Radiofrequency Catheter Ablation of Ventricular Tachycardia After Myocardial Infarction

Stevenson, William G.; Friedman, Peter L.; Kocovic, Dusan Z.; Sager, Philip T.; Saxon, Leslie A.; Pavri, Behzad

doi:10.1161/01.cir.98.4.308

Cited by 267 publications

(204 citation 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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confidence: 99%

Electrocardiographic Recognition of the Epicardial Origin of Ventricular Tachycardias

et al. 2004

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“…Termination of VT during RF application was used as the end point for assessing effect, as described previously. [3][4][5] The efficacy of termination was compared for identical types of sites, as identified by entrainment and the presence of isolated potentials. The duration of RF application at sites without termination was analyzed and found to be similar for the cooled and standard RF applications.…”

Section: Discussionmentioning

confidence: 99%

“…Patients had to meet the following criteria: (1) sustained, monomorphic VT was present or inducible in the electrophysiology laboratory, and (2) pacing for entrainment was performed at a mapping site followed immediately by application of RF current for ablation, allowing assessment of whether VT terminated during the RF application. 3,4 Patient characteristics are shown in Table 1.…”

Section: Methodsmentioning

confidence: 99%

“…The mapping and ablation approach has been previously described. 3,4 Access to the left ventricle was achieved with a retrograde aortic or trans-septal approach. Systemic anticoagulation was maintained with the intravenous administration of heparin.…”

Section: Methodsmentioning

confidence: 99%

“…3,4 We hypothesized that if salineirrigated ablation produced larger lesions in vivo in human infarct regions, it would be more effective in interrupting VT compared with standard RF ablation. Therefore, the effect of cooled RF ablation and standard RF ablation on induced, sustained VT was compared in patients undergoing VT ablation after infarction.…”

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confidence: 99%

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Saline-Cooled Versus Standard Radiofrequency Catheter Ablation for Infarct-Related Ventricular Tachycardias

et al. 2001

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Background-Saline cooling of the electrode during radiofrequency (RF) ablation increases lesion size in animal models.If cooled RF also increases lesion size in human infarcts, it should facilitate the termination of ventricular tachycardia (VT). Methods and Results-In 66 patients with VT due to prior infarction, 366 ablation sites, which were classified by entrainment and isolated potentials followed by ablation during VT with either standard RF energy (247 sites

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Catheter ablation versus escalation of antiarrhythmic medications for management of ventricular tachycardia in patients with ischaemic heart disease

Kakarla

Benson

Abbas

et al. 2021

Cochrane Database of Systematic Reviews

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Radiofrequency Catheter Ablation of Ventricular Tachycardia After Myocardial Infarction

Abstract: Radiofrequency catheter ablation controls VT that is sufficiently stable to allow mapping in 67% of patients despite failure of antiarrhythmic drug therapy and multiple inducible VTs. However, ablation was largely adjunctive to amiodarone and defibrillators in this referral population.

Cited by 267 publications

References 20 publications

Electrocardiographic Recognition of the Epicardial Origin of Ventricular Tachycardias

Electrocardiographic Recognition of the Epicardial Origin of Ventricular Tachycardias

Saline-Cooled Versus Standard Radiofrequency Catheter Ablation for Infarct-Related Ventricular Tachycardias

Catheter ablation versus escalation of antiarrhythmic medications for management of ventricular tachycardia in patients with ischaemic heart disease

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