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European Heart Journal 2002 23(9):742-752; doi:10.1053/euhj.2001.2939
Copyright © 2002 by the European Society of Cardiology.
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Non-contact mapping to guide catheter ablation of untolerated ventricular tachycardia

P. Della Bellaa,f1, A. Pappalardob, S. Rivaa, C. Tondoa, G. Fassinia and N. Trevisia

a Institute of Cardiology, University of Milan, IRCCS, Centro Cardiologico ‘Fondazione I. Monzino’ Milan
b Department of Heart Sciences, Ospedale S. Camillo, Rome, Italy

Received March 14, 2001; accepted July 25, 2001

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±60ms, range 230–450ms), mapped for 15–20s, 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±15ms 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±49ms 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.

Key Words: Non-contact mapping, ventricular tachycardia, radiofrequency catheter ablation

f1 Correspondence: Paolo Della Bella, MD, Institute of Cardiology, University of Milan, Centro Cardiologico, IRCCS, Via Parea, 4–20138 Milano, Italy.

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