Document Detail


Mechanical interruption of postinfarction ventricular tachycardia as a guide for catheter ablation.
MedLine Citation:
PMID:  15992721     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: Mechanical trauma has been described as a helpful guide for ablation of atrial tachycardias and accessory pathways. In postinfarction ventricular tachycardia (VT), the reentrant circuit is partly endocardial and therefore may be susceptible to catheter trauma. OBJECTIVES: The purpose of this study was to determine the prevalence and significance of VT termination resulting from catheter trauma. METHODS: A consecutive series of 39 patients (mean age 68 +/- 7 years, ejection fraction 0.25 +/- 0.02) underwent left ventricular mapping for postinfarction VT. Mapping was performed during 62 hemodynamically tolerated VTs (mean cycle length 451 +/- 88 ms). Only hemodynamically tolerated VTs that did not terminate spontaneously and VTs that were reproducibly inducible were included in the study. VT termination was considered mechanical only if it was not caused by a premature depolarization. RESULTS: In 13 of 62 VTs (21%) in 8 of 39 patients (21%), either VT terminated during catheter placement at a particular site (n = 7) or a previously reproducibly inducible VT became no longer inducible with the mapping catheter located at a particular site (n = 6). The stimulus-QRS interval was significantly shorter at sites where mechanical trauma affected the reentrant circuit compared with sites having concealed entrainment (102 +/- 56 ms vs 253 +/- 134 ms, P = .003). At the site that was susceptible to mechanical trauma, the pace map was identical or highly similar in 13 of 13 VTs. After radiofrequency ablation at these sites, the targeted VTs were no longer inducible. No patient had recurrence of the targeted VT during a mean follow-up of 15 +/- 11 months. CONCLUSIONS: Catheter contact at a critical endocardial site can interrupt postinfarction VT or prevent its induction. Radiofrequency ablation at sites of mechanical termination of VT has a high probability of success.
Authors:
Frank Bogun; Eric Good; Jihn Han; Kamala Tamirisa; Stephen Reich; Darryl Elmouchi; Petar Igic; Kristina Lemola; Hakan Oral; Aman Chugh; Frank Pelosi; Fred Morady
Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Heart rhythm : the official journal of the Heart Rhythm Society     Volume:  2     ISSN:  1547-5271     ISO Abbreviation:  Heart Rhythm     Publication Date:  2005 Jul 
Date Detail:
Created Date:  2005-07-04     Completed Date:  2005-10-27     Revised Date:  2009-10-27    
Medline Journal Info:
Nlm Unique ID:  101200317     Medline TA:  Heart Rhythm     Country:  United States    
Other Details:
Languages:  eng     Pagination:  687-91     Citation Subset:  IM    
Affiliation:
Division of Cardiology, University of Michigan Medical Center, Ann Arbor, Michigan 48109-0366, USA. fbogun@umich.edu
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MeSH Terms
Descriptor/Qualifier:
Aged
Catheter Ablation / methods*
Electrodes
Endocardium / physiopathology*
Female
Follow-Up Studies
Humans
Male
Middle Aged
Myocardial Infarction / complications*
Physical Stimulation
Prospective Studies
Tachycardia, Ventricular / etiology*,  physiopathology,  surgery*
Comments/Corrections
Comment In:
Heart Rhythm. 2005 Jul;2(7):692-3   [PMID:  15992722 ]

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


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