Circulation, Vol 75, 1037-1049, Copyright © 1987 by American Heart Association
F Morady, MM Scheinman, LA Di Carlo Jr, JC Davis, JM Herre, JC Griffin, SA Winston, M de Buitleir, CB Hantler and JA Wahr
Catheter electrical ablation of ventricular tachycardia (VT) was attempted
in 33 patients who had recurrent unimorphic VT refractory to 3.7 +/- 1.2
(mean +/- SD) antiarrhythmic drugs. Their mean age was 56 +/- 14 years.
Twenty-two patients had coronary artery disease, six had other types of
heart disease, and five had no structural heart disease. The mean left
ventricular ejection fraction was 0.34 +/- 0.17. Thirty patients had only
one documented morphologic type of spontaneous VT, whereas three patients
had more than one. One to four shocks of 100 to 300 J each were delivered
to the endocardial exit site of VT, as identified by endocardial activation
mapping and pace-mapping. In each patient endocardial activation at the
exit site of VT preceded the onset of the QRS complex (mean activation time
-50 +/- 30 msec). Pace- mapping was possible in 26 patients, and in all but
two patients the QRS complexes during VT and during pacing at the exit site
of VT were very similar in at least 10 of 12 electrocardiographic leads. In
29 patients, shocks were delivered between an endocardial electrode
(cathode) and a patch electrode on the chest wall (anode). Seven patients
(including three who first received shocks using an external anode) whose
VT originated in the septum received transseptal shocks between two
electrodes positioned on either side of the septum. The procedure was
successful in 15 patients (45%), who had no recurrence of VT either on no
antiarrhythmic therapy or on the same regimen that was ineffective before
ablation, over a follow-up period of 15.5 +/- 10 months (range 5 to 35).
The ablation attempt was unsuccessful in 18 patients (55%). There were no
significant differences in clinical and electrophysiologic variables
between patients with and without a successful outcome. Seven nonfatal
complications occurred in six patients: sustained nonclinical VT
immediately after the shock, ventricular fibrillation on days 5 and 6 after
ablation, neurologic deficits (n = 2), atrioventricular block (n = 2), and
brachial artery thrombosis. In conclusion, catheter electrical ablation of
VT has modest efficacy and is relatively safe in a selected group of
patients who have predominantly one configuration of unimorphic VT.
ARTICLES
Catheter ablation of ventricular tachycardia with intracardiac shocks: results in 33 patients
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