Radiofrequency ablation therapy in idiopathic left ventricular tachycardia with no obvious structural heart disease.

Abstract

Background The feasibility and efficacy of radiofrequency ablation therapy in idiopathic left ventricular tachycardia has not been assessed in a large group of patients.Methods and Results Twenty consecutive patients with idiopathic left ventricular tachycardia and without structural heart disease underwent electrophysiological study, pharmacological interventions with administration of verapamil and adenosine, and radiofrequency ablation therapy. There were 17 men and 3 women with a mean age of 28±8 years. The QRS configuration during tachycardia was of right bundle branch block and superior axis in 13 patients, indeterminate axis in 6 patients, and right axis in 1 patient. The tachycardia was electrically inducible and responsive to verapamil but not to adenosine. Thirteen patients demonstrated entrainment. Activation and pace-mapping studies disclosed that the tachycardia originated from the inferior apical septum in 15 patients, the midseptum in 4 patients, and the anterior lateral wall of the left ventricle in 1 patient. Radiofrequency ablation was successful in 17 of the 20 patients (85%). The successful

Clinical Application of an Integrated 3-Phase Mapping Technique for Localization of the Site of Origin of Idiopathic Ventricular Tachycardia

“…Successful ablation could be performed in this study with relatively low fluoroscopic exposure. The mean fluoroscopy time was 30Ϯ18 minutes, compared with 46Ϯ18 and 40Ϯ15 minutes reported by Wen et al 5 and Zardini et al, 7 respectively. The mean number of RF pulses in this study was 3.3Ϯ2.2, which is lower than the mean number of RF applications in most other large studies (varying between 5.5Ϯ7.7 and 8.1Ϯ11).…”

“…The mean number of RF pulses in this study was 3.3Ϯ2.2, which is lower than the mean number of RF applications in most other large studies (varying between 5.5Ϯ7.7 and 8.1Ϯ11). 2,3,5,6 Mapping Phase 1 By comparing the VT QRS integral maps with the databases, the correct or an adjacent segment of VT origin could be identified in 14 of the 19 patients (74%). Thus, in most patients, body surface QRS integral mapping allowed for rapid initial localization of the region of interest.…”

“…[1][2][3][4][5][6][7] The 2 most common types of idiopathic VT originate from the right ventricular outflow tract (RVOT) or apical posterior left ventricle (LV). 8 -11 Several previous studies have described RF catheter ablation for idiopathic VT, and the success percentages varied from 69% to 94%.…”

“…8 -11 Several previous studies have described RF catheter ablation for idiopathic VT, and the success percentages varied from 69% to 94%. 2,3,5,6 Despite these promising results, mapping with a single catheter may still be cumbersome and timeconsuming, because large areas need to be explored in a sequential fashion. Furthermore, a point-to-point activation mapping approach may not be possible when initiation of the VT is difficult or not feasible at all.…”

Re-entry Circuit in Ventricular Tachycardia Due to Focal Fatty-fibrosis in a Patient with Myotonic Dystrophy

“…There are several reports of successful catheter ablation against VT in DM1 (13, 24), but, the long-term prognosis has not yet been determined. In the present case, catheter ablation therapy was very useful in reentrant VT (25) and a good long-term prognosis is anticipated, as this case did not show obvious fatty infiltration of the right ventricle on MRI. Catheter ablation resulted in a radical cure of VT, but we should continue to carefully follow this patient carefully for a long period.…”