Circulation, Vol 57, 440-447, Copyright © 1978 by American Heart Association
ME Josephson, LN Horowitz, A Farshidi, JF Spear, JA Kastor and EN Moore
Endocardial ventricular mapping of 21 ventricular tachyardias (VT) in 17
patients was performed using electrode catheters. Activation at multiple
left and right ventricular sites was utilized to determine the site of
origin of the VT. Eleven VT had a left bundle branch block pattern
(VT-LBBB) and 10 VT had right bundle branch block pattern (VT- RBBB). In
all VT-RBBB the earliest site of activation was in the LV or septum. In
VT-LBBB the earliest site was RV (4/11), LV (5/11) and septum (2/11). All
ventricular tachycardias with QRS less than 140 msec arose in the septum.
In patients with an aneurysm, the site of origin of ventricular tachycardia
was always in the aneursm. All VT-LBBB arising from the left ventricle
originated in an aneurysm involving the septum. QRS changes during
ventricular tachycardia were associated with alterations in the patterm of
ventricular activation without alteration of the site of origin. In three
patients the site of origin predicted by endocardial ventricular mapping
was confirmed intraoperatively by epi- and/or endocardial mapping. We
conclude that endocardial ventricular mapping demonstrates the limitations
of the surface electrocardiogram in localizing the site of origin of
ventricular tachycardia. The method may provide important data upon which
the surgical therapy of ventricular tachycardia is based.
ARTICLES
Recurrent sustained ventricular tachycardia. 2. Endocardial mapping
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