Objective-To study the value of epicardial mapping through the coronary venous system in patients with sustained ventricular tachycardia. Design-20 consecutive patients with sustained ventricular tachycardia who were candidates for radiofrequency ablation. Setting-Electrophysiological laboratory. Interventions-Coronary venous angiography was performed with a catheter, which provided coronary sinus occlusion during injection of contrast media. Multipolar microelectrode catheters were then manoeuvred into the tributaries of coronary sinus, using an over-wire system or an on-wire system. An endocardial ablation catheter was positioned in the left ventricle. Conventional programmed ventricular stimulation was performed for sustained ventricular tachycardia induction. Endocardial radiofrequency ablation was performed using impedance or temperature monitoring. Results-Coronary veins were catheterised in all patients; 20 had induction of sustained ventricular tachycardia, 14 were stable. Presystolic epicardial electrograms were recorded in six patients and concealed entrainment in two, helping as a landmark for endocardial ablation. After simultaneous epicardial and endocardial mapping, successful endocardial radiofrequency ablation was achieved in nine of 14 patients with stable ventricular tachycardia (64%). Conclusions-Epicardial mapping through the coronary veins in patients with ventricular tachycardia is feasible, safe, and can be a useful landmark for endocardial catheter mapping and ablation.
When you have eliminated the impossible, whatever remains, however improbable, must be the truth.-Sherlock Holmes, The Sign of Four (1) Determining the cause of recurrent unexplained syncope remains a clinical challenge and a permanent quest. Guidelines and multiple studies emphasize that a clear deductive method based on a thorough interrogation and examination can usually disclose the etiology of syncope in the majority of cases (2). Nonetheless, in daily clinical practice, applying a simple comprehensive diagnostic approach to the patient that manifests with syncope remains an unmet goal. From a practical perspective, the main goals when evaluating the patient with recurrent syncope are simple: 1) establish a diagnosis and prognosis; and 2) implement therapy. As simple as this may sound, the reality is that in clinical practice, the strategy for evaluation of the patient with recurrent syncope is inconsistent and usually leads to multiple, low-yield, costly, and unnecessary testing and unwarranted hospital admissions (2).
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