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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
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
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
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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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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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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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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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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. [Full Text] [PDF]
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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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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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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. [Full Text] [PDF]
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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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 P. A Friedman Novel mapping techniques for cardiac electrophysiology Heart, June 1, 2002; 87(6): 575 - 582. [Full Text] [PDF]
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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. [Full Text] [PDF]
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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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R.J. Schilling Can catheter ablation cure post-infarction ventricular tachycardia? Eur. Heart J., March 1, 2002; 23(5): 352 - 354. [Full Text] [PDF]
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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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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. [Abstract] [Full Text] [PDF]
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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. [Full Text]
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