Document Detail

Characteristics of electrograms recorded at reentry circuit sites and bystanders during ventricular tachycardia after myocardial infarction.
MedLine Citation:
PMID:  10440149     Owner:  NLM     Status:  MEDLINE    
OBJECTIVES: The purpose of this study was to determine the relation of isolated potentials (IPs) recorded during ventricular tachycardia (VT) to reentry circuit sites identified by entrainment. BACKGROUND: Reentry circuits causing VT late after myocardial infarction are complex. Both IPs and entrainment have been useful for identifying successful ablation sites, but the relation of IPs to the location in the reentry circuit as determined by entrainment has not been completely defined. METHODS: Data from catheter mapping of 70 monomorphic VTs in 36 patients with prior myocardial infarction were retrospectively analyzed. Entrainment followed by radiofrequency current (RF) ablation was performed at 384 sites. On the basis of entrainment, sites were classified as reentry circuit exit, central-proximal, inner or outer loop sites. Sites outside the circuit were divided into remote and adjacent bystanders. RESULTS: Isolated potentials were recorded at 50% (51 of 101) of reentry circuit exit, central and proximal sites as compared with only 8% (11 of 146, p < 0.001) of inner loop and outer loop sites and only 1.8% (2 of 106) of remote bystander sites (p < 0.001). Isolated potentials were also present at 45% of adjacent bystander sites. At central and proximal sites the presence of an IP increased the incidence of tachycardia termination by RF to 47.5% from 24% (p = 0.05). At exit sites tachycardia termination occurred frequently regardless of the presence or absence of IPs (45% vs. 48%, p = NS). Isolated potentials at exit, central and proximal sites had a shorter duration at sites where ablation terminated VT than at sites without termination (20.9 +/- 9.6 ms vs. 35.7 +/- 15.3 ms, p < 0.001). CONCLUSIONS: Isolated potentials are a useful guide to sites in the central-proximal region of the reentry circuit, but often fail to identify exit sites where ablation is successful. Entrainment and analysis of electrograms provide complementary information during mapping of VT.
D Z Kocovic; T Harada; P L Friedman; W G Stevenson
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Journal of the American College of Cardiology     Volume:  34     ISSN:  0735-1097     ISO Abbreviation:  J. Am. Coll. Cardiol.     Publication Date:  1999 Aug 
Date Detail:
Created Date:  1999-08-17     Completed Date:  1999-08-17     Revised Date:  2004-11-17    
Medline Journal Info:
Nlm Unique ID:  8301365     Medline TA:  J Am Coll Cardiol     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  381-8     Citation Subset:  AIM; IM    
Department of Medicine, Hospital of the University of Pennsylvania, Philadelphia 19104, USA.
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MeSH Terms
Catheter Ablation
Heart Conduction System / physiopathology
Myocardial Infarction / complications*
Retrospective Studies
Tachycardia, Ventricular / etiology,  physiopathology*,  therapy

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