No abstract

BackgroundϪA variety of mapping criteria have been proposed to localize critical sites at which radiofrequency (RF) can predictably terminate reentrant ventricular tachycardia (VT) caused by coronary artery disease. The purpose of this study was to determine the accuracy of using a combination of 3 mapping criteria in predicting termination of VT by a single RF lesion. Methods and ResultsϪFifteen consecutive patients with coronary artery disease and recurrent sustained VT underwent an attempted RF ablation of 20 monomorphic VTs. Successful termination of VT by a single RF lesion was predicted if all the following mapping criteria were met: (1) an exact QRS match in the 12-lead ECG during entrainment; (2) a return cycle length Յ10 ms of the VT cycle length; (3) presystolic potentials (Ͻ70% of VT cycle length) with an activation time to the QRS within 10 ms of the stimulus to QRS. Inability to meet these 3 criteria was considered to predict failure of VT termination by RF energy at that site. RF ablation was applied to 44 left ventricular sites in 20 VTs at which at least 1 of the mapping criteria was met. VT was terminated with a single RF lesion in 19 of 19 sites meeting all criteria; RF failed to terminate VT at 24 of 25 sites at which all 3 criteria were not met (PϽ0.0005). ConclusionsϪTo maximize success and minimize the number of RF lesions in patients with infarct-related VT, all the above 3 mapping criteria should be met before the application of RF energy. (Circulation. 1999;99:2283-2289.)

In patients who experience conversion of atrial fibrillation to atrial flutter during antiarrhythmic drug treatment, ablation and continuation of pharmacologic therapy is a safe and effective means of achieving and maintaining sinus rhythm.