[Application of dynamic substrate mapping in ablation of ventricular tachycardias in arrhythmogenic right ventricular cardiomyopathy].
OBJECTIVE
To study the application of abnormal electrophysiological substrate mapping for guiding ablation of ventricular tachycardias in arrhythmogenic right ventricular cardiomyopathy (ARVC-VTs) using a non-contact mapping system.


METHODS
Dynamic substrate mapping was performed in three male ARVC patients during sinus rhythm. The sites of the earliest activation, exit point and activation sequence were mapped for each induced VT.


RESULTS
Three different patterns of substrates were determined in 3 patients, which located in right ventricular outflow tract, anterior right ventricular wall, and anterolateral right ventricular wall, respectively. Five different clinical VTs [mean CL (348 +/- 65) ms] were induced. Of 5 VTs, three were originated from substrate or boundary of substrate, and two had a remote origin. One VT conducted through the substrate. Linear ablations were created between the sites of the earliest ventricular activation and the VT exit point, or across the critical isthmus. The five clinical VTs were successfully ablated. There were no VT recurrences during 20 months of follow-up.


CONCLUSIONS
Defining the abnormal electrophysiologic VT substrates is useful for understanding the mechanisms of ARVC-VTs and determining an ablation strategy. Linear ablation across a critical isthmus or between the earliest activation and the exit point can effectively cure these arrhythmias.
Zou
Jian-Gang
JG
Department of Cardiology, The First Affiliated Hospital, Nanjing Medical University, Nanjing 210029, China.
Cao
Ke-Jiang
KJ
Yang
Bing
B
Chen
Ming-Long
ML
Shan
Qi-Jun
QJ
Chen
Chun
C
Li
Wen-Qi
WQ
D000328:Adult; D019571:Arrhythmogenic Right Ventricular Dysplasia / Q000209:etiology / Q000503:physiopathology / Q000628:therapy*; D017115:Catheter Ablation / Q000379:methods*; D022062:Electrophysiologic Techniques, Cardiac; D006801:Humans; D008297:Male; D017180:Tachycardia, Ventricular / Q000150:complications / Q000503:physiopathology / Q000628:therapy*