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Document Details : Title: Catheter ablation of haemodynamically unstable or non-sustained ventricular tachycardia Author(s): WU, S. , KERWIN, W.F. , PETER, C.T. , GANG, E.S. , MA, H. Journal: Acta Cardiologica Volume: 62 Issue: 2 Date: 2007 Pages: 163-169 DOI: 10.2143/AC.62.2.2020237 Abstract : Background — Ventricular tachycardia (VT) may be haemodynamically unstable or non-sustained, interfering with detailed activation mapping. Non-contact mapping permits beat-by-beat analysis of VT, projected upon a 3-dimensional reconstructed geometry of the cardiac chamber. Objective — The aim of the present study is to determine the utility of non-contact endocardial mapping to guide ablation of haemodynamically unstable VT or non-sustained VT. Methods and results — Eighteen VTs in 17 patients were induced (cycle length 336 ± 58 ms) and mapped. Three patients were mapped during premature ventricular complexes (PVCs) because sustained VT could not be induced. Analysis of the archived non-contact activation maps was performed to identify the exit point and/or the diastolic pathway of the VT reentry circuit. The endocardial exit points (10 ± 16 ms before QRS) were defined in 17/18 VTs (94%). A diastolic pathway was identified in 5/6 ischaemic VTs. The earliest activation sites were identified in all 3 patients with PVCs. Radiofrequency current was applied around the exit point or to create a line of block across the diastolic pathway. Catheter ablation was performed in 17/18 VTs, including 3 patients mapped using only PVCs. Ablation was successful in 16/18 VTs (89%) and in 15/17 patients (82%). Catheter ablation was not performed in one patient (peri-hisian VT) and was unsuccessful in one patient (mapped during PVCs). Conclusions — Non-contact endocardial mapping is useful to guide radiofrequency catheter ablation of untolerated or non-sustained VTs. |
