Data di Pubblicazione:
2002
Citazione:
Non-contact mapping to guide catheter ablation of untolerated ventricular tachycardia / D.B. Paolo, P. A., R. S., C. Tondo, F. G., T. N.. - In: EUROPEAN HEART JOURNAL. - ISSN 0195-668X. - 23:9(2002), pp. 742-752. [10.1053/euhj.2001.2939]
Abstract:
Aims: The role of a novel non-contact mapping system (ESI 3000, Endocardial Solutions) to guide radiofrequency catheter ablation of untolerated ventricular tachycardia was investigated in 17 patients; 11 with prior myocardial infarction, three with arrhythmogenic right ventricular dysplasia, and three with idiopathic dilated cardiomyopathy. Methods: Twenty-seven monomorphic ventricular tachycardias were induced (mean cycle 320 ± 60 ms, range 230-450 ms), mapped for 15-20 s, and terminated by overdrive pacing or DC shock. Off-line analysis of isopotential activation mapping was performed to identify the diastolic pathway and/or the exit point of the ventricular tachycardia reentry circuit. Radiofrequency current was applied to create a line of block across the diastolic pathway or around the exit point. Results: All 27 ventricular tachycardias were mapped with the non-contact system. The endocardial exit point (- 7 ± 15 ms before QRS onset) was defined in 21/21 postinfarction ventricular tachycardias, in 3/3 arrhythmogenic right ventricular dysplasia and in 1/3 idiopathic dilated cardiomyopathy ventricular tachycardias, respectively. The diastolic pathway (earliest endocardial diastolic activity: - 65 ± 49 ms before QRS onset) was identified in 17/21 postinfarction ventricular tachycardias, in 1/3 arrhythmogenic right ventricular dysplasia and in 1/3 idiopathic dilated cardiomyopathy ventricular tachycardias, respectively. Catheter ablation was performed in 25/27 ventricular tachycardias (93%) in 15/17 patients (88%): 16/25 ventricular tachycardias (64%) were successfully ablated in 10/17 patients (59%). Catheter ablation was not performed in two patients or proved unsuccessful in five patients. At a follow-up of 15 ± 5 months, there was no recurrence of documented ventricular tachycardia in all 10 patients with successful catheter ablation; in two of them a previously non-documented ventricular tachycardia occurred. A high recurrence of ventricular tachycardia was observed in patients with a failed procedure (5/7: 71%). No major complication or death occurred. Conclusions: Non-contact mapping can be effectively used to map and guide radiofrequency catheter ablation of untolerated ventricular tachycardias. Given the favourable acute and clinical long-term results, this approach proves to be more effective in patients with postinfarction ventricular tachycardias, in comparison to patients with arrhythmogenic right ventricular dysplasia and idiopathic dilated cardiomyopathy.
Tipologia IRIS:
01 - Articolo su periodico
Keywords:
Non-contact mapping; Radiofrequency catheter ablation; Ventricular tachycardia; Adult; Aged; Combined Modality Therapy; Electrophysiologic Techniques, Cardiac; Endpoint Determination; Female; Follow-Up Studies; Heart Conduction System; Hemodynamics; Humans; Male; Middle Aged; Recurrence; Tachycardia, Ventricular; Time Factors; Treatment Outcome; Body Surface Potential Mapping; Catheter Ablation; Cardiology and Cardiovascular Medicine
Elenco autori:
D.B. Paolo, P. A., R. S., C. Tondo, F. G., T. N.
Link alla scheda completa: