Circulation, Vol 85, 1666-1674, Copyright © 1992 by American Heart Association
LS Klein, HT Shih, FK Hackett, DP Zipes and WM Miles
BACKGROUND. Radiofrequency energy has been used safely and successfully to
eliminate accessory pathways in patients with the Wolff-Parkinson- White
syndrome and the substrate for atrioventricular nodal reentrant
tachycardia. However, this form of ablation has had only limited success in
eliminating ventricular tachycardia in patients with structural heart
disease. In contrast, direct-current catheter ablation has been used
successfully to eliminate ventricular tachycardia in patients with and
without structural heart disease. The purpose of this study was to test
whether radiofrequency energy can safely and effectively ablate ventricular
tachycardia in patients without structural heart disease. METHODS AND
RESULTS. Sixteen patients (nine women and seven men; mean age, 38 years;
range, 18-55 years) without structural heart disease who had ventricular
tachycardia underwent radiofrequency catheter ablation to eliminate the
ventricular tachycardia. Two patients presented with syncope, nine with
presyncope, and five with palpitations only. Mean duration of symptoms was
6.7 years (range, 0.5-20 years). Radiofrequency catheter ablation
successfully eliminated ventricular tachycardia in 15 of 16 patients (94%).
Sites of ventricular tachycardia origin included the high right ventricular
outflow tract (12 patients), the right ventricular septum near the
tricuspid valve (three patients), and the left ventricular septum (one
patient). The only ablation failure was in a patient whose ventricular
tachycardia arose from a region near the His bundle. An accurate pace map,
early local endocardial activation, and firm catheter contact with
endocardium were associated with successful ablation. Radiofrequency
ablation did not cause arrhythmias, produced minimal cardiac enzyme rise,
and resulted in no detectable change in cardiac function by Doppler
echocardiography. CONCLUSIONS. Radiofrequency catheter ablation of
ventricular tachycardia in patients without structural heart disease is
effective and safe and may be considered as early therapy in these
patients.
ARTICLES
Radiofrequency catheter ablation of ventricular tachycardia in patients without structural heart disease
Krannert Institute of Cardiology, Department of Medicine, Indiana University School of Medicine, Indianapolis.
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