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Value of Right Ventricular Mapping in Patients with Post-infarction Ventricular Tachycardia.
MedLine Citation:
PMID:  22322328     Owner:  NLM     Status:  Publisher    
BACKGROUND: Post-infarction ventricular tachycardia (VT) typically involves the left ventricular endocardium. Right ventricular involvement in the arrhythmogenic substrate of post-infarction VT is considered unusual. The purpose of this study was to assess the role of right ventricular mapping and ablation in patients with prior septal myocardial infarction. METHODS AND RESULTS: From among 37 consecutive patients with recurrent post-infarction VT, 18 patients were identified in whom there was evidence of left ventricular septal involvement of myocardial infarction; these patients were the subjects of this report. In these 18 patients 166 VTs (cycle length 372±117 ms) were induced. Right ventricular voltage mapping was performed in all 18 patients with left ventricular septal myocardial infarction. Right ventricular voltage mapping showed areas of low voltage in 11 patients; pace-mapping from these areas revealed matching pace-maps for 17 VTs and radiofrequency ablation from the right ventricular endocardium but not the left ventricular endocardium eliminated 14/17 VTs. VTs with critical components in the right ventricle had a left bundle branch block (LBBB) morphology that had similar characteristics as LBBB VTs with critical areas involving the left ventricular septum. Patients with right ventricular VT breakthrough sites had a lower ejection fraction than patients without VT breaking out on the right ventricular septum (18±5% vs 33±15%; P=0.01). CONCLUSIONS: Right ventricular mapping and ablation may be necessary in order to eliminate all inducible VTs in patients with post-infarction VT. More than half the patients with septal myocardial infarction have right ventricular septal areas that are critical for post-infarction VT and that cannot be eliminated by left ventricular ablation alone.
Miki Yokokawa; Eric Good; Thomas Crawford; Aman Chugh; Frank Pelosi; Rakesh Latchamsetty; Hakan Oral; Fred Morady; Frank Bogun
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Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2012-2-6
Journal Detail:
Title:  Heart rhythm : the official journal of the Heart Rhythm Society     Volume:  -     ISSN:  1556-3871     ISO Abbreviation:  -     Publication Date:  2012 Feb 
Date Detail:
Created Date:  2012-2-10     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  101200317     Medline TA:  Heart Rhythm     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
Copyright Information:
Copyright © 2012. Published by Elsevier Inc.
Division of Cardiovascular Medicine, University of Michigan, Ann Arbor, MI, USA.
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