Document Detail


Intra-coronary guidewire mapping-a novel technique to guide ablation of human ventricular tachycardia.
MedLine Citation:
PMID:  17464557     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
HYPOTHESIS: Endocardial catheter ablation of ventricular tachycardia (VT) may fail if originating from epicardial or intramural locations. We hypothesized that mapping could be achieved using an angioplasty guidewire in the coronary circulation, to guide trans-coronary ablation. METHODS AND RESULTS: Six patients (2 male), 64 +/- 14 years and previously unsuccessful endocardial VT ablation were studied. Using ECG and existing endocardial mapping data, a coronary artery supplying the predicted VT origin was selected. A 0.014-in angioplasty guidewire was advanced into branches of the artery and connected to an amplifier to record unipolar signals against an indifferent electrode within the inferior vena cava. An uninflated angioplasty balloon was advanced over the wire such that only the distal 5 mm was used for mapping. One VT per patient was mapped (CL 348 +/- 102.1 ms). Diastolic potentials were recorded from all (77.7 +/- 43.8 ms pre-QRS onset) and concealed entrainment demonstrated in 3. Pacemapping during sinus rhythm was used in the remainder due to failure of entrainment (n = 2) or degeneration to VF (n = 1). Following branch identification, cold saline injection causing VT termination was used for further confirmation. Five VTs were ablated using intra-coronary ethanol injection via the central lumen of the inflated over the wire balloon. The other was ablated using radiofrequency energy in a coronary vein adjacent to the target artery, which was too small for an angioplasty balloon. No complications or recurrence of ablated VT was seen over 19 +/- 17 months of follow up. CONCLUSIONS: Intracoronary guidewire mapping is a novel method of electrophysiological epicardial mapping to help guide trans-coronary VT ablation.
Authors:
Oliver R Segal; Tom Wong; Anthony W C Chow; Julian W E Jarman; Richard J Schilling; Vias Markides; Nicholas S Peters; D Wyn Davies
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Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't     Date:  2007-04-27
Journal Detail:
Title:  Journal of interventional cardiac electrophysiology : an international journal of arrhythmias and pacing     Volume:  18     ISSN:  1383-875X     ISO Abbreviation:  J Interv Card Electrophysiol     Publication Date:  2007 Mar 
Date Detail:
Created Date:  2007-05-28     Completed Date:  2007-10-16     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  9708966     Medline TA:  J Interv Card Electrophysiol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  143-54     Citation Subset:  IM    
Affiliation:
St. Mary's Hospital and Imperial College of Medicine, London, UK.
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MeSH Terms
Descriptor/Qualifier:
Adult
Aged
Angioplasty, Transluminal, Percutaneous Coronary / instrumentation*
Body Surface Potential Mapping
Catheterization*
Coronary Vessels
Electrophysiologic Techniques, Cardiac*
Ethanol / administration & dosage*
Female
Humans
Male
Middle Aged
Tachycardia, Ventricular / therapy*
Grant Support
ID/Acronym/Agency:
//Wellcome Trust
Chemical
Reg. No./Substance:
64-17-5/Ethanol

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


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