Published Online
on December 31, 2001

A more recent version of this article appeared on February 12, 2002

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Submitted on August 14, 2001
Revised on November 27, 2001
Accepted on December 14, 2001

Isthmus Characteristics of Reentrant Ventricular Tachycardia After Myocardial Infarction

Christian de Chillou MD, PhD^*, Dominique Lacroix MD, Didier Klug MD, Isabelle Magnin-Poull MD, Christelle Marquié MD, Marc Messier PhD, Marius Andronache MD, Claude Kouakam MD, Nicolas Sadoul MD, Jian Chen MD, Etienne Aliot MD, and Salem Kacet MD

From the Department of Cardiology (C.d.C., I.M.-P., M.M., M.A., N.S., J.C., E.A.), University Hospital Nancy, Nancy, France, and the Department of Cardiology (D.L., D.K., C.M., C.K., S.K.), University Hospital Lille, Lille, France.

^* To whom correspondence should be addressed. E-mail: c.dechillou{at}chu-nancy.fr.

Background—The reentrant mechanism of postinfarct ventricular tachycardia (VT) has been documented by surgical mapping analysis, but little is known about postinfarct VT circuits and the characteristics of their related protected isthmus with the use of 3D catheter mapping systems.

Methods and Results—A 3D electroanatomic mapping was performed in 21 patients with well-tolerated, postinfarct, sustained VT. In total, 33 episodes of tachycardia (mean cycle length 432±74 ms) were induced and mapped. Complete maps demonstrated macroreentrant circuits with 1 loop (n=8) or 2 loops (n=25) rotating around a protected isthmus bounded by 2 approximately parallel conduction barriers that consisted of a line of double potentials, a scar area, or the mitral annulus. A total of 26 critical isthmi were identified for the 33 VTs mapped, with the same isthmus being shared by 2 to 4 different tachycardic morphologies in 5 patients. On average, isthmi were 31±7 mm long (ranging from 18 to 41 mm) and 16±8 mm wide (ranging from 6 to 36 mm) and harbored diastolic electrograms. The isthmus axis was oriented parallel to the mitral annulus plane in perimitral circuits and perpendicular to the mitral annulus plane in all other circuits. Linear radiofrequency ablation performed across the most accessible part of the isthmus prevented the recurrence of tachycardia in 19 patients (90%) with a follow-up at 16±8 months.

Conclusions—Detailed 3D electroanatomic mapping is helpful in reconstructing postinfarct VT circuits and in defining the characteristics of their related protected isthmi. The wide range of isthmus width values supports the need of linear radiofrequency lesions to eliminate the reentrant substrate of postinfarct VTs.

Key words: catheter ablation • mapping • myocardial infarction • tachycardia

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