Circulation, Vol 89, 1690-1696, Copyright © 1994 by American Heart Association
MS Wen, SJ Yeh, CC Wang, FC Lin, IC Chen and D Wu
BACKGROUND: The feasibility and efficacy of radiofrequency ablation therapy
in idiopathic left ventricular tachycardia has not been assessed in a large
group of patients. METHODS AND RESULTS: Twenty consecutive patients with
idiopathic left ventricular tachycardia and without structural heart
disease underwent electrophysiological study, pharmacological interventions
with administration of verapamil and adenosine, and radiofrequency ablation
therapy. There were 17 men and 3 women with a mean age of 28 +/- 8 years.
The QRS configuration during tachycardia was of right bundle branch block
and superior axis in 13 patients, indeterminate axis in 6 patients, and
right axis in 1 patient. The tachycardia was electrically inducible and
responsive to verapamil but not to adenosine. Thirteen patients
demonstrated entrainment. Activation and pace-mapping studies disclosed
that the tachycardia originated from the inferior apical septum in 15
patients, the midseptum in 4 patients, and the anterior lateral wall of the
left ventricle in 1 patient. Radiofrequency ablation was successful in 17
of the 20 patients (85%). The successful ablation sites were characterized
by an endocardial activation time 30 milliseconds earlier than the onset of
QRS during tachycardia and by a pace-mapping QRS similar to or closely
resembling the tachycardia. All patients displayed sharp spikes preceding
the local ventricular electrogram at the ablation site. However, these
sharp spikes also were noted in 15 control patients and were not specific
for this tachycardia; they persisted after ablation. There were no
complications. A follow-up of 7 +/- 8 months in the 17 successfully ablated
patients showed no symptomatic tachyarrhythmias without medications. Six
patients underwent repeat electrophysiological study, and no induction of
tachycardia was revealed. CONCLUSIONS: Radiofrequency ablation therapy is
effective and safe in patients with idiopathic left ventricular
tachycardia. It should be considered as the primary therapeutic modality in
these patients.
ARTICLES
Radiofrequency ablation therapy in idiopathic left ventricular tachycardia with no obvious structural heart disease
Department of Medicine, Chang Gung Memorial Hospital, Chang Gung Medical College, Taipei, Taiwan.
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