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

• DOI: 10.1016/j.jacc.2005.12.062
• Publication Date: 2006-05-03T13:21:07Z
• Authors: Frank Bogun; Eric Good; Stephen Reich; Darryl Elmouchi; Petar Igic; Kristina Lemola; David Tschopp; Krit Jongnarangsin; Hakan Oral; Aman Chugh; Frank Pelosi; Fred Morady
• Keywords: Male; Myocardial Infarction; Action Potentials; Stroke Volume; Middle Aged; Cicatrix; Electrocardiography; 03 medical and health sciences; 0302 clinical medicine; Heart Conduction System; Heart Rate; Catheter Ablation; Tachycardia, Ventricular; Humans; Female; Cardiology and Cardiovascular Medicine; Electrophysiologic Techniques, Cardiac; Aged

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 > or =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.