Circulation. 2001;104:664-669
doi: 10.1161/hc3101.093764
doi: 10.1161/hc3101.093764
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(Circulation. 2001;104:664.)
© 2001 American Heart Association, Inc.
Clinical Investigation and Reports |
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
From the Cardiovascular Division, Department of Internal Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Mass.
Correspondence to William G. Stevenson, MD, Cardiovascular Division, Brigham and Women’s Hospital, Harvard Medical School, 75 Francis St, Boston, MA 02115. E-mail wstevenson{at}rics.bwh.harvard.edu
Background—— Extensive lines of radiofrequency (RF) lesions through infarct (MI) can ablate multiple and unstable ventricular tachycardias (VTs). Methods for guiding ablation that minimize unnecessary RF applications are needed. This study assesses the feasibility of guiding RF line placement by mapping to identify a reentry circuit isthmus.
Methods and Results—— Catheter mapping and ablation were performed in 40 patients (MI location: inferior, 28; anterior, 7; and both, 5) with an electroanatomic mapping system to measure the infarct region and ablation lines. The initial line was placed in the MI region either through a circuit isthmus identified from entrainment mapping or a target identified from pace mapping. A total of 143 VTs (42 stable, 101 unstable) were induced. An isthmus was identified in 25 patients (63%; 5 with only stable VTs, 5 with only unstable VTs, and 15 with both VTs). Inducible VTs were abolished or modified in 100% of patients when the RF line included an isthmus compared with 53% when RF had to be guided by pace mapping (P=0.0002); those with an isthmus identified received shorter ablation lines (4.9±2.4 versus 7.4±4.3 cm total length, P=0.02). During follow-up, spontaneous VT decreased markedly regardless of whether an isthmus was identified. VT stability and number of morphologies did not influence outcome.
Conclusions—— A 4- to 5-cm line of RF lesions abolishes all inducible VTs in more than 50% of patients. Less ablation is required if a reentry circuit isthmus is identified even when multiple and unstable VTs are present.
Key Words: tachyarrhythmias • catheter ablation • lesion • mapping
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