Document Detail


Catheter ablation of idiopathic left ventricular tachycardia.
MedLine Citation:
PMID:  7659579     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
Idiopathic left ventricular tachycardia (ILVT) characterized by right bundle branch block, left axis morphology, response to verapamil and inducibility from the atrium in patients without structural heart disease may represent a distinct clinical entity. We report our experience with catheter ablation of this uncommon arrhythmia using radiofrequency energy (RF) and/or direct current (DC) shocks. Six men and 2 women, aged 16-50 years (mean +/- SD, 32 +/- 13), had recurrent VT for 16 +/- 16 years with a mean frequency of 4 +/- 3 episodes/year. Three patients had syncope during VT. None had identifiable structural heart disease. Catheter ablation was guided by earliest endocardial activation, presence of a high frequency presystolic potential and/or pacemapping of the left ventricle. The left ventricle was accessed via a retrograde aortic approach in 6 patients, a transeptal approach in 1 patient, and a combined approach in the remaining patient. All patients had inducible right bundle branch block morphology, left axis VT with a mean cycle length (CL) of 361 +/- 61 ms. A presystolic potential preceding ventricular activation and the His potential during VT was identified in 4 patients. All ablation sites were identified in a relatively uniform location, in the inferoapical left ventricle. Noninducibility of VT was obtained with RF in 3 patients and with DC in 5 patients. In 1 patient, DC delivery after unsuccessful RF prevented further inducibility. Similarly, RF was successful in 1 patient in whom an initial DC attempt was ineffective. Mean total procedure time was 282 +/- 51 minutes and mean total fluoroscopy time was 40 +/- 15 minutes. There were no complications. One patient treated with DC shock had recurrence of VT during treadmill test the day after ablation and refused repeat ablation. During a mean follow-up of 17 +/- 13 months, no VT recurrences or other cardiovascular events occurred. In conclusion, catheter ablation in the inferoapical left ventricle is an effective treatment for this type of ILVT. RF energy can be safely complemented by low energy DC shocks when the former is ineffective.
Authors:
M Zardini; R K Thakur; G J Klein; R Yee
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Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  Pacing and clinical electrophysiology : PACE     Volume:  18     ISSN:  0147-8389     ISO Abbreviation:  Pacing Clin Electrophysiol     Publication Date:  1995 Jun 
Date Detail:
Created Date:  1995-10-02     Completed Date:  1995-10-02     Revised Date:  2006-11-15    
Medline Journal Info:
Nlm Unique ID:  7803944     Medline TA:  Pacing Clin Electrophysiol     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  1255-65     Citation Subset:  IM    
Affiliation:
Arrhythmia Service, University Hospital, London, Ontario, Canada.
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MeSH Terms
Descriptor/Qualifier:
Adult
Bundle-Branch Block / diagnosis,  physiopathology,  surgery
Cardiac Pacing, Artificial
Catheter Ablation*
Electric Countershock
Electrocardiography
Female
Follow-Up Studies
Heart Conduction System / physiopathology,  surgery*
Humans
Male
Tachycardia, Ventricular / diagnosis,  physiopathology,  surgery*
Time Factors
Ventricular Function, Left / physiology

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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