Document Detail


Endocardial Ablation of Post-Infarction Ventricular Tachycardia With Non-Endocardial Exit Sites.
MedLine Citation:
PMID:  23416378     Owner:  NLM     Status:  Publisher    
Abstract/OtherAbstract:
BACKGROUND: Most infarct-related ventricular tachycardias (VTs) have an exit site that can be targeted by endocardial ablation. However, some VT reentry circuits have an exit site that is intramural or epicardial. Even these circuits may have an endocardial component that can be endocardially ablated. OBJECTIVE: The purpose of this study was to assess the prevalence of post-infarction VTs with a non-endocardial exit site that can be successfully eliminated by endocardial ablation. METHODS AND RESULTS: Twenty-eight consecutive patients with post-infarction VT (27 men, age=69±8 years, ejection fraction=0.25±0.15) were referred for VT ablation. A total of 213 VTs were inducible (cycle length 378±100 ms). Pace-mapping was performed throughout the scar and critical sites were identified for 137 VTs (64.5%). Critical sites identified by entrainment mapping and/or pace-mapping were divided into exit and non-exit sites depending on the stimulus-QRS/VT cycle length ratio (S-QRS/VT CL ≤0.3 vs. >0.3). Endocardial exit sites (S-QRS/VTCL ≤0.3) were identified for 100/137 VTs. Only critical non-exit sites were identified for 37/137 VTs (27%). Non-exit sites were confined to a smaller area within the endocardium (1.81±1.7 cm(2)) and were located within dense scar (0.28±0.24 mV) further away from the border zone (2.05±2.79 cm) than the VT exit sites. Exit sites had a larger area of matching pace-maps (3.86±1.9 cm(2); p<0.01) and were at a closer distance to the border zone (0.93±1.06 cm; p<0.01). A total of 133 of the 137 VTs were ablated. The success rate was similar for VTs in which exit sites were targeted (n=90/100) and VTs in which only non-exit sites were targeted (n=36/37); p=0.83. CONCLUSION: In about one third of post-infarction VTs for which critical sites were identified, the exit site was not endocardial. Critical non-exit sites that are effective for ablation are often within dense scar at a distance from the border zone and can be missed if only the border zone is targeted.
Authors:
Mohamad C Sinno; Miki Yokokawa; Eric Good; Hakan Oral; Frank Pelosi; Aman Chugh; Krit Jongnarangsin; Fred Morady; Bogun Frank
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Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2013-2-13
Journal Detail:
Title:  Heart rhythm : the official journal of the Heart Rhythm Society     Volume:  -     ISSN:  1556-3871     ISO Abbreviation:  Heart Rhythm     Publication Date:  2013 Feb 
Date Detail:
Created Date:  2013-2-18     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  101200317     Medline TA:  Heart Rhythm     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
Copyright Information:
Copyright © 2013. Published by Elsevier Inc.
Affiliation:
Division of Cardiology, University of Michigan Cardiovascular Center, Ann Arbor, Michigan.
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