Document Detail

Tachycardia-related channel in the scar tissue in patients with sustained monomorphic ventricular tachycardias: influence of the voltage scar definition.
MedLine Citation:
PMID:  15492309     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: Endocardial mapping before sustained monomorphic ventricular tachycardia (SMVT) induction may reduce mapping time during tachycardia and facilitate the ablation of unmappable VT. METHODS AND RESULTS: Left ventricular electroanatomic voltage maps obtained during right ventricular apex pacing in 26 patients with chronic myocardial infarction referred for VT ablation were analyzed to identify conducting channels (CCs) inside the scar tissue. A CC was defined by the presence of a corridor of consecutive electrograms differentiated by higher voltage amplitude than the surrounding area. The effect of different levels of voltage scar definition, from 0.5 to 0.1 mV, was analyzed. Twenty-three channels were identified in 20 patients. The majority of CCs were identified when the voltage scar definition was < or =0.2 mV. Electrograms with > or =2 components were recorded more frequently at the inner than at the entrance of CCs (100% versus 75%, P< or =0.01). The activation time of the latest component was longer at the inner than at the entrance of CCs (200+/-40 versus 164+/-53 ms, P< or =0.001). Pacing from these CCs gave rise to a long-stimulus QRS interval (110+/-49 ms). Radiofrequency lesion applied to CCs suppressed the inducibility in 88% of CC-related tachycardias. During a follow-up of 17+/-11 months, 23% of the patients experienced a VT recurrence. CONCLUSIONS: CCs represent areas of slow conduction that can be identified in 75% of patients with SMVT. A tiered decreasing-voltage definition of the scar is critical for CC identification.
Angel Arenal; Silvia del Castillo; Esteban Gonzalez-Torrecilla; Felipe Atienza; Mercedes Ortiz; Javier Jimenez; Alberto Puchol; Javier García; Jesús Almendral
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Publication Detail:
Type:  Journal Article     Date:  2004-10-18
Journal Detail:
Title:  Circulation     Volume:  110     ISSN:  1524-4539     ISO Abbreviation:  Circulation     Publication Date:  2004 Oct 
Date Detail:
Created Date:  2004-10-26     Completed Date:  2005-05-12     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0147763     Medline TA:  Circulation     Country:  United States    
Other Details:
Languages:  eng     Pagination:  2568-74     Citation Subset:  AIM; IM    
Department of Cardiology, Hospital General Universitario Gregorio Marañón, Madrid, Spain.
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MeSH Terms
Catheter Ablation*
Cicatrix / physiopathology
Electrophysiologic Techniques, Cardiac
Myocardial Infarction / complications
Pacemaker, Artificial
Tachycardia, Ventricular / etiology,  physiopathology,  surgery*

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