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(Circulation. 1999;99:1300-1311.)
© 1999 American Heart Association, Inc.

Clinical Investigation and Reports

Clinical Application of an Integrated 3-Phase Mapping Technique for Localization of the Site of Origin of Idiopathic Ventricular Tachycardia

Heidi A. P. Peeters, MD; Arne SippensGroenewegen, MD; Eric F. D. Wever, MD; Hemanth Ramanna, MD; André C. Linnenbank, PhD; Mark Potse, MSc; Cornelis A. Grimbergen, PhD; Norbert M. van Hemel, MD; Richard N. W. Hauer, MD; Etienne O. Robles de Medina, MD

From the Department of Cardiology, Heart-Lung Institute, University Hospital Utrecht, Netherlands (H.A.P.P., A.S., E.F.D.W., H.R., R.N.W.H., E.O.R.d.M.); the Section of Cardiac Electrophysiology, Department of Medicine, and the Cardiovascular Research Institute, University of California, San Francisco (A.S.); the Department of Medical Physics, Academic Medical Center, Amsterdam, Netherlands (A.C.L., M.P., C.A.G.); and the Department of Cardiology, St Antonius Hospital, Nieuwegein, Netherlands (N.M.v.H.).

Correspondence to Heidi A.P. Peeters, MD, Department of Cardiology, Heart-Lung Institute, University Hospital Utrecht, Heidelberglaan 100, 3584 CX Utrecht, Netherlands.

Background—Radiofrequency (RF) catheter ablation provides curative treatment for idiopathic ventricular tachycardia (VT).

Methods and Results—Nineteen consecutive patients with an idiopathic VT underwent RF catheter ablation. An integrated 3-phase mapping approach was used, consisting of the successive application of online 62-lead body surface QRS integral mapping, directed regional paced body surface QRS integral mapping, and local activation sequence mapping. Mapping phase 1 was localization of the segment of VT origin by comparing the VT QRS integral map with a database of mean paced QRS integral maps. Mapping phase 2 was body surface pace mapping during sinus rhythm in the segment localized in phase 1 until the site at which the paced QRS integral map matched the VT QRS integral map was identified (ie, VT exit site). Mapping phase 3 was local activation sequence mapping at the circumscribed area identified in phase 2 to identify the site with the earliest local endocardial activation (ie, site of VT origin). This site became the ablation target. Ten VTs were ablated in the right ventricular outflow tract, 2 at the basal LV septum, and 7 at the midapical posterior left ventricle. A high long-term ablation success (mean follow-up duration, 14±9 months) was achieved in 17 of the 19 patients (89%) with a low number of RF pulses (mean, 3.3±2.2 pulses per patient).

Conclusions—This prospective study shows that integrated 3-phase mapping for localization of the site of origin of idiopathic VT offers efficient and accurate localization of the target site for RF catheter ablation.

Key Words: mapping • electrocardiography • tachycardia • cather ablation

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