 3- to 5-cm intervals along all aspects of the border zone. (Figure 5Up).

Sequential point lesions created the linear lesions. For each point lesion, radiofrequency energy was applied for 90 to 120 s using a power output to achieve a targeted temperature of 60°C (SteeroCath-T catheter) or a targeted impedance drop of 6 to 10 ohms (Navistar catheter). Power output started at 5 W and was titrated over 30 s to a maximum output of 50 W or until the targeted temperature or impedance was achieved. To avoid an impedance rise, output was decreased manually whenever the impedance drop exceeded 10 ohms or temperature exceeded 60°C to 65°C. For the first 3 patients, the linear lesion location and size were estimated using fluoroscopy. This process was facilitated using 3D magnetic mapping (CARTO-Biosense) in the last 13 patients.5 6 Radiofrequency energy applications were "tagged" for display, and the length of the linear lesion was documented (Tables 2Up and 3Up).

In 8 of the 16 patients, programmed stimulation was repeated after making linear lesions on one end of the endocardium that demonstrated abnormal electrograms to assess the inducibility of specific, targeted tachycardia morphologies. In all but one of the 16 patients, stimulation that resulted in VT in the baseline state (and that included triple extrastimuli) was performed after creating all linear lesions. In the one patient in whom this was not done, prolonged periods of hemodynamic instability followed the prior episodes of VT.

Follow-Up
VT recurrence was identified via device interrogation and a report of clinical symptoms. No new antiarrhythmic drug therapy was added (Table 4Down). In addition, we assessed the effects of the linear lesions on the LV by using gated nuclear blood pool scanning in 6 patients with ischemic cardiomyopathy. A policy regarding anticoagulation after the procedure was established after the first 2 left-sided ablation procedures. Coumadin was prescribed for 3 months to achieve an international normalized ratio >2.0.


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Table 4. Outcome After Ablation

Statistical Analysis
Results are presented as mean±SD unless otherwise indicated. Comparisons of total procedure and fluoroscopy time between patients with coronary disease and those with nonischemic cardiomyopathy were made using an unpaired Student’s t test. A comparison of LV ejection fraction before and after the ablation procedure was made using a paired Student’s t test. P<0.05 was considered significant.


*    Results
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Endocardial Voltage Maps in Patients With Coronary Disease
The extent of LV endocardium subtended by contiguous bipolar recordings demonstrating abnormal electrograms in patients with coronary artery disease was 65±24 cm2 and ranged from 51 to 110 cm2 (Table 2Up and Figures 2Up, 5Up, and 6Up). The dense scar (<0.5 mV) ranged from 5 to 44 cm2 (Table 2Up).

Endocardial Voltage Maps in Patients With Dilated Cardiomyopathy
In all patients with dilated cardiomyopathy, abnormal endocardial electrograms were recorded from the RV septum and free wall (Figures 1Up and 6Up). In contrast, abnormal electrograms were recorded from the LV in only 3 patients. Only one of these patients had extensive LV septal and free wall abnormalities (Table 3Up).

The extent of the RV endocardium subtended by contiguous bipolar recordings demonstrating abnormal electrograms was 60±36 cm2 and ranged from 25 to 127 cm2 (Table 3Up). The abnormal endocardium in the single patient with extensive LV involvement measured 45 cm2. Dense scar (<0.5 mV) was also identifiable in all patients with nonischemic cardiomyopathy. The estimated size of the dense scar ranged from 8 to 50 cm2 (Table 3Up).

Linear Radiofrequency Ablation Lesions
A total of 8 to 87 (median, 55) radiofrequency lesions were applied per patient. Point lesions created 1 to 9 linear lesions (median, 4). The average length of the linear lesion was 3.9 cm, and the range was 1.4 to 9.4 cm (Tables 2Up and 3Up).

Programmed Stimulation After Ablation
In 6 of the 8 patients in whom programmed stimulation was repeated after making lesions on one end of the scar, only VT morphologies consistent with an origin from the opposite end of the scar were induced (Table 4Up). In response to stimulation at the completion of all ablation lines, 7 of the 15 patients had no inducible VT. Of the 8 patients with persistent inducible VT, 5 had rapid VTs inducible with double (2 patients) or triple (3 patients) extrastimuli. These VTs did not match the cycle length or morphology of the spontaneous arrhythmias. In the remaining 3 patients, a slower tachycardia was still inducible. In 1 of these 3 patients, the induced VT did not match spontaneous VT. In the second patient, the VT matched a clinical VT morphology but was slower in rate. In the last patient, no ECG information was available for the spontaneous VT.

Duration of Procedure and Fluoroscopy Exposure and Complications
The total procedure time ranged from 6.0 to 13.5 hours (mean, 8.8±1.9 hours). The total fluoroscopy time ranged from 60 to 196 minutes (mean, 121±38 minutes). The total procedure time (10.8±2.1 versus 8.1±2.1 hours; P<0.05) and the total fluoroscopy time (156±32 versus 90±27 minutes; P<0.01) were greater for patients with VT who had nonischemic rather than ischemic cardiomyopathy.

None of the 6 patients with LV ejection fraction measurements before (mean, 24±6%) and after (mean, 23±9%) ablation demonstrated a deterioration (>5%). One patient experienced a cerebral vascular accident with right-sided hemiparesis at the end of the procedure. Residual arm weakness persisted at 6 months. In this patient, an impedance rise occurred during radiofrequency energy application. When the ablation catheter was removed through a transseptal sheath, residual coagulum was noted.

Follow-Up
All patients have been followed for >=3 months (range, 3 to 36 months; median, 8 months; Table 4Up). Three patients died at 3, 4, and 8 months after the ablation procedure from refractory heart failure (baseline LV ejection fraction was 18%, with associated severe mitral regurgitation), pneumonia, and complications of abdominal surgery. Fifteen patients were free of VT during the initial follow-up month (Figure 7Down), and 12 patients (75%) have been free of any recurrence of VT during the entire duration of follow-up. Only 1 of the 4 patients with VT during follow-up had frequent recurrences. Recurrent VT in this patient has been slow and amenable to pacing therapy.



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Figure 7. Outcome after linear lesions for unmappable VT. All patients had frequent VT during month before ablation. A total of 12 patients remained arrhythmia-free during follow-up. Isolated VT occurred at 3, 9, and 13 months in 3 patients, with frequent VT in only one patient.


*    Discussion
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*Discussion
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The current study describes a new approach for the ablation of unmappable, unimorphic VT associated with ischemic and nonischemic cardiomyopathy. The study documents that (1) the extent and voltage characteristics of the abnormal endocardium can be defined using sinus rhythm, bipolar electrogram, voltage mapping, and (2) catheter-based ablative therapy that creates linear lesions targeting the border zone can control recurrent VT.

Electroanatomic Substrate for VT
The magnetic mapping system (CARTO) provided a tool for creating a 3D bipolar electrogram voltage map.5 6 In patients with both ischemic and nonischemic cardiomyopathy, the extent of abnormal electrogram recordings was large, averaging >50 cm2 (Tables 2Up and 3Up). Cassidy and colleagues7 noted a comparable degree of endocardial electrogram abnormalities in patients with monomorphic VT in the setting of ischemic and nonischemic cardiomyopathy. Of note, sampling was typically limited to <20 sites in that study. By sampling from hundreds of sites, we could characterize the electroanatomic substrate in more detail. Almost uniformly, contiguous areas of very abnormal signals with an amplitude <0.5 mV were identified in patients with ischemic and nonischemic cardiomyopathy. This dense scar was typically surrounded by large "border zone" areas with signal amplitudes between 0.5 and 1.5 mV, which transitioned into normal myocardium (Figures 1 through 6UpUpUpUpUpUp).

Linear Lesion Deployment Based on Surgical Experience
Subendocardial resection guided by the presence of the endocardial scar is associated with a 70% to 80% arrhythmia cure rate.11 12 Such surgical therapy is performed when uniform, sustained VT can not be initiated at the time of surgery. This extensive surgical experience served as the basis for creating linear lesions that connected the dense scar area to the normal endocardium; we used electrogram recordings during sinus rhythm as a guide. The magnetic electroanatomic mapping system assisted in creating contiguous lesions through the defined border zone by documenting the location of the catheter tip and its relationship to the endocardial anatomy.

Use of 12-Lead ECG During VT and Pacemapping to Guide Placement of Linear Lesions
Eliminating all of the border zone endocardium using current catheter-based ablative techniques would be impractical and possibly unsafe. The placement of linear lesions was guided by an interpretation of the 12-lead ECG during VT and pacemapping in the border zone.9 10 Linear lesions were created in regions that crossed the border zone and intersected the best pacemap site. We hypothesized that the best pacemap site approximated the exit site of the VT circuit and that the described endocardial linear lesion would likely interrupt a portion of a reentrant circuit (Figure 8Down). This described modification to a purely anatomic approach allowed us to target specific regions of the border zone in most patients.



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Figure 8. Schema for suggested mechanism of linear lesion technique contrasted with surgical subendocardial resection. Bipolar electrogram voltage map identifies dense scar (consistent with aneurysm formation), border zone, and normal endocardium. Subendocardial linear lesions extend from dense scar to normal endocardium. Linear lesions guided by pacemapping may interrupt potential for reentry, much like subendocardial resection.

Limitations
Because of the variability in the frequency of VT, it is difficult to ascertain whether a good clinical response is causally related to any ablation procedure. We validated the assumption of causality by (1) documenting the frequency of VT in the month before ablation, (2) using diagnostic information from the implantable defibrillator to document VT recurrence, (3) not adding new antiarrhythmic drug therapy, and (4) including only patients followed for >=3 months. Because of these strict criteria, we are confident that arrhythmia control after ablation occurred in most patients.

Although linear lesions were created using repeated point radiofrequency applications, we do not wish to imply that we created conduction block. Our technique is descriptive, and the mechanism of efficacy is speculative.

Each patient had unimorphic tachycardia that was documented. We do not know whether a similar ablation technique would be effective in patients with polymorphic VT. In addition, given the average duration of the procedure and the duration of fluoroscopic exposure, the technique as described might not be practically applied in many institutions.

Finally, although we think that we have validated the efficacy of the described technique, we cannot be as certain about its safety. Indeed, we found no evidence of deterioration in LV function with repeat radionuclide scans. Nevertheless, a cerebral vascular accident occurred in one of our patients. The use of magnetic mapping catheters with temperature-monitoring capabilities may decrease the risk of thromboembolic phenomena.

Received May 6, 1999; revision received September 21, 1999; accepted October 7, 1999.


*    References
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up arrowAbstract
up arrowIntroduction
up arrowMethods
up arrowResults
up arrowDiscussion
*References
 
1. Morady F, Harvey M, Kalbfleisch SJ, El-Atassi R, Calkins H, Langberg JL. Radiofrequency catheter ablation of VT in patients with coronary artery disease. Circulation. 1993;87:363–372.[Abstract/Free Full Text]

2. Stevenson WG, Khan H, Sager P, Saxton LA, Middlekauff HR, Natterson PD, Weiner I. Identification of reentry circuit sites during catheter mapping and radiofrequency ablation of VT late after myocardial infarction. Circulation. 1993;88:I647–I670.

3. Callans DJ, Zado E, Sarter BH, Schwartzman D, Gottlieb CD, Marchlinski FE. Efficacy of radiofrequency ablation for VT in healed myocardial infarction. Am J Cardiol. 1998;82:429–432.[Medline] [Order article via Infotrieve]

4. Cassidy DM, Vassallo JA, Marchlinski FE, Buxton AE, Unterecker WJ, Josephson ME. Endocardial mapping in humans in sinus rhythm with normal LVs: activation patterns and characteristics of electrograms. Circulation. 1984;70:37–42.[Abstract/Free Full Text]

5. Shpun S, Gepstein L, Hayam G, Ben-Haim SA. Guidance of radiofrequency endocardial ablation with real-time three-dimensional magnetic navigation system. Circulation. 1997;96:2016–2021.[Abstract/Free Full Text]

6. Gepstein L, Hayam G, Ben-Haim SA. A novel method for nonfluoroscopic catheter-based electroanatomical mapping of the heart: in vitro and in vivo accuracy results. Circulation. 1997;95:1611–1622.[Abstract/Free Full Text]

7. Cassidy DM, Vassallo JA, Miller JM, Poll DS, Buxton AE, Marchlinski FE, Josephson ME. Endocardial catheter mapping during sinus rhythm: relation of underlying heart disease and ventricular arrhythmia. Circulation. 1986;73:645–652.[Abstract/Free Full Text]

8. Kienzle MG, Miller J, Falcone FA, Harken A, Josephson ME. Intraoperative endocardial mapping during sinus rhythm: relationship to site of origin of VT. Circulation. 1984;70:957–965.[Abstract/Free Full Text]

9. Miller JM, Marchlinski FE, Buxton AE, Josephson ME. Relationship between the 12-lead electrocardiogram during VT and endocardial site of origin inpatients with coronary artery disease. Circulation. 1988;77:759–766.[Abstract/Free Full Text]

10. Josephson ME, Waxman HL, Cain ME, Gardner MJ, Buxton AE. Ventricular activation during ventricular endocardial pacing, II: role of pace-mapping to localize the origin of VT. Am J Cardiol. 1982;50:11–22.[Medline] [Order article via Infotrieve]

11. Moran JM, Kehoe RH, Loeb JM, Lichtenthal PR, Sanders JH, Michaelis LL. Extended endocardial resection for the treatment of VT and ventricular fibrillation. Ann Thorac Surg. 1982;34:538–552.[Abstract]

12. Horowitz LN, Harken AH, Kastor JA, Josephson ME. Ventricular resection guided by epicardial and endocardial mapping for treatment of recurrent VT. N Engl J Med. 1980;302:589–593.[Abstract]




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J Am Coll CardiolHome page
F. M. Bogun, B. Desjardins, E. Good, S. Gupta, T. Crawford, H. Oral, M. Ebinger, F. Pelosi, A. Chugh, K. Jongnarangsin, et al.
Delayed-enhanced magnetic resonance imaging in nonischemic cardiomyopathy utility for identifying the ventricular arrhythmia substrate.
J. Am. Coll. Cardiol., March 31, 2009; 53(13): 1138 - 1145.
[Abstract] [Full Text] [PDF]


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CirculationHome page
W. G. Stevenson, D. J. Wilber, A. Natale, W. M. Jackman, F. E. Marchlinski, T. Talbert, M. D. Gonzalez, S. J. Worley, E. G. Daoud, C. Hwang, et al.
Irrigated Radiofrequency Catheter Ablation Guided by Electroanatomic Mapping for Recurrent Ventricular Tachycardia After Myocardial Infarction: The Multicenter Thermocool Ventricular Tachycardia Ablation Trial
Circulation, December 16, 2008; 118(25): 2773 - 2782.
[Abstract] [Full Text] [PDF]


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Circ Arrhythm ElectrophysiolHome page
G. Sivagangabalan, J. Pouliopoulos, K. Huang, J. Lu, M. A. Barry, A. Thiagalingam, D. L. Ross, S. P. Thomas, and P. Kovoor
Comparison of Electroanatomic Contact and Noncontact Mapping of Ventricular Scar in a Postinfarct Ovine Model With Intramural Needle Electrode Recording and Histological Validation
Circ Arrhythm Electrophysiol, December 1, 2008; 1(5): 363 - 369.
[Abstract] [Full Text] [PDF]


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EuropaceHome page
C. Knackstedt, P. Schauerte, and P. Kirchhof
Electro-anatomic mapping systems in arrhythmias
Europace, November 1, 2008; 10(suppl_3): iii28 - iii34.
[Abstract] [Full Text] [PDF]


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J Am Coll CardiolHome page
A. Codreanu, F. Odille, E. Aliot, P.-Y. Marie, I. Magnin-Poull, M. Andronache, D. Mandry, W. Djaballah, D. Regent, J. Felblinger, et al.
Electroanatomic Characterization of Post-Infarct Scars: Comparison With 3-Dimensional Myocardial Scar Reconstruction Based on Magnetic Resonance Imaging
J. Am. Coll. Cardiol., September 2, 2008; 52(10): 839 - 842.
[Abstract] [Full Text] [PDF]


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Circ Arrhythm ElectrophysiolHome page
F. E. Marchlinski
Ventricular Tachycardia Ablation: Moving Beyond Treatment of Last Resort
Circ Arrhythm Electrophysiol, August 1, 2008; 1(3): 147 - 149.
[Full Text] [PDF]


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Circ Arrhythm ElectrophysiolHome page
F. Sacher, U. B. Tedrow, M. E. Field, J.-M. Raymond, B. A. Koplan, L. M. Epstein, and W. G. Stevenson
Ventricular Tachycardia Ablation: Evolution of Patients and Procedures Over 8 Years
Circ Arrhythm Electrophysiol, August 1, 2008; 1(3): 153 - 161.
[Abstract] [Full Text] [PDF]


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J Am Coll CardiolHome page
T. Sasano, M. R. Abraham, K.-C. Chang, H. Ashikaga, K. J. Mills, D. P. Holt, J. Hilton, S. G. Nekolla, J. Dong, A. C. Lardo, et al.
Abnormal sympathetic innervation of viable myocardium and the substrate of ventricular tachycardia after myocardial infarction.
J. Am. Coll. Cardiol., June 10, 2008; 51(23): 2266 - 2275.
[Abstract] [Full Text] [PDF]


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J Am Coll CardiolHome page
D. Corrado, C. Basso, L. Leoni, B. Tokajuk, P. Turrini, B. Bauce, F. Migliore, A. Pavei, G. Tarantini, M. Napodano, et al.
Three-Dimensional Electroanatomical Voltage Mapping and Histologic Evaluation of Myocardial Substrate in Right Ventricular Outflow Tract Tachycardia.
J. Am. Coll. Cardiol., February 19, 2008; 51(7): 731 - 739.
[Abstract] [Full Text] [PDF]


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CirculationHome page
C. Carbucicchio, M. Santamaria, N. Trevisi, G. Maccabelli, F. Giraldi, G. Fassini, S. Riva, M. Moltrasio, M. Cireddu, F. Veglia, et al.
Catheter Ablation for the Treatment of Electrical Storm in Patients With Implantable Cardioverter-Defibrillators: Short- and Long-Term Outcomes in a Prospective Single-Center Study
Circulation, January 29, 2008; 117(4): 462 - 469.
[Abstract] [Full Text] [PDF]


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J Am Coll Cardiol ImgHome page
T. Dickfeld, P. Lei, V. Dilsizian, J. Jeudy, J. Dong, A. Voudouris, R. Peters, M. Saba, R. Shekhar, and S. Shorofsky
Integration of three-dimensional scar maps for ventricular tachycardia ablation with positron emission tomography-computed tomography.
J. Am. Coll. Cardiol. Img., January 1, 2008; 1(1): 73 - 82.
[Abstract] [Full Text] [PDF]


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NEJMHome page
V. Y. Reddy, M. R. Reynolds, P. Neuzil, A. W. Richardson, M. Taborsky, K. Jongnarangsin, S. Kralovec, L. Sediva, J. N. Ruskin, and M. E. Josephson
Prophylactic Catheter Ablation for the Prevention of Defibrillator Therapy
N. Engl. J. Med., December 27, 2007; 357(26): 2657 - 2665.
[Abstract] [Full Text] [PDF]


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NEJMHome page
N.A. M. Estes III
Ablation after ICD Implantation -- Bridging the Gap between Promise and Practice
N. Engl. J. Med., December 27, 2007; 357(26): 2717 - 2719.
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Eur Heart J SupplHome page
C. Wolpert, H. Pitschner, and M. Borggrefe
Evolution of ablation techniques: from WPW to complex arrhythmias
Eur. Heart J. Suppl., December 1, 2007; 9(suppl_I): I116 - I121.
[Abstract] [Full Text] [PDF]


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CirculationHome page
K. Zeppenfeld, M. J. Schalij, M. M. Bartelings, U. B. Tedrow, B. A. Koplan, K. Soejima, and W. G. Stevenson
Catheter Ablation of Ventricular Tachycardia After Repair of Congenital Heart Disease: Electroanatomic Identification of the Critical Right Ventricular Isthmus
Circulation, November 13, 2007; 116(20): 2241 - 2252.
[Abstract] [Full Text] [PDF]


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CirculationHome page
R. E. Eckart, T. W. Hruczkowski, U. B. Tedrow, B. A. Koplan, L. M. Epstein, and W. G. Stevenson
Sustained Ventricular Tachycardia Associated With Corrective Valve Surgery
Circulation, October 30, 2007; 116(18): 2005 - 2011.
[Abstract] [Full Text] [PDF]


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Circ. Res.Home page
H. Ashikaga, T. Sasano, J. Dong, M. M. Zviman, R. Evers, B. Hopenfeld, V. Castro, R. H. Helm, T. Dickfeld, S. Nazarian, et al.
Magnetic Resonance Based Anatomical Analysis of Scar-Related Ventricular Tachycardia: Implications for Catheter Ablation
Circ. Res., October 26, 2007; 101(9): 939 - 947.
[Abstract] [Full Text] [PDF]


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CirculationHome page
J. Almendral and M. E. Josephson
All Patients With Hemodynamically Tolerated Postinfarction Ventricular Tachycardia Do Not Require an Implantable Cardioverter-Defibrillator
Circulation, September 4, 2007; 116(10): 1204 - 1212.
[Full Text] [PDF]


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J Am Coll CardiolHome page
D. Dalal, R. Jain, H. Tandri, J. Dong, S. M. Eid, K. Prakasa, C. Tichnell, C. James, T. Abraham, S. D. Russell, et al.
Long-Term Efficacy of Catheter Ablation of Ventricular Tachycardia in Patients With Arrhythmogenic Right Ventricular Dysplasia/Cardiomyopathy
J. Am. Coll. Cardiol., July 31, 2007; 50(5): 432 - 440.
[Abstract] [Full Text] [PDF]


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CirculationHome page
W. G. Stevenson and K. Soejima
Catheter Ablation for Ventricular Tachycardia
Circulation, May 29, 2007; 115(21): 2750 - 2760.
[Full Text] [PDF]


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CirculationHome page
H. U. Klemm, R. Ventura, D. Steven, C. Johnsen, T. Rostock, B. Lutomsky, T. Risius, T. Meinertz, and S. Willems
Catheter Ablation of Multiple Ventricular Tachycardias After Myocardial Infarction Guided by Combined Contact and Noncontact Mapping
Circulation, May 29, 2007; 115(21): 2697 - 2704.
[Abstract] [Full Text] [PDF]


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CirculationHome page
A. Aryana, A. d'Avila, E. K. Heist, T. Mela, J. P. Singh, J. N. Ruskin, and V. Y. Reddy
Remote Magnetic Navigation to Guide Endocardial and Epicardial Catheter Mapping of Scar-Related Ventricular Tachycardia
Circulation, March 13, 2007; 115(10): 1191 - 1200.
[Abstract] [Full Text] [PDF]


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EuropaceHome page
M. Volkmer, F. Ouyang, F. Deger, S. Ernst, M. Goya, D. Bansch, K. Berodt, K.-H. Kuck, and M. Antz
Substrate mapping vs. tachycardia mapping using CARTO in patients with coronary artery disease and ventricular tachycardia: impact on outcome of catheter ablation.
Europace, November 1, 2006; 8(11): 968 - 976.
[Abstract] [Full Text] [PDF]


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J Am Coll CardiolHome page
Developed in Collaboration With the European Heart, D. P. Zipes, A. J. Camm, M. Borggrefe, A. E. Buxton, B. Chaitman, M. Fromer, G. Gregoratos, G. Klein, A. J. Moss, et al.
ACC/AHA/ESC 2006 Guidelines for Management of Patients With Ventricular Arrhythmias and the Prevention of Sudden Cardiac Death: A Report of the American College of Cardiology/American Heart Association Task Force and the European Society of Cardiology Committee for Practice Guidelines (Writing Committee to Develop Guidelines for Management of Patients With Ventricular Arrhythmias and the Prevention of Sudden Cardiac Death)
J. Am. Coll. Cardiol., September 5, 2006; 48(5): e247 - e346.
[Full Text] [PDF]


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EuropaceHome page
Writing Committee Members, D. P. Zipes, A. J. Camm, M. Borggrefe, A. E. Buxton, B. Chaitman, M. Fromer, G. Gregoratos, G. Klein, A. J. Moss, et al.
ACC/AHA/ESC 2006 guidelines for management of patients with ventricular arrhythmias and the prevention of sudden cardiac death: A report of the American College of Cardiology/American Heart Association Task Force and the European Society of Cardiology Committee for Practice Guidelines (Writing Committee to Develop Guidelines for Management of Patients With Ventricular Arrhythmias and the Prevention of Sudden Cardiac Death) Developed in collaboration with the European Heart Rhythm Association and the Heart Rhythm Society
Europace, September 1, 2006; 8(9): 746 - 837.
[Full Text] [PDF]


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EuropaceHome page
B. K. Kantharia, J. A. Patel, B. S. Nagra, and G. S. Ledley
Electrical storm of monomorphic ventricular tachycardia after a cardiac-resynchronization-therapy-defibrillator upgrade
Europace, August 1, 2006; 8(8): 625 - 628.
[Abstract] [Full Text] [PDF]


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J Am Coll CardiolHome page
F. Bogun, E. Good, S. Reich, D. Elmouchi, P. Igic, K. Lemola, D. Tschopp, K. Jongnarangsin, H. Oral, A. Chugh, et al.
Isolated Potentials During Sinus Rhythm and Pace-Mapping Within Scars as Guides for Ablation of Post-Infarction Ventricular Tachycardia
J. Am. Coll. Cardiol., May 16, 2006; 47(10): 2013 - 2019.
[Abstract] [Full Text] [PDF]


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J Am Coll CardiolHome page
T. Dickfeld, R. Kato, M. Zviman, S. Lai, G. Meininger, A. C. Lardo, A. Roguin, D. Blumke, R. Berger, H. Calkins, et al.
Characterization of Radiofrequency Ablation Lesions With Gadolinium-Enhanced Cardiovascular Magnetic Resonance Imaging
J. Am. Coll. Cardiol., January 17, 2006; 47(2): 370 - 378.
[Abstract] [Full Text] [PDF]


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CirculationHome page
J. Dong, H. Calkins, S. B. Solomon, S. Lai, D. Dalal, A. Lardo, E. Brem, A. Preiss, R. D. Berger, H. Halperin, et al.
Integrated Electroanatomic Mapping With Three-Dimensional Computed Tomographic Images for Real-Time Guided Ablations
Circulation, January 17, 2006; 113(2): 186 - 194.
[Abstract] [Full Text] [PDF]


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CirculationHome page
B. Schumacher, F. H. Gietzen, H. Neuser, J. Schummelfeder, M. Schneider, S. Kerber, R. Schimpf, C. Wolpert, and M. Borggrefe
Electrophysiological Characteristics of Septal Hypertrophy in Patients With Hypertrophic Obstructive Cardiomyopathy and Moderate to Severe Symptoms
Circulation, October 4, 2005; 112(14): 2096 - 2101.
[Abstract] [Full Text] [PDF]


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J Am Coll CardiolHome page
H. U. Klein and S. Reek
"The Older the Broader": Electrogram Characteristics Help Identify the Critical Isthmus During Catheter Ablation of Postinfarct Ventricular Tachycardia
J. Am. Coll. Cardiol., August 16, 2005; 46(4): 675 - 677.
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CirculationHome page
A. Verma, F. Kilicaslan, E. Pisano, N. F. Marrouche, R. Fanelli, J. Brachmann, J. Geunther, D. Potenza, D. O. Martin, J. Cummings, et al.
Response of Atrial Fibrillation to Pulmonary Vein Antrum Isolation Is Directly Related to Resumption and Delay of Pulmonary Vein Conduction
Circulation, August 2, 2005; 112(5): 627 - 635.
[Abstract] [Full Text] [PDF]


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CirculationHome page
A. Verma, F. Kilicaslan, R. A. Schweikert, G. Tomassoni, A. Rossillo, N. F. Marrouche, V. Ozduran, O. M. Wazni, S. C. Elayi, L. C. Saenz, et al.
Short- and Long-Term Success of Substrate-Based Mapping and Ablation of Ventricular Tachycardia in Arrhythmogenic Right Ventricular Dysplasia
Circulation, June 21, 2005; 111(24): 3209 - 3216.
[Abstract] [Full Text] [PDF]


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CirculationHome page
D. Corrado, C. Basso, L. Leoni, B. Tokajuk, B. Bauce, G. Frigo, G. Tarantini, M. Napodano, P. Turrini, A. Ramondo, et al.
Three-Dimensional Electroanatomic Voltage Mapping Increases Accuracy of Diagnosing Arrhythmogenic Right Ventricular Cardiomyopathy/Dysplasia
Circulation, June 14, 2005; 111(23): 3042 - 3050.
[Abstract] [Full Text] [PDF]


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J Am Coll CardiolHome page
A. Verma, O. M. Wazni, N. F. Marrouche, D. O. Martin, F. Kilicaslan, S. Minor, R. A. Schweikert, W. Saliba, J. Cummings, J. D. Burkhardt, et al.
Pre-existent left atrial scarring in patients undergoing pulmonary vein antrum isolation: An independent predictor of procedural failure
J. Am. Coll. Cardiol., January 18, 2005; 45(2): 285 - 292.
[Abstract] [Full Text] [PDF]


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J Am Coll CardiolHome page
V. Y. Reddy, Z. J. Malchano, G. Holmvang, E. J. Schmidt, A. d'Avila, C. Houghtaling, R. C. Chan, and J. N. Ruskin
Integration of cardiac magnetic resonance imaging with three-dimensional electroanatomic mapping to guide left ventricular catheter manipulation: Feasibility in a porcine model of healed myocardial infarction
J. Am. Coll. Cardiol., December 7, 2004; 44(11): 2202 - 2213.
[Abstract] [Full Text] [PDF]


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J Am Coll CardiolHome page
U. Tedrow, W. H. Maisel, L. M. Epstein, K. Soejima, and W. G. Stevenson
Feasibility of adjusting paced left ventricular activation by manipulating stimulus strength
J. Am. Coll. Cardiol., December 7, 2004; 44(11): 2249 - 2252.
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CirculationHome page
A. Thiagalingam, E. M. Wallace, C. R. Campbell, A. C. Boyd, V. E. Eipper, K. Byth, D. L. Ross, and P. Kovoor
Value of Noncontact Mapping for Identifying Left Ventricular Scar in an Ovine Model
Circulation, November 16, 2004; 110(20): 3175 - 3180.
[Abstract] [Full Text] [PDF]


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CirculationHome page
A. Arenal, S. del Castillo, E. Gonzalez-Torrecilla, F. Atienza, M. Ortiz, J. Jimenez, A. Puchol, J. Garcia, and J. Almendral
Tachycardia-Related Channel in the Scar Tissue in Patients With Sustained Monomorphic Ventricular Tachycardias: Influence of the Voltage Scar Definition
Circulation, October 26, 2004; 110(17): 2568 - 2574.
[Abstract] [Full Text] [PDF]


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CirculationHome page
V. V. Patel, R. W. Rho, E. P. Gerstenfeld, H. H. Hsia, D. J. Callans, and F. E. Marchlinski
Right Bundle-Branch Block Ventricular Tachycardias: Septal Versus Lateral Ventricular Origin Based on Activation Time to the Right Ventricular Apex
Circulation, October 26, 2004; 110(17): 2582 - 2587.
[Abstract] [Full Text] [PDF]


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J Am Coll CardiolHome page
L. Szumowski, P. Sanders, F. Walczak, M. Hocini, P. Jais, R. Kepski, E. Szufladowicz, P. Urbanek, P. Derejko, R. Bodalski, et al.
Mapping and ablation of polymorphic ventricular tachycardia after myocardial infarction
J. Am. Coll. Cardiol., October 19, 2004; 44(8): 1700 - 1706.
[Abstract] [Full Text] [PDF]


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CirculationHome page
F. E. Marchlinski, E. Zado, S. Dixit, E. Gerstenfeld, D. J. Callans, H. Hsia, D. Lin, H. Nayak, A. Russo, and W. Pulliam
Electroanatomic Substrate and Outcome of Catheter Ablative Therapy for Ventricular Tachycardia in Setting of Right Ventricular Cardiomyopathy
Circulation, October 19, 2004; 110(16): 2293 - 2298.
[Abstract] [Full Text] [PDF]


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CirculationHome page
C. B. Brunckhorst, E. Delacretaz, K. Soejima, W. H. Maisel, P. L. Friedman, and W. G. Stevenson
Identification of the Ventricular Tachycardia Isthmus After Infarction by Pace Mapping
Circulation, August 10, 2004; 110(6): 652 - 659.
[Abstract] [Full Text] [PDF]


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Eur Heart JHome page
P. Della Bella, S. Riva, G. Fassini, F. Giraldi, M. Berti, C. Klersy, and N. Trevisi
Incidence and significance of pleomorphism in patients with postmyocardial infarction ventricular tachycardia: Acute and long-term outcome of radiofrequency catheter ablation
Eur. Heart J., July 1, 2004; 25(13): 1127 - 1138.
[Abstract] [Full Text] [PDF]


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J Am Coll CardiolHome page
K. Soejima, W. G. Stevenson, J. L. Sapp, A. P. Selwyn, G. Couper, and L. M. Epstein
Endocardial and epicardial radiofrequency ablation of ventricular tachycardia associated with dilated cardiomyopathy: The importance of low-voltage scars
J. Am. Coll. Cardiol., May 19, 2004; 43(10): 1834 - 1842.
[Abstract] [Full Text] [PDF]


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CirculationHome page
A. d'Avila, C. Houghtaling, P. Gutierrez, O. Vragovic, J. N. Ruskin, M. E. Josephson, and V. Y. Reddy
Catheter Ablation of Ventricular Epicardial Tissue: A Comparison of Standard and Cooled-Tip Radiofrequency Energy
Circulation, May 18, 2004; 109(19): 2363 - 2369.
[Abstract] [Full Text] [PDF]


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J Am Coll CardiolHome page
N. F. Marrouche, A. Verma, O. Wazni, R. Schweikert, D. O. Martin, W. Saliba, F. Kilicaslan, J. Cummings, J. D. Burkhardt, M. Bhargava, et al.
Mode of initiation and ablation of ventricular fibrillation storms in patients with ischemic cardiomyopathy
J. Am. Coll. Cardiol., May 5, 2004; 43(9): 1715 - 1720.
[Abstract] [Full Text] [PDF]


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CirculationHome page
H. H. Hsia, D. J. Callans, and F. E. Marchlinski
Characterization of Endocardial Electrophysiological Substrate in Patients With Nonischemic Cardiomyopathy and Monomorphic Ventricular Tachycardia
Circulation, August 12, 2003; 108(6): 704 - 710.
[Abstract] [Full Text] [PDF]


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CirculationHome page
V. Y. Reddy, D. Wrobleski, C. Houghtaling, M. E. Josephson, and J. N. Ruskin
Combined Epicardial and Endocardial Electroanatomic Mapping in a Porcine Model of Healed Myocardial Infarction
Circulation, July 1, 2003; 107(25): 3236 - 3242.
[Abstract] [Full Text] [PDF]


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J Am Coll CardiolHome page
V. Y. Reddy, P. Neuzil, M. Taborsky, and J. N. Ruskin
Short-term results of substrate mapping and radiofrequency ablation of ischemic ventricular tachycardia using a saline-irrigated catheter
J. Am. Coll. Cardiol., June 18, 2003; 41(12): 2228 - 2236.
[Abstract] [Full Text] [PDF]


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J Am Coll CardiolHome page
E. P. Gerstenfeld, S. Dixit, D. J. Callans, Y. Rajawat, R. Rho, and F. E. Marchlinski
Quantitative comparison of spontaneous and paced 12-lead electrocardiogram during right ventricular outflow tract ventricular tachycardia
J. Am. Coll. Cardiol., June 4, 2003; 41(11): 2046 - 2053.
[Abstract] [Full Text] [PDF]


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CirculationHome page
F. Ouyang, M. Antz, F. T. Deger, D. Bansch, A. Schaumann, S. Ernst, and K.-H. Kuck
An Underrecognized Subepicardial Reentrant Ventricular Tachycardia Attributable to Left Ventricular Aneurysm in Patients With Normal Coronary Arteriograms
Circulation, June 3, 2003; 107(21): 2702 - 2709.
[Abstract] [Full Text] [PDF]


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CirculationHome page
I. A. Fuller and M. A. Wood
Intramural Coronary Vasculature Prevents Transmural Radiofrequency Lesion Formation: Implications for Linear Ablation
Circulation, April 8, 2003; 107(13): 1797 - 1803.
[Abstract] [Full Text] [PDF]


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J Am Coll CardiolHome page
C. B. Brunckhorst, W. G. Stevenson, K. Soejima, W. H. Maisel, E. Delacretaz, P. L. Friedman, and S. A. Ben-Haim
Relationship of slow conduction detected by pace-mapping to ventricular tachycardia re-entry circuit sites after infarction
J. Am. Coll. Cardiol., March 5, 2003; 41(5): 802 - 809.
[Abstract] [Full Text] [PDF]


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J Am Coll CardiolHome page
A. Arenal, E. Glez-Torrecilla, M. Ortiz, J. Villacastin, J. Fdez-Portales, E. Sousa, S. del Castillo, L. Perez de Isla, J. Jimenez, and J. Almendral
Ablation of electrograms with an isolated, delayed component as treatment of unmappable monomorphic ventricular tachycardias in patients with structural heart disease
J. Am. Coll. Cardiol., January 1, 2003; 41(1): 81 - 92.
[Abstract] [Full Text] [PDF]


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Eur Heart JHome page
P. Della Bella and N. Trevisi
Catheter ablation: is it good for all postinfarction ventricular tachycardias?
Eur. Heart J., November 1, 2002; 23(21): 1645 - 1647.
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Eur Heart JHome page
D. O'Donnell, J.P. Bourke, R. Anilkumar, E. Simeonidou, and S.S. Furniss
Radiofrequency ablation for post infarction ventricular tachycardia. Report of a single centre experience of 112 cases
Eur. Heart J., November 1, 2002; 23(21): 1699 - 1705.
[Abstract] [Full Text] [PDF]


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CirculationHome page
K. Soejima, W. G. Stevenson, W. H. Maisel, J. L. Sapp, and L. M. Epstein
Electrically Unexcitable Scar Mapping Based on Pacing Threshold for Identification of the Reentry Circuit Isthmus: Feasibility for Guiding Ventricular Tachycardia Ablation
Circulation, September 24, 2002; 106(13): 1678 - 1683.
[Abstract] [Full Text] [PDF]


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CirculationHome page
K. Soejima and W. G. Stevenson
Ventricular Tachycardia Associated With Myocardial Infarct Scar: A Spectrum of Therapies for a Single Patient
Circulation, July 9, 2002; 106(2): 176 - 179.
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Eur Heart JHome page
C.B. Brunckhorst, W.G. Stevenson, W.M. Jackman, K.-H. Kuck, K. Soejima, H. Nakagawa, R. Cappato, and S.A. Ben-Haim
Ventricular mapping during atrial and ventricular pacing. Relationship of multipotential electrograms to ventricular tachycardia reentry circuits after myocardial infarction
Eur. Heart J., July 2, 2002; 23(14): 1131 - 1138.
[Abstract] [Full Text] [PDF]


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HeartHome page
P. A Friedman
Novel mapping techniques for cardiac electrophysiology
Heart, June 1, 2002; 87(6): 575 - 582.
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Eur Heart JHome page
H. Kottkamp and G. Hindricks
Catheter ablation of untolerated ventricular tachycardia--a new front line
Eur. Heart J., May 1, 2002; 23(9): 697 - 699.
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Eur Heart JHome page
P. Della Bella, A. Pappalardo, S. Riva, C. Tondo, G. Fassini, and N. Trevisi
Non-contact mapping to guide catheter ablation of untolerated ventricular tachycardia
Eur. Heart J., May 1, 2002; 23(9): 742 - 752.
[Abstract] [Full Text] [PDF]


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Eur Heart JHome page
R.J. Schilling
Can catheter ablation cure post-infarction ventricular tachycardia?
Eur. Heart J., March 1, 2002; 23(5): 352 - 354.
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CirculationHome page
F. Ouyang, R. Cappato, S. Ernst, M. Goya, M. Volkmer, J. Hebe, M. Antz, T. Vogtmann, A. Schaumann, P. Fotuhi, et al.
Electroanatomic Substrate of Idiopathic Left Ventricular Tachycardia: Unidirectional Block and Macroreentry Within the Purkinje Network
Circulation, January 29, 2002; 105(4): 462 - 469.
[Abstract] [Full Text] [PDF]


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J Am Coll CardiolHome page
M. Boulos, I. Lashevsky, S. Reisner, and L. Gepstein
Electroanatomic mapping of arrhythmogenic right ventricular dysplasia
J. Am. Coll. Cardiol., December 1, 2001; 38(7): 2020 - 2027.
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CirculationHome page
K. Soejima, M. Suzuki, W. H. Maisel, C. B. Brunckhorst, E. Delacretaz, L. Blier, S. Tung, H. Khan, and W. G. Stevenson
Catheter Ablation in Patients With Multiple and Unstable Ventricular Tachycardias After Myocardial Infarction: Short Ablation Lines Guided by Reentry Circuit Isthmuses and Sinus Rhythm Mapping
Circulation, August 7, 2001; 104(6): 664 - 669.
[Abstract] [Full Text] [PDF]


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W. G Stevenson and E. Delacretaz
ELECTROPHYSIOLOGY: Radiofrequency catheter ablation of ventricular tachycardia
Heart, November 1, 2000; 84(5): 553 - 559.
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