title: Usefulness of a limited linear ablation of post-myocardial infarction ventricular tachycardia using a standardized approach based on sinus rhythm mapping.
abstract: The ablation of ventricular tachycardia (VT) can be achieved using anatomically guided approaches using differentiated mapping and ablation techniques. The aim of this study was to evaluate the efficacy of limited linear ablation in the VT exit region identified during sinus rhythm mapping alone. One hundred fifteen consecutive patients presenting for ablation of post-myocardial infarction VT were included. After induction of the target VT during invasive electrophysiology, left ventricular substrate mapping during sinus rhythm to identify scar and border zone on the basis of endocardial bipolar voltage was performed. The exit site of the target VT was regionalized by a simplified vector pace mapping approach and targeted using limited linear ablation within the scar border zone. Seventy-seven percent of all inducible VT was successfully ablated. In 71 patients (62%), no sustained VT was inducible at the end of ablation procedure (complete success). During a median follow-up period of 16 + or - 10 months, 89 patients (77%) had no documented sustained ventricular arrhythmia. Seven patients (2%) had recurrences of the initially ablated VT, and 16 (14%) had new-onset VT. Patients with complete success had a significantly lower number of ventricular arrhythmia reoccurrences than patients with incomplete ablation success (11% vs 37%, p = 0.002). In conclusion, postinfarct VT was effectively ablated in 97% of patients without mapping during ongoing VT using a simplified regional linear ablation approach targeting the scar border zone. Freedom from any ventricular arrhythmia was achieved in 77% of patients during midterm follow-up.
authors.affiliation: University Heart Centre Bochum, BG Clinic Bergmannsheil, Ruhr-Universität Bochum, Bochum, Germany. thomas.deneke@rub.de
authors.forename: Thomas
authors.initials: T
authors.lastname: Deneke
authors.forename: Thomas
authors.initials: T
authors.lastname: Lawo
authors.forename: Peter H
authors.initials: PH
authors.lastname: Grewe
authors.forename: Bernd
authors.initials: B
authors.lastname: Calcum
authors.forename: Ricarda
authors.initials: R
authors.lastname: Rausse
authors.forename: Leif
authors.initials: L
authors.lastname: Bösche
authors.forename: Dong-In
authors.initials: DI
authors.lastname: Shin
authors.forename: Markus
authors.initials: M
authors.lastname: Zarse
authors.forename: Marc
authors.initials: M
authors.lastname: Horlitz
authors.forename: Andreas
authors.initials: A
authors.lastname: Mügge
authors.forename: Bernd
authors.initials: B
authors.lastname: Lemke
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D018780:Body Surface Potential Mapping / Q000379:methods / Q000592:standards*; D017115:Catheter Ablation; D005260:Female; D005500:Follow-Up Studies; D006339:Heart Rate / Q000502:physiology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000150:complications* / Q000503:physiopathology; D012008:Recurrence; D015203:Reproducibility of Results; D012189:Retrospective Studies; D017180:Tachycardia, Ventricular / Q000175:diagnosis / Q000209:etiology / Q000601:surgery*