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MedLine Citation:
PMID:  24946895     Owner:  NLM     Status:  Publisher    
BACKGROUND: There is a paucity of data on biophysical parameters during radiofrequency ablation of scar-mediated ventricular tachycardia (VT).
METHODS AND RESULTS: Data was collected from consecutive patients undergoing VT ablation with open-irrigation. Complete data was available for 372 lesions in 21 patients. The frequency of biophysical parameter changes were: >10Ω reduction (80%), bipolar EGM reduction (69%), while loss of capture was uncommon (32%). Unipolar injury current was seen in 72% of radiofrequency applications. Both EGM reduction and impedance drop were seen in 57% and a change in all 3 parameters was seen in only 20% of lesions. Late potentials were eliminated in 33%, reduced/modified in 56%, and remained after ablation in 11%. Epicardial lesions exhibited an impedance drop (90% vs 76%, p = 0.002) and loss of capture (46% vs 27%, p<0.001) more frequently than endocardial lesions. Lesions delivered manually exhibited a >10Ω impedance drop (83% vs 71%, p = 0.02) and an EGM reduction (71% vs 40%, p< 0.001) more frequently than lesions applied using magnetic navigation, although loss of capture, elimination of LPs, and a change in all 3 parameters were similarly observed.
CONCLUSIONS: VT ablation is inefficient as the majority of radiofrequency lesions do not achieve more than one targeted biophysical parameter. Only one-third of RF applications targeted at LPs result in complete elimination. Epicardial ablation within scar may be more effective than endocardial lesions and lesions applied manually may be more effective than lesions applied using magnetic navigation. New technologies directed at identifying and optimizing ablation effectiveness in scar are clinically warranted. This article is protected by copyright. All rights reserved.
Tara Bourke; Eric Buch; Nilesh Mathuria; Yoav Michowitz; Ricky Yu; Ravi Mandapati; Kalyanam Shivkumar; Roderick Tung
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Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2014-6-20
Journal Detail:
Title:  Journal of cardiovascular electrophysiology     Volume:  -     ISSN:  1540-8167     ISO Abbreviation:  J. Cardiovasc. Electrophysiol.     Publication Date:  2014 Jun 
Date Detail:
Created Date:  2014-6-20     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  9010756     Medline TA:  J Cardiovasc Electrophysiol     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
Copyright Information:
This article is protected by copyright. All rights reserved.
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