Circulation. 2001;104:664-669
doi: 10.1161/hc3101.093764
doi: 10.1161/hc3101.093764
(Circulation. 2001;104:664.)
© 2001 American Heart Association, Inc.
Clinical Investigation and Reports |
Catheter Ablation in Patients With Multiple and Unstable Ventricular Tachycardias After Myocardial Infarction
Short Ablation Lines Guided by Reentry Circuit Isthmuses and Sinus Rhythm Mapping
From the Cardiovascular Division, Department of Internal Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Mass.
Correspondence to William G. Stevenson, MD, Cardiovascular Division, Brigham and Women’s Hospital, Harvard Medical School, 75 Francis St, Boston, MA 02115. E-mail wstevenson{at}rics.bwh.harvard.edu
Background—— Extensive lines of radiofrequency (RF) lesions through infarct (MI) can ablate multiple and unstable ventricular tachycardias (VTs). Methods for guiding ablation that minimize unnecessary RF applications are needed. This study assesses the feasibility of guiding RF line placement by mapping to identify a reentry circuit isthmus.
Methods and Results—— Catheter mapping and ablation were performed in 40 patients (MI location: inferior, 28; anterior, 7; and both, 5) with an electroanatomic mapping system to measure the infarct region and ablation lines. The initial line was placed in the MI region either through a circuit isthmus identified from entrainment mapping or a target identified from pace mapping. A total of 143 VTs (42 stable, 101 unstable) were induced. An isthmus was identified in 25 patients (63%; 5 with only stable VTs, 5 with only unstable VTs, and 15 with both VTs). Inducible VTs were abolished or modified in 100% of patients when the RF line included an isthmus compared with 53% when RF had to be guided by pace mapping (P=0.0002); those with an isthmus identified received shorter ablation lines (4.9±2.4 versus 7.4±4.3 cm total length, P=0.02). During follow-up, spontaneous VT decreased markedly regardless of whether an isthmus was identified. VT stability and number of morphologies did not influence outcome.
Conclusions—— A 4- to 5-cm line of RF lesions abolishes all inducible VTs in more than 50% of patients. Less ablation is required if a reentry circuit isthmus is identified even when multiple and unstable VTs are present.
Key Words: tachyarrhythmias • catheter ablation • lesion • mapping
This article has been cited by other articles:
 |
|
 |
|
  C. Carbucicchio, M. Santamaria, N. Trevisi, G. Maccabelli, F. Giraldi, G. Fassini, S. Riva, M. Moltrasio, M. Cireddu, F. Veglia, et al. Catheter Ablation for the Treatment of Electrical Storm in Patients With Implantable Cardioverter-Defibrillators: Short- and Long-Term Outcomes in a Prospective Single-Center Study Circulation, January 29, 2008; 117(4): 462 - 469. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 T. Dickfeld, P. Lei, V. Dilsizian, J. Jeudy, J. Dong, A. Voudouris, R. Peters, M. Saba, R. Shekhar, and S. Shorofsky Integration of Three-Dimensional Scar Maps for Ventricular Tachycardia Ablation With Positron Emission Tomography-Computed Tomography J. Am. Coll. Cardiol. Img., January 1, 2008; 1(1): 73 - 82. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 H. Ashikaga, T. Sasano, J. Dong, M. M. Zviman, R. Evers, B. Hopenfeld, V. Castro, R. H. Helm, T. Dickfeld, S. Nazarian, et al. Magnetic Resonance Based Anatomical Analysis of Scar-Related Ventricular Tachycardia: Implications for Catheter Ablation Circ. Res., October 26, 2007; 101(9): 939 - 947. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 S. H. Hohnloser and E. N. Prystowsky CRT-D use in heart failure: too little or too much? Eur. Heart J. Suppl., September 1, 2007; 9(suppl_G): G9 - G16. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
W. G. Stevenson and K. Soejima Catheter Ablation for Ventricular Tachycardia Circulation, May 29, 2007; 115(21): 2750 - 2760. [Full Text] [PDF]
|
|
|
|
|
|
A. Aryana, A. d'Avila, E. K. Heist, T. Mela, J. P. Singh, J. N. Ruskin, and V. Y. Reddy Remote Magnetic Navigation to Guide Endocardial and Epicardial Catheter Mapping of Scar-Related Ventricular Tachycardia Circulation, March 13, 2007; 115(10): 1191 - 1200. [Abstract] [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]
|
|
|
|
 |
|
 J. Zak Mapping Ventricular Tachycardia Crit. Care Nurse, October 1, 2006; 26(5): 13 - 20. [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]
|
|
|
|
|
|
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]
|
|
|
|
|
|
Developed in Collaboration With the American Colle, Endorsed by the Heart Rhythm Society, S. A. Hunt, W. T. Abraham, M. H. Chin, A. M. Feldman, G. S. Francis, T. G. Ganiats, M. Jessup, M. A. Konstam, et al. ACC/AHA 2005 Guideline Update for the Diagnosis and Management of Chronic Heart Failure in the Adult--Summary Article: A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Update the 2001 Guidelines for the Evaluation and Management of Heart Failure) J. Am. Coll. Cardiol., September 20, 2005; 46(6): 1116 - 1143. [Full Text] [PDF]
|
|
|
|
|
|
S. A. Hunt, W. T. Abraham, M. H. Chin, A. M. Feldman, G. S. Francis, T. G. Ganiats, M. Jessup, M. A. Konstam, D. M. Mancini, K. Michl, et al. ACC/AHA 2005 Guideline Update for the Diagnosis and Management of Chronic Heart Failure in the Adult--Summary Article: A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Update the 2001 Guidelines for the Evaluation and Management of Heart Failure): Developed in Collaboration With the American College of Chest Physicians and the International Society for Heart and Lung Transplantation: Endorsed by the Heart Rhythm Society Circulation, September 20, 2005; 112(12): 1825 - 1852. [Full Text] [PDF]
|
|
|
|
|
|
H. U. Klein and S. Reek "The Older the Broader": Electrogram Characteristics Help Identify the Critical Isthmus During Catheter Ablation of Postinfarct Ventricular Tachycardia J. Am. Coll. Cardiol., August 16, 2005; 46(4): 675 - 677. [Full Text] [PDF]
|
|
|
|
|
|
A. Verma, F. Kilicaslan, R. A. Schweikert, G. Tomassoni, A. Rossillo, N. F. Marrouche, V. Ozduran, O. M. Wazni, S. C. Elayi, L. C. Saenz, et al. Short- and Long-Term Success of Substrate-Based Mapping and Ablation of Ventricular Tachycardia in Arrhythmogenic Right Ventricular Dysplasia Circulation, June 21, 2005; 111(24): 3209 - 3216. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
V. Y. Reddy, Z. J. Malchano, G. Holmvang, E. J. Schmidt, A. d'Avila, C. Houghtaling, R. C. Chan, and J. N. Ruskin Integration of cardiac magnetic resonance imaging with three-dimensional electroanatomic mapping to guide left ventricular catheter manipulation: Feasibility in a porcine model of healed myocardial infarction J. Am. Coll. Cardiol., December 7, 2004; 44(11): 2202 - 2213. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
V. V. Patel, R. W. Rho, E. P. Gerstenfeld, H. H. Hsia, D. J. Callans, and F. E. Marchlinski Right Bundle-Branch Block Ventricular Tachycardias: Septal Versus Lateral Ventricular Origin Based on Activation Time to the Right Ventricular Apex Circulation, October 26, 2004; 110(17): 2582 - 2587. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
L. Szumowski, P. Sanders, F. Walczak, M. Hocini, P. Jais, R. Kepski, E. Szufladowicz, P. Urbanek, P. Derejko, R. Bodalski, et al. Mapping and ablation of polymorphic ventricular tachycardia after myocardial infarction J. Am. Coll. Cardiol., October 19, 2004; 44(8): 1700 - 1706. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
C. B. Brunckhorst, E. Delacretaz, K. Soejima, W. H. Maisel, P. L. Friedman, and W. G. Stevenson Identification of the Ventricular Tachycardia Isthmus After Infarction by Pace Mapping Circulation, August 10, 2004; 110(6): 652 - 659. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
K. Soejima, W. G. Stevenson, J. L. Sapp, A. P. Selwyn, G. Couper, and L. M. Epstein Endocardial and epicardial radiofrequency ablation of ventricular tachycardia associated with dilated cardiomyopathy: The importance of low-voltage scars J. Am. Coll. Cardiol., May 19, 2004; 43(10): 1834 - 1842. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
A. d'Avila, C. Houghtaling, P. Gutierrez, O. Vragovic, J. N. Ruskin, M. E. Josephson, and V. Y. Reddy Catheter Ablation of Ventricular Epicardial Tissue: A Comparison of Standard and Cooled-Tip Radiofrequency Energy Circulation, May 18, 2004; 109(19): 2363 - 2369. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
V. Y. Reddy, D. Wrobleski, C. Houghtaling, M. E. Josephson, and J. N. Ruskin Combined Epicardial and Endocardial Electroanatomic Mapping in a Porcine Model of Healed Myocardial Infarction Circulation, July 1, 2003; 107(25): 3236 - 3242. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
W. G. Stevenson and K. Soejima Inside or out? Another option for incessant ventricular tachycardia J. Am. Coll. Cardiol., June 4, 2003; 41(11): 2044 - 2045. [Full Text] [PDF]
|
|
|
|
|
|
E. P. Gerstenfeld, S. Dixit, D. J. Callans, Y. Rajawat, R. Rho, and F. E. Marchlinski Quantitative comparison of spontaneous and paced 12-lead electrocardiogram during right ventricular outflow tract ventricular tachycardia J. Am. Coll. Cardiol., June 4, 2003; 41(11): 2046 - 2053. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
F. Ouyang, M. Antz, F. T. Deger, D. Bansch, A. Schaumann, S. Ernst, and K.-H. Kuck An Underrecognized Subepicardial Reentrant Ventricular Tachycardia Attributable to Left Ventricular Aneurysm in Patients With Normal Coronary Arteriograms Circulation, June 3, 2003; 107(21): 2702 - 2709. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
C. B. Brunckhorst, W. G. Stevenson, K. Soejima, W. H. Maisel, E. Delacretaz, P. L. Friedman, and S. A. Ben-Haim Relationship of slow conduction detected by pace-mapping to ventricular tachycardia re-entry circuit sites after infarction J. Am. Coll. Cardiol., March 5, 2003; 41(5): 802 - 809. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 E. J. Ciaccio Premature excitation and onset of reentrant ventricular tachycardia Am J Physiol Heart Circ Physiol, October 1, 2002; 283(4): H1703 - H1712. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
K. Soejima, W. G. Stevenson, W. H. Maisel, J. L. Sapp, and L. M. Epstein Electrically Unexcitable Scar Mapping Based on Pacing Threshold for Identification of the Reentry Circuit Isthmus: Feasibility for Guiding Ventricular Tachycardia Ablation Circulation, September 24, 2002; 106(13): 1678 - 1683. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
K. Soejima and W. G. Stevenson Ventricular Tachycardia Associated With Myocardial Infarct Scar: A Spectrum of Therapies for a Single Patient Circulation, July 9, 2002; 106(2): 176 - 179. [Full Text] [PDF]
|
|
|
|
 |
|
 C.B. Brunckhorst, W.G. Stevenson, W.M. Jackman, K.-H. Kuck, K. Soejima, H. Nakagawa, R. Cappato, and S.A. Ben-Haim Ventricular mapping during atrial and ventricular pacing. Relationship of multipotential electrograms to ventricular tachycardia reentry circuits after myocardial infarction Eur. Heart J., July 2, 2002; 23(14): 1131 - 1138. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 P. A Friedman Novel mapping techniques for cardiac electrophysiology Heart, June 1, 2002; 87(6): 575 - 582. [Full Text] [PDF]
|
|
|
|
|
|
H. Kottkamp and G. Hindricks Catheter ablation of untolerated ventricular tachycardia--a new front line Eur. Heart J., May 1, 2002; 23(9): 697 - 699. [Full Text] [PDF]
|
|