Document Detail

Septal involvement in patients with post-infarction ventricular tachycardia: implications for mapping and radiofrequency ablation.
MedLine Citation:
PMID:  22133849     Owner:  NLM     Status:  MEDLINE    
OBJECTIVES: The purpose of this study was to assess the prevalence of the re-entry circuit within the interventricular septum in post-infarction patients referred for ventricular tachycardia (VT) ablation.
BACKGROUND: Post-infarction ventricular tachycardia can involve the endocardial myocardium, the intramural myocardium, the epicardium, or the His Purkinje system.
METHODS: Among 74 consecutive patients with recurrent post-infarction VT, 33 patients (45%) were identified in whom the critical part of the VT involved the interventricular septum. A total of 206 VTs were induced in these 33 patients. In 46 of the 206 VTs, a critical component was identified in the interventricular septum. The critical isthmus of the re-entry circuit was identified by entrainment mapping, activation mapping, or pace-mapping.
RESULTS: In 32 of 46 VTs (70%), the critical component of the re-entry circuit was confined to the endocardium. In 9 of 46 VTs (20%), the critical component involved the Purkinje system, and in 5 of 46 VTs (11%), an intramural area was critical. Entrainment and/or pace-mapping helped to identify critical areas of endocardial VTs as well as VTs involving the Purkinje fibers, but neither of these mapping techniques localized intramural VTs. Electrocardiographic characteristics were specific for each of the septal locations. All VTs mapped to the interventricular septum were acutely successfully ablated. VTs recurred in 9 of 33 patients with septal VTs during a mean follow-up period of 40 ± 20 months.
CONCLUSIONS: Post-infarction VT involving the interventricular septum can involve the endocardial muscle, Purkinje fibers, or intramural muscle fibers. Electrocardiographic characteristics differ depending on the type of tissue involved.
Kentaro Yoshida; Miki Yokokawa; Benoit Desjardins; Eric Good; Hakan Oral; Aman Chugh; Frank Pelosi; Fred Morady; Frank Bogun
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Publication Detail:
Type:  Journal Article; Research Support, N.I.H., Extramural; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  Journal of the American College of Cardiology     Volume:  58     ISSN:  1558-3597     ISO Abbreviation:  J. Am. Coll. Cardiol.     Publication Date:  2011 Dec 
Date Detail:
Created Date:  2011-12-02     Completed Date:  2012-01-18     Revised Date:  2013-06-27    
Medline Journal Info:
Nlm Unique ID:  8301365     Medline TA:  J Am Coll Cardiol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  2491-500     Citation Subset:  AIM; IM    
Copyright Information:
Copyright © 2011 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.
University of Michigan Medical Center, Ann Arbor, MI 48109, USA.
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MeSH Terms
Catheter Ablation*
Electrophysiologic Techniques, Cardiac*
Endocardium / physiopathology
Heart Conduction System / physiopathology
Magnetic Resonance Imaging
Middle Aged
Myocardial Infarction / complications*
Purkinje Fibers / physiopathology
Tachycardia, Ventricular / etiology,  physiopathology,  surgery*
Ventricular Septum / physiopathology*
Grant Support

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