title: Catheter ablation of ventricular tachycardia following myocardial infarction using three-dimensional electroanatomical mapping.
abstract: One challenge encountered during catheter ablation of postinfarction ventricular tachycardia (VT) is the inducibility of multiple VT morphologies associated with variable hemodynamic instability. The clinical usefulness and safety of a three-dimensional electroanatomical mapping in guiding radiofrequency (RF) catheter ablation of VT, used in parallel with a multichannel recording system, was studied in 28 men (mean age = 63.8 +/- 10.6 years, mean left ventricular ejection fraction = 28% +/- 9%). Three-dimensional voltage maps of the left ventricle were obtained in sinus rhythm with annotation of areas of fractionated or late potentials, zones of slow conduction and/or dense scar with no pacing capture at 10 mA. RF lesions were created either in sinus rhythm or during hemodynamically stable VT within reconstructed critical zones of the circuit. A total of 82 VTs were induced (mean = 2.9 +/- 1.0/patient). Hemodynamically unstable clinical VTs were induced in 5 patients, and clinical or nonclinical unstable VT in 14. Clinical VT was rendered noninducible in 24/28 (85.7%) patients, and monomorphic VT was eliminated in 16/28 (57.1%) patients. The mean procedural time was 258 +/- 82 minutes, and fluoroscopic exposure 13.5 +/- 8.8 minutes. During a mean follow-up period of 10.6 +/- 6.4 months, catheter ablation was repeated in 6 patients for VT recurrences. No significant complications occurred except for a transient cerebral ischemic attack in one patient. In conclusion, electroanatomical mapping assisted the successful and safe catheter ablation of both mappable and nonmappable VTs in a significant proportion of patients after myocardial infarction.
authors.affiliation: Department of Cardiology, Institute for Clinical and Experimental Medicine, Vídenská 1958/9, 140 21 Prague 4, Czech Republic. josef.kautzner@medicon.cz
authors.forename: Josef
authors.initials: J
authors.lastname: Kautzner
authors.forename: Robert
authors.initials: R
authors.lastname: Cihák
authors.forename: Petr
authors.initials: P
authors.lastname: Peichl
authors.forename: Vlastimil
authors.initials: V
authors.lastname: Vancura
authors.forename: Jan
authors.initials: J
authors.lastname: Bytesník
mesh_terms: D017115:Catheter Ablation / Q000379:methods*; D022062:Electrophysiologic Techniques, Cardiac; D006801:Humans; D021621:Imaging, Three-Dimensional; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000150:complications*; D012008:Recurrence; D012086:Reoperation; D012815:Signal Processing, Computer-Assisted; D017180:Tachycardia, Ventricular / Q000209:etiology / Q000601:surgery*