Details

Autor(en) / Beteiligte

• Bogun, Frank
• Good, Eric
• Reich, Stephen
• Elmouchi, Darryl
• Igic, Petar
• Lemola, Kristina
• Tschopp, David
• Jongnarangsin, Krit
• Oral, Hakan
• Chugh, Aman
• Pelosi, Frank
• Morady, Fred

Titel

Isolated Potentials During Sinus Rhythm and Pace-Mapping Within Scars as Guides for Ablation of Post-Infarction Ventricular Tachycardia

Ist Teil von

• Journal of the American College of Cardiology, 2006-05, Vol.47 (10), p.2013-2019

Ort / Verlag

New York, NY: Elsevier Inc

Erscheinungsjahr

2006

Quelle

Electronic Journals Library

Beschreibungen/Notizen

• Isolated Potentials During Sinus Rhythm and Pace-Mapping Within Scars as Guides for Ablation of Post-Infarction Ventricular Tachycardia Frank Bogun, Eric Good, Stephen Reich, Darryl Elmouchi, Petar Igic, Kristina Lemola, David Tschopp, Krit Jongnarangsin, Hakan Oral, Aman Chugh, Frank Pelosi, Fred Morady Mapping and ablation of post-infarction ventricular tachycardia (VT) was performed in 19 patients with 81 inducible VTs. With pace-mapping during sinus rhythm (SR) and entrainment mapping, 41 VT isthmus sites could be identified in 16 patients. All but one of the isthmus sites displayed isolated potentials during SR. Of 81 VTs for which no isthmus could be identified, 22 were no longer inducible after the ablation. None of the 16 patients in whom ≥1 isthmus could be identified had arrhythmic events during a follow-up of 10 months. Matching pace-maps at sites of isolated potentials identify critical components of post-infarction VT. The purpose of this study was to identify ventricular tachycardia (VT) isthmus sites by pace-mapping within scar tissue and to identify electrogram characteristics that are helpful in identifying VT isthmus sites during sinus rhythm (SR). Pace-mapping has been used in the scar border zone to identify the exit site of post-infarction VT. In 19 consecutive patients (18 men, mean age 66 ± 9 years, mean ejection fraction 0.24 ± 0.12) with post-infarction VT, a left ventricular voltage map was generated during SR. Pace-mapping was performed at sites with abnormal electrograms or isolated potentials. Radiofrequency ablation was performed at isthmus sites as defined by pace-mapping (perfect pace-map = 12/12 matching electrocardiogram leads; good pace-map = 10/12 to 11/12 matching electrocardiogram leads) and/or entrainment mapping. A total of 81 VTs (mean cycle length 396 ± 124 ms) were inducible. In 16 of the 19 patients, a total of 41 distinct isthmus areas of 41 distinct VTs were identified and successfully ablated. All but one displayed isolated potentials during SR. Furthermore, 22 of the 81 VTs (27%) for which no isthmus was identified became noninducible after ablation of a targeted VT. The 16 patients in whom ≥1 isthmus was identified and ablated were free of arrhythmic events during a mean follow-up of 10 months. During SR, excellent or good pace-maps at sites of isolated potentials within areas of scar identify areas of fixed block that are protected and part of the critical isthmus of post-infarction VT. Shared common pathways might explain why non-targeted VTs might become noninducible after ablation of other VTs.