Circulation, Vol 89, 1094-1102, Copyright © 1994 by American Heart Association
YH Kim, G Sosa-Suarez, TG Trouton, SS O'Nunain, S Osswald, BA McGovern, JN Ruskin and H Garan
BACKGROUND: Recurrent sustained ventricular tachycardia (VT) is not
responsive to antiarrhythmic drugs in the majority of patients, who
therefore need therapy with nonpharmacological methods. We evaluated
prospectively the feasibility, safety, and efficacy of transcatheter
radiofrequency (RF) ablation of VT in 21 selected patients with ischemic
heart disease and VT. METHODS AND RESULTS: Twenty-one patients with
ischemic heart disease and recurrent, drug-refractory VT documented by
12-lead ECG were selected who had sufficient hemodynamic tolerance of VT to
undergo transcatheter mapping. Documented clinical VT was reproduced by
programmed cardiac stimulation (PCS), and the site of origin was localized
by a combination of techniques, including pace mapping, activation-sequence
mapping, recordings of middiastolic potentials, and application of
resetting and entrainment principles. RF current at 55 V was applied (3.8
+/- 3.1 applications per patient) for as long as 30 seconds at a time to
target sites. Twenty-four distinct clinical VTs (mean cycle length, 445 +/-
52 milliseconds) were mapped and ablated in 21 patients. In 17 of 21
patients (81%), the procedure was acutely successful, and the target
clinical VT could no longer be induced by PCS after the procedure, whereas
in 4 patients, clinical VT remained inducible. By contrast, VTs with
shorter cycle length and different QRS morphology than the ablated VT could
still be induced by PCS in 12 of 21 patients. One patient died in
intractable congestive heart failure 10 days after the procedure, and the
remaining 20 are alive at the end of the follow-up period. The majority of
the patients continued to be treated with at least one additional mode of
antiarrhythmic therapy; 12 patients were still taking antiarrhythmic drugs,
and 9 patients received an implantable cardioverter/defibrillator. During a
mean follow-up period of 13.2 +/- 5.0 months, 9 of 20 patients (45%) had
recurrent VT. In 4 patients, the recurrent VT was different than the
previously ablated one. Clinical VT recurred in all 4 patients in whom RF
ablation had been acutely unsuccessful. Four patients with recurrent VT
underwent repeat RF ablation procedures that were acutely successful and
had no further recurrence. CONCLUSION: Transcatheter RF ablation is
feasible but has only moderately high efficacy in a small, selected group
of patients with ischemic heart disease and drug-refractory, highly
frequent, hemodynamically tolerated, sustained VT. In the majority of the
patients, this treatment technique is palliative rather than definitive,
and many of the patients continue to require other methods of
antiarrhythmic therapy.
ARTICLES
Treatment of ventricular tachycardia by transcatheter radiofrequency ablation in patients with ischemic heart disease
Cardiac Unit, Massachusetts General Hospital, Harvard Medical School, Boston 02114.
This article has been cited by other articles:
 |
|
 |
|
  K.-H. Kuck Should Catheter Ablation be the Preferred Therapy for Reducing ICD Shocks?: Ventricular Tachycardia in Patients With an Implantable Defibrillator Warrants Catheter Ablation Circ Arrhythm Electrophysiol, December 1, 2009; 2(6): 713 - 720. [Full Text] [PDF]
|
|
|
|
 |
|
 E. M. Aliot, W. G. Stevenson, J. M. Almendral-Garrote, F. Bogun, C. H. Calkins, E. Delacretaz, P. D. Bella, G. Hindricks, P. Jais, M. E. Josephson, et al. EHRA/HRS Expert Consensus on Catheter Ablation of Ventricular Arrhythmias: Developed in a partnership with the European Heart Rhythm Association (EHRA), a Registered Branch of the European Society of Cardiology (ESC), and the Heart Rhythm Society (HRS); in collaboration with the American College of Cardiology (ACC) and the American Heart Association (AHA) Europace, June 1, 2009; 11(6): 771 - 817. [Full Text] [PDF]
|
|
|
|
|
|
G. Sivagangabalan, J. Pouliopoulos, K. Huang, J. Lu, M. A. Barry, A. Thiagalingam, D. L. Ross, S. P. Thomas, and P. Kovoor Comparison of Electroanatomic Contact and Noncontact Mapping of Ventricular Scar in a Postinfarct Ovine Model With Intramural Needle Electrode Recording and Histological Validation Circ Arrhythm Electrophysiol, December 1, 2008; 1(5): 363 - 369. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 J. Almendral and M. E. Josephson All Patients With Hemodynamically Tolerated Postinfarction Ventricular Tachycardia Do Not Require an Implantable Cardioverter-Defibrillator Circulation, September 4, 2007; 116(10): 1204 - 1212. [Full Text] [PDF]
|
|
|
|
|
|
M. Volkmer, F. Ouyang, F. Deger, S. Ernst, M. Goya, D. Bansch, K. Berodt, K.-H. Kuck, and M. Antz Substrate mapping vs. tachycardia mapping using CARTO in patients with coronary artery disease and ventricular tachycardia: impact on outcome of catheter ablation. Europace, November 1, 2006; 8(11): 968 - 976. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 Developed in Collaboration With the European Heart, D. P. Zipes, A. J. Camm, M. Borggrefe, A. E. Buxton, B. Chaitman, M. Fromer, G. Gregoratos, G. Klein, A. J. Moss, et al. ACC/AHA/ESC 2006 Guidelines for Management of Patients With Ventricular Arrhythmias and the Prevention of Sudden Cardiac Death--Executive Summary: A Report of the American College of Cardiology/American Heart Association Task Force and the European Society of Cardiology Committee for Practice Guidelines (Writing Committee to Develop Guidelines for Management of Patients With Ventricular Arrhythmias and the Prevention of Sudden Cardiac Death) J. Am. Coll. Cardiol., September 5, 2006; 48(5): 1064 - 1108. [Full Text] [PDF]
|
|
|
|
|
|
Developed in Collaboration With the European Heart, D. P. Zipes, A. J. Camm, M. Borggrefe, A. E. Buxton, B. Chaitman, M. Fromer, G. Gregoratos, G. Klein, A. J. Moss, et al. ACC/AHA/ESC 2006 Guidelines for Management of Patients With Ventricular Arrhythmias and the Prevention of Sudden Cardiac Death: A Report of the American College of Cardiology/American Heart Association Task Force and the European Society of Cardiology Committee for Practice Guidelines (Writing Committee to Develop Guidelines for Management of Patients With Ventricular Arrhythmias and the Prevention of Sudden Cardiac Death) J. Am. Coll. Cardiol., September 5, 2006; 48(5): e247 - e346. [Full Text] [PDF]
|
|
|
|
 |
|
 D. P. Zipes, D. P. Zipes, A. J. Camm, M. Borggrefe, A. E. Buxton, B. Chaitman, M. Fromer, G. Gregoratos, G. Klein, A. J. Moss, et al. ACC/AHA/ESC 2006 guidelines for management of patients with ventricular arrhythmias and the prevention of sudden cardiac death--executive summary: A report of the American College of Cardiology/American Heart Association Task Force and the European Society of Cardiology Committee for Practice Guidelines (Writing Committee to Develop Guidelines for Management of Patients with Ventricular Arrhythmias and the Prevention of Sudden Cardiac Death) Developed in collaboration with the European Heart Rhythm Association and the Heart Rhythm Society. Eur. Heart J., September 1, 2006; 27(17): 2099 - 2140. [Full Text] [PDF]
|
|
|
|
|
|
Writing Committee Members, D. P. Zipes, A. J. Camm, M. Borggrefe, A. E. Buxton, B. Chaitman, M. Fromer, G. Gregoratos, G. Klein, A. J. Moss, et al. ACC/AHA/ESC 2006 guidelines for management of patients with ventricular arrhythmias and the prevention of sudden cardiac death: A report of the American College of Cardiology/American Heart Association Task Force and the European Society of Cardiology Committee for Practice Guidelines (Writing Committee to Develop Guidelines for Management of Patients With Ventricular Arrhythmias and the Prevention of Sudden Cardiac Death) Developed in collaboration with the European Heart Rhythm Association and the Heart Rhythm Society Europace, September 1, 2006; 8(9): 746 - 837. [Full Text] [PDF]
|
|
|
|
|
|
P. Della Bella, S. Riva, G. Fassini, F. Giraldi, M. Berti, C. Klersy, and N. Trevisi Incidence and significance of pleomorphism in patients with postmyocardial infarction ventricular tachycardia: Acute and long-term outcome of radiofrequency catheter ablation Eur. Heart J., July 1, 2004; 25(13): 1127 - 1138. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
V. Y. Reddy, P. Neuzil, M. Taborsky, and J. N. Ruskin Short-term results of substrate mapping and radiofrequency ablation of ischemic ventricular tachycardia using a saline-irrigated catheter J. Am. Coll. Cardiol., June 18, 2003; 41(12): 2228 - 2236. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
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]
|
|
|
|
|
|
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]
|
|
|
|
|
|
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]
|
|
|
|
|
|
P. Della Bella, R. De Ponti, J.A.S. Uriarte, C. Tondo, C. Klersy, C. Carbucicchio, C. Storti, S. Riva, and M. Longobardi Catheter ablation and antiarrhythmic drugs for haemodynamically tolerated post-infarction ventricular tachycardia. Long-term outcome in relation to acute electrophysiological findings Eur. Heart J., March 1, 2002; 23(5): 414 - 424. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 S Furniss, R Anil-Kumar, J P Bourke, R Behulova, and E Simeonidou Radiofrequency ablation of haemodynamically unstable ventricular tachycardia after myocardial infarction Heart, December 1, 2000; 84(6): 648 - 652. [Abstract] [Full Text]
|
|
|
|
|
|
H. Calkins, A. Epstein, D. Packer, A. M. Arria, J. Hummel, D. M. Gilligan, J. Trusso, M. Carlson, R. Luceri, H. Kopelman, et al. Catheter ablation of ventricular tachycardia in patients with structural heart disease using cooled radiofrequency energy: Results of a prospective multicenter study J. Am. Coll. Cardiol., June 1, 2000; 35(7): 1905 - 1914. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
E. Sosa, M. Scanavacca, A. d'Avila, F. Oliveira, and J. A. F. Ramires Nonsurgical transthoracic epicardial catheter ablation to treat recurrent ventricular tachycardia occurring late after myocardial infarction J. Am. Coll. Cardiol., May 1, 2000; 35(6): 1442 - 1449. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M. E. Josephson Epicardial approach to the ablation of ventricular tachycardia in coronary artery disease: an alternative or ancillary approach J. Am. Coll. Cardiol., May 1, 2000; 35(6): 1450 - 1452. [Full Text] [PDF]
|
|
|
|
|
|
S. A. Strickberger, B. P. Knight, G. F. Michaud, F. Pelosi, and F. Morady Mapping and ablation of ventricular tachycardia guided by virtual electrograms using a noncontact, computerized mapping system J. Am. Coll. Cardiol., February 1, 2000; 35(2): 414 - 421. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
A. El-Shalakany, T. Hadjis, P. Papageorgiou, K. Monahan, L. Epstein, and M. E. Josephson Entrainment/Mapping Criteria for the Prediction of Termination of Ventricular Tachycardia by Single Radiofrequency Lesion in Patients With Coronary Artery Disease Circulation, May 4, 1999; 99(17): 2283 - 2289. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
D. L. Ware, P. Boor, C. Yang, A. Gowda, J. J. Grady, and M. Motamedi Slow Intramural Heating With Diffused Laser Light : A Unique Method for Deep Myocardial Coagulation Circulation, March 30, 1999; 99(12): 1630 - 1636. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 F. Morady Radio-Frequency Ablation as Treatment for Cardiac Arrhythmias N. Engl. J. Med., February 18, 1999; 340(7): 534 - 544. [Full Text] [PDF]
|
|
|
|
|
|
H. H. Petersen, X. Chen, A. Pietersen, J. H. Svendsen, and S. Haunso Lesion Dimensions During Temperature-Controlled Radiofrequency Catheter Ablation of Left Ventricular Porcine Myocardium : Impact of Ablation Site, Electrode Size, and Convective Cooling Circulation, January 19, 1999; 99(2): 319 - 325. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
K. Ellison, P. Friedman, L. Ganz, and W. Stevenson Entrainment mapping and radiofrequency catheter ablation of ventricular tachycardia in right ventricular dysplasia J. Am. Coll. Cardiol., September 1, 1998; 32(3): 724 - 728. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
W. G. Stevenson, P. L. Friedman, D. Kocovic, P. T. Sager, L. A. Saxon, and B. Pavri Radiofrequency Catheter Ablation of Ventricular Tachycardia After Myocardial Infarction Circulation, July 28, 1998; 98(4): 308 - 314. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
S. A. Rothman, H. H. Hsia, S. F. Cossu, I. L. Chmielewski, A. E. Buxton, and J. M. Miller Radiofrequency Catheter Ablation of Postinfarction Ventricular Tachycardia : Long-term Success and the Significance of Inducible Nonclinical Arrhythmias Circulation, November 18, 1997; 96(10): 3499 - 3508. [Abstract] [Full Text]
|
|
|
|
|
|
J. M. Ormaetxe, J. Almendral, J. D. Martinez-Alday, J. P. Villacastin, A. Arenal, A. Pastor, T. Echeverria, and J. L. Delcan Analysis of the Degree of QRS Fusion Necessary for Its Visual Detection : Importance for the Recognition of Transient Entrainment Circulation, November 18, 1997; 96(10): 3509 - 3516. [Abstract] [Full Text]
|
|
|
|
|
|
C. Costeas, N. S. Peters, B. Waldecker, E. J. Ciaccio, A. L. Wit, and J. Coromilas Mechanisms Causing Sustained Ventricular Tachycardia With Multiple QRS Morphologies : Results of Mapping Studies in the Infarcted Canine Heart Circulation, November 18, 1997; 96(10): 3721 - 3731. [Abstract] [Full Text]
|
|
|
|
|
|
M. Eldar, D. G. Ohad, J. J. Goldberger, Z. Rotstein, S. Hsu, D. K. Swanson, and A. J. Greenspon Transcutaneous Multielectrode Basket Catheter for Endocardial Mapping and Ablation of Ventricular Tachycardia in the Pig Circulation, October 7, 1997; 96(7): 2430 - 2437. [Abstract] [Full Text]
|
|
|
|
|
|
W. G. Stevenson, P. L. Friedman, and M. O. Sweeney Catheter Ablation as an Adjunct to ICD Therapy Circulation, September 2, 1997; 96(5): 1378 - 1380. [Full Text]
|
|
|
|
|
|
S. A. Strickberger, K. C. Man, E. G. Daoud, R. Goyal, K. Brinkman, C. Hasse, F. Bogun, B. P. Knight, R. Weiss, M. Bahu, et al. A Prospective Evaluation of Catheter Ablation of Ventricular Tachycardia as Adjuvant Therapy in Patients With Coronary Artery Disease and an Implantable Cardioverter-Defibrillator Circulation, September 2, 1997; 96(5): 1525 - 1531. [Abstract] [Full Text]
|
|
|
|
|
|
H. Kottkamp, G. Hindricks, E. Horst, T. Baal, C. Fechtrup, G. Breithardt, and M. Borggrefe Subendocardial and Intramural Temperature Response During Radiofrequency Catheter Ablation in Chronic Myocardial Infarction and Normal Myocardium Circulation, April 15, 1997; 95(8): 2155 - 2161. [Abstract] [Full Text]
|
|
|
|
|
|
F. Bogun, M. Bahu, B. P. Knight, R. Weiss, W. Paladino, M. Harvey, R. Goyal, E. Daoud, K. C. Man, S. A. Strickberger, et al. Comparison of Effective and Ineffective Target Sites That Demonstrate Concealed Entrainment in Patients With Coronary Artery Disease Undergoing Radiofrequency Ablation of Ventricular Tachycardia Circulation, January 7, 1997; 95(1): 183 - 190. [Abstract] [Full Text]
|
|
|
|
|
|
G. J. Fahy, E. B. Sgarbossa, P. J. Tchou, and S. L. Pinski Hospital Readmission in Patients Treated With Tiered-Therapy Implantable Defibrillators Circulation, September 15, 1996; 94(6): 1350 - 1356. [Abstract] [Full Text]
|
|
|
|
|
|
D. J. Wilber, D. E. Kopp, D. N. Glascock DO, C. A. Kinder, and J. G. Kall Catheter Ablation of the Mitral Isthmus for Ventricular Tachycardia Associated With Inferior Infarction Circulation, December 15, 1995; 92(12): 3481 - 3489. [Abstract] [Full Text]
|
|
|
|
|
|
H. Kottkamp, G. Hindricks, X. Chen, J. Brunn, S. Willems, W. Haverkamp, M. Block, G. Breithardt, and M. Borggrefe Radiofrequency Catheter Ablation of Sustained Ventricular Tachycardia in Idiopathic Dilated Cardiomyopathy Circulation, September 1, 1995; 92(5): 1159 - 1168. [Abstract] [Full Text]
|
|
|
|
|
|
H. Nakagawa, W. S. Yamanashi, J. V. Pitha, M. Arruda, X. Wang, K. Ohtomo, K. J. Beckman, J. H. McClelland, R. Lazzara, and W. M. Jackman Comparison of In Vivo Tissue Temperature Profile and Lesion Geometry for Radiofrequency Ablation With a Saline-Irrigated Electrode Versus Temperature Control in a Canine Thigh Muscle Preparation Circulation, April 15, 1995; 91(8): 2264 - 2273. [Abstract] [Full Text]
|
|
|
|
 |
|
 J. McMurray and A. Rankin Recent Advances: Cardiology II: Treatment of heart failure and atrial fibrillation and arrhythmias BMJ, December 17, 1994; 309(6969): 1631 - 1635. [Full Text]
|
|