Circulation, Vol 77, 806-814, Copyright © 1988 by American Heart Association
DM Fitzgerald, KJ Friday, JA Wah, R Lazzara and WM Jackman
Ventricular tachycardia in patients with remote myocardial infarction is
thought to be due to reentry. To improve the efficacy of catheter ablation,
we sought to identify electrograms identifying essential components of the
reentrant circuit. In this study we compared the efficacy of shocks
delivered at sites of early ventricular activation during tachycardia
(presumably exit sites from the reentrant circuit) with that of shocks
delivered at sites recording mid-diastolic potentials that were not
continuous with the main ventricular potential recorded during the QRS
complex, but that always remained associated with the tachycardia during
initiation, termination, and resetting with extrastimuli (presumably
activation of a segment of the slowly conducting region of the reentrant
circuit). A total of 20 attempts was made to ablate 14 monomorphic
ventricular tachycardias in 10 patients with remote myocardial infarction
with use of one to five shocks of 50 to 370 J (200 J in 70%). All seven
tachycardias in which isolated mid- diastolic potentials were targeted were
successfully ablated, although one required a second attempt. Twelve
attempts were made to ablate seven tachycardias by delivering shocks at
sites of early activation during tachycardia when mid-diastolic potentials
were not identified. Only three attempts (25%) were successful. Activation
preceded the QRS complex by 60, 85, and 120 msec in the three successful
attempts and by 20 to 110 msec (median 55 msec) in the nine unsuccessful
attempts. For the total 20 attempts, there was no significant difference
between successful and nonsuccessful ablation in the number of shocks or
total energy delivered.(ABSTRACT TRUNCATED AT 250 WORDS)
ARTICLES
Electrogram patterns predicting successful catheter ablation of ventricular tachycardia
Department of Medicine, University of Oklahoma Health Sciences Center, OK 73190.
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