Identification of the ventricular tachycardia isthmus after infarction by pace mapping.
BACKGROUND
Ventricular tachycardia (VT) isthmuses can be defined by fixed or functional block. During sinus rhythm, pace mapping near the exit of an isthmus should produce a QRS similar to that of VT. Pace mapping at sites proximal to the exit may produce a similar QRS with a longer stimulus-to-QRS interval (S-QRS). The aim of the study was to determine whether a VT isthmus could be identified and followed by pace mapping.


RESULTS
Left ventricular pace mapping during sinus rhythm was performed at 819 sites in 11 patients with VT late after infarction, and corresponding CARTO maps were reconstructed. An isthmus site was defined by entrainment and/or VT termination by ablation. Pace-mapping data were analyzed from the identified isthmus site and from sites at progressively increasing distances from this initial isthmus site. Sites where pace mapping produced the same QRS with different S-QRS delays were identified to attempt to trace the course of the isthmus. In 11 patients, 13 confluent low-voltage infarct regions were present. In all these regions, parts of VT isthmuses were identified by pace mapping. In 11 of 13 of the identified isthmus parts, the QRS morphology of the pace map matched a VT QRS. In 10 of 11 patients, radiofrequency ablation rendered clinical VTs noninducible. Successful ablation sites were localized within an isthmus identified by pace mapping in all of these 10 patients.


CONCLUSIONS
VT isthmuses can be identified and part of their course delineated by pace mapping during sinus rhythm. This method could help target isthmus sites for ablation during stable sinus rhythm.
Brunckhorst
Corinna B
CB
Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass, USA. corinna.brunckhorst@usz.ch
Delacretaz
Etienne
E
Soejima
Kyoko
K
Maisel
William H
WH
Friedman
Peter L
PL
Stevenson
William G
WG
D000368:Aged; D000889:Anti-Arrhythmia Agents / Q000494:pharmacology / Q000627:therapeutic use; D006328:Cardiac Catheterization; D002304:Cardiac Pacing, Artificial; D017115:Catheter Ablation; D003131:Combined Modality Therapy; D017147:Defibrillators, Implantable; D004351:Drug Resistance; D004558:Electric Stimulation; D004562:Electrocardiography; D006329:Heart Conduction System / Q000503:physiopathology; D006801:Humans; D021621:Imaging, Three-Dimensional; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000150:complications; D009206:Myocardium / Q000473:pathology*; D017180:Tachycardia, Ventricular / Q000188:drug therapy / Q000209:etiology / Q000503:physiopathology* / Q000601:surgery / Q000628:therapy
D000889:Anti-Arrhythmia Agents