Document Detail


Short-term results of substrate mapping and radiofrequency ablation of ischemic ventricular tachycardia using a saline-irrigated catheter.
MedLine Citation:
PMID:  12821253     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVES: We evaluated the safety and acute procedural efficacy of a combined electrophysiologic and anatomic approach to ablation of all inducible ventricular tachycardias (VT) during sinus rhythm using an irrigated radiofrequency (RF) ablation catheter. BACKGROUND: Ventricular tachycardia associated with chronic myocardial infarction (MI) is frequently hemodynamically intolerable and associated with multiple electrocardiographic morphologies. Because traditional mapping techniques are contingent on hemodynamic stability for adequate VT mapping, VT ablation therapy for many patients has been disappointing. METHODS: High-density electroanatomic mapping was performed during either sinus rhythm in 11 consecutive patients with a history of MI and ventricular arrhythmias. The RF ablation was performed using an irrigated-tip ablation catheter. All inducible VTs were targeted for catheter ablation during sinus rhythm. RESULTS: The RF ablation lesions were placed in a linear fashion traversing the border zones of infarcted and normal tissue (mean of 3.4 linear lesions/patient). With this strategy, the target VT was eliminated in 9 of 11 patients (82%). Furthermore, when targeting all inducible monomorphic VTs, complete procedural success was achieved in 7 of 11 patients (64%). During the follow-up period (mean 13.1 +/- 1.9 weeks), spontaneous VT was only noted in the two patients with no acute procedural benefit. CONCLUSIONS: By identifying potentially arrhythmogenic tissue during sinus rhythm, substrate mapping can guide the ablation of a majority of inducible VTs using an irrigated RF ablation catheter. This emerging therapeutic paradigm may be considered in the management of patients with multiple hemodynamically unstable monomorphic VTs.
Authors:
Vivek Y Reddy; Petr Neuzil; Milos Taborsky; Jeremy N Ruskin
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Publication Detail:
Type:  Evaluation Studies; Journal Article; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  Journal of the American College of Cardiology     Volume:  41     ISSN:  0735-1097     ISO Abbreviation:  J. Am. Coll. Cardiol.     Publication Date:  2003 Jun 
Date Detail:
Created Date:  2003-06-24     Completed Date:  2003-07-09     Revised Date:  2006-11-15    
Medline Journal Info:
Nlm Unique ID:  8301365     Medline TA:  J Am Coll Cardiol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  2228-36     Citation Subset:  AIM; IM    
Affiliation:
Cardiac Arrhythmia Service, Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts 02114, USA. vreddy@partners.org
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MeSH Terms
Descriptor/Qualifier:
Aged
Catheter Ablation / adverse effects*,  methods*
Electrocardiography / adverse effects,  methods
Female
Follow-Up Studies
Heart Conduction System / physiopathology*,  surgery*
Humans
Irrigation / adverse effects*,  methods*
Male
Middle Aged
Myocardial Ischemia / complications,  physiopathology*,  surgery*
Outcome Assessment (Health Care)*
Postoperative Complications*
Severity of Illness Index
Sodium Chloride / administration & dosage,  therapeutic use*
Tachycardia, Ventricular / etiology,  physiopathology*,  surgery*
Time Factors
Chemical
Reg. No./Substance:
7647-14-5/Sodium Chloride

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


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