title: Catheter ablation guided by termination of postinfarction ventricular tachycardia by pacing with nonglobal capture.
abstract: OBJECTIVE
  We prospectively investigated the prevalence and value of this criterion for identifying a target site for ablation in patients with postinfarction ventricular tachycardia (VT).
  
  
  BACKGROUND
  Termination of postinfarction VT by pacing with nonglobal capture identifies a critical component of the reentrant circuit.
  
  
  METHODS
  In a consecutive series of 34 patients with prior infarction (age 67 +/- 10 years, ejection fraction 0.26 +/- 0.1) referred for radiofrequency catheter ablation, mapping was performed in the left ventricle. At sites with abnormal electrograms, pacing was performed during VT. If VT terminated with nonglobal capture during the pacing train, radiofrequency energy was delivered.
  
  
  RESULTS
  Sixty-two VTs (cycle length 450 +/- 84 ms) were mapped and targeted for radiofrequency ablation. Concealed entrainment was present at 101 endocardial sites. Among the 101 sites, VT terminated by pacing with nonglobal capture at 5 sites (5%). At 10 additional sites in 10 patients, VT terminated by pacing with nonglobal capture, and concealed entrainment could not be documented at these sites because of reproducible termination of the VT. An application of radiofrequency energy resulted in VT termination at all 15 sites where nonglobal capture was documented and the targeted VTs were no longer inducible after ablation.
  
  
  CONCLUSIONS
  Termination of VT by pacing with nonglobal capture can be demonstrated in approximately one third of patients with postinfarction VT and is a specific criterion for identifying a critical component of the reentrant circuit, whether or not concealed entrainment can be documented at that site.
authors.affiliation: University of Michigan, Ann Arbor, 48109, USA. fbogun@umich.edu
authors.forename: Frank
authors.initials: F
authors.lastname: Bogun
authors.forename: Subramaniam C
authors.initials: SC
authors.lastname: Krishnan
authors.forename: Joseph E
authors.initials: JE
authors.lastname: Marine
authors.forename: Stefan H
authors.initials: SH
authors.lastname: Hohnloser
authors.forename: Claudio
authors.initials: C
authors.lastname: Schuger
authors.forename: Hakan
authors.initials: H
authors.lastname: Oral
authors.forename: Frank
authors.initials: F
authors.lastname: Pelosi
authors.forename: Aman
authors.initials: A
authors.lastname: Chugh
authors.forename: Fred
authors.initials: F
authors.lastname: Morady
mesh_terms: D000368:Aged; D002304:Cardiac Pacing, Artificial; D017115:Catheter Ablation / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D009203:Myocardial Infarction / Q000503:physiopathology*; D015995:Prevalence; D011446:Prospective Studies; D017180:Tachycardia, Ventricular / Q000628:therapy*