Radiofrequency catheter ablation of ventricular tachycardia in patients with coronary artery disease.

Morady, Fred; Harvey, Mark; Kalbfleisch, Steven J.; El‐Atassi, Rafel; Calkins, Hugh; Langberg, Jonathan J.

doi:10.1161/01.cir.87.2.363

Cited by 372 publications

(137 citation statements)

References 36 publications

(8 reference statements)

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“…However, the success rate of the procedure depends on the underlying heart disease and the location of the circuit. Efficacy of RF ablation of VTs ranges from 45% to 76% in patients with ischemic heart disease [1][2][3] to Ϸ100% in patients with fascicular or bundle-branch block reentry tachycardias [4][5][6] in which a crucial part of the reentrant circuit of the tachycardia is the conduction system, located in the subendocardium.…”

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confidence: 99%

Electrocardiographic Recognition of the Epicardial Origin of Ventricular Tachycardias

et al. 2004

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Background-Some ventricular tachycardias (VTs) originating from the epicardium are not suitable for endocardial radiofrequency ablation and require an epicardial approach. The aim of this study was to define the ECG characteristics that may identify an epicardial origin of VTs. Methods and Results-We analyzed the 12-lead ECG recordings during epicardial and endocardial left ventricular pacing in 9 patients to verify the hypothesis that the epicardial origin of the ventricular activation widens the initial part of the QRS complex. Then, we analyzed the ECG pattern in 14 VTs successfully ablated from the epicardium after a failed endocardial approach (group A), in 27 VTs successfully ablated from the endocardium (group B), and in 28 additional VTs that could not be ablated from the endocardium (group C). Four distinct intervals of ventricular activation were defined and measured: (1) the pseudodelta wave, (2) the intrinsicoid deflection time in V2, (3) the shortest RS complex, and (4) the QRS complex. VTs from groups A and C showed a significantly longer pseudodelta wave, intrinsicoid deflection time, and RS complex duration compared with VTs of group B. There was no difference between groups A and C. A pseudodelta wave of Ն34 ms has a sensitivity of 83% and a specificity of 95%, an intrinsicoid deflection time of Ն85 ms has a sensitivity of 87% and a specificity of 90%, and an RS complex duration of Ն121 ms has a sensitivity of 76% and a specificity of 85% in identifying an epicardial origin of the VTs. Conclusions-ECG suggests VTs originating from the epicardium and those with an unsuccessful radiofrequency ablation from the endocardium.

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Electrocardiographic Recognition of the Epicardial Origin of Ventricular Tachycardias

et al. 2004

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“…Several studies [3][4][5][6][7][8] have reported on the RF ablation of VT in post-MI patients with the use of the so-called conventional electrophysiological approach to identify the critical part of the arrhythmia. A reentrant mechanism of the VT is usually suspected when the procedure is successful, but the VT circuit is not reconstructed by the conventional approach.…”

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confidence: 99%

Isthmus Characteristics of Reentrant Ventricular Tachycardia After Myocardial Infarction

Chillou¹,

Lacroix²,

Klug³

et al. 2002

Circulation

200

100

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Background-The reentrant mechanism of postinfarct ventricular tachycardia (VT) has been documented by surgical mapping analysis, but little is known about postinfarct VT circuits and the characteristics of their related protected isthmus with the use of 3D catheter mapping systems. Methods and Results-A 3D electroanatomic mapping was performed in 21 patients with well-tolerated, postinfarct, sustained VT. In total, 33 episodes of tachycardia (mean cycle length 432Ϯ74 ms) were induced and mapped. Complete maps demonstrated macroreentrant circuits with 1 loop (nϭ8) or 2 loops (nϭ25) rotating around a protected isthmus bounded by 2 approximately parallel conduction barriers that consisted of a line of double potentials, a scar area, or the mitral annulus. A total of 26 critical isthmi were identified for the 33 VTs mapped, with the same isthmus being shared by 2 to 4 different tachycardic morphologies in 5 patients. On average, isthmi were 31Ϯ7 mm long (ranging from 18 to 41 mm) and 16Ϯ8 mm wide (ranging from 6 to 36 mm) and harbored diastolic electrograms. The isthmus axis was oriented parallel to the mitral annulus plane in perimitral circuits and perpendicular to the mitral annulus plane in all other circuits. Linear radiofrequency ablation performed across the most accessible part of the isthmus prevented the recurrence of tachycardia in 19 patients (90%) with a follow-up at 16Ϯ8 months. Conclusions-Detailed

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“…In patients with coronary artery disease, success rates are between 50 % and 70 %, both for DC fulguration and RF catheter ablation, [16][17][18] despite the introduction of various mapping criteria such as pace mapping, 19,20) earliest endocardial activation, 21) entrainment with concealed fusion, 22,23) and analysis of the postpacing interval after pacing from the mapping catheter. 24) Potential reasons for this include insufficient lesion size generated by RF current 24,25) or an even more complex arrhythmogenic substrate than described by currently accepted mapping criteria.…”

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confidence: 99%

Radiofrequency Catheter Ablation of Ventricular Tachycardia from the Anterobasal Left Ventricle.

et al. 2000

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HE most common form of left-sided idiopathic ventricular tachycardia (VT) arises close to or in the posterior fascicle of the left bundle branch and shows a right bundle branch block (RBBB) morphology and left axis deviation. [1][2][3][4][5] Idiopathic left VT also arises from or close to the anterior fascicle of the left bundle and shows RBBB morphology and right axis deviation.6-9) Idiopathic left VT is responsive to verapamil but not adenosine. 5) Reentry is thought to be the operative mechanism of the tachycardia. There are sporadic case reports showing that some idiopathic left VT may be responsive to adenosine and that the operative mechanism may not be reentry. [10][11][12][13] Recent studies have demonstrated an epicardial origin in a specific subgroup of patients with idiopathic left ventricular outflow tract tachycardia.14,15) We report two cases of VT originating SUMMARY Ventricular tachycardia (VT) in coronary artery disease arises mostly from endocardial sites. However, little is known about the site of origin in other diseases. We report two patients who had VT originating from an anterior aspect of the left ventricle just below the mitral annulus, adjacent to the left ventricular outflow tract. The QRS configuration of VT showed an inferior axis and monophasic R waves in all the precordial leads. Radiofrequency current delivered to this site from the endocardial site successfully ablated the tachycardia in both. (Jpn Heart J 2000; 41: 215-225)

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Radiofrequency catheter ablation of ventricular tachycardia in patients with coronary artery disease.

Cited by 372 publications

References 36 publications

Electrocardiographic Recognition of the Epicardial Origin of Ventricular Tachycardias

Electrocardiographic Recognition of the Epicardial Origin of Ventricular Tachycardias

Isthmus Characteristics of Reentrant Ventricular Tachycardia After Myocardial Infarction

Radiofrequency Catheter Ablation of Ventricular Tachycardia from the Anterobasal Left Ventricle.

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