Author + information
- Received June 21, 1993
- Revision received November 15, 1993
- Accepted December 9, 1993
- Published online May 1, 1994.
- Dwain L. Coggins, MD, FACCa,
- Randall J. Lee, MDa,
- John Sweeney, MDa,
- Walter W. Chein, MD, FACCa,∗,
- George Van Hare, MD, FACCa,
- Laurence Epstein, MDa,1,
- Rolando Gonzalez, MDa,
- Jerry C. Griffin, MD, FACCa,
- Michael D. Lesh, MD, FACCa,1 and
- Melvin M. Scheinman, MD, FACCa,∗
- ↵∗Address for correspondence: Dr. Melvin M. Scheinman, Room 312. Moffitt Hospital, Box 0214, University of California, San Francisco, California 94143.
Objectives. The purpose of this study was 1) to investigate the efficacy and safely of radiofrequency energy catheter ablation as curative treatment for idiopathic tachycardia of both left and right ventricular origin, and 2) to compare the usefulness of different methods used to map the site of origin of idiopathic veotricular tachycardia.
Background. Percutaneous radiofrequency catheter ablation has been used with dramatic success in the treatment of patients with Wolff-Parkinson-White syndrome, atrioventricular node reentrant tachycardia and bundle branch reentrant tachycardia. Limited data are available on the use of radiofrequency energy catheter ablation as curative treatment for idiopathic tachycardia of both left and right ventricular origin.
Methods. Twenty-eight consecutive patients (13 to 71 years old) presenting with idiopathic ventricular tachycardia were enrolled in the study. The site of origin of both left and right ventricular tachycardia was mapped using earliest endocardial activation times during tachycardia and by pace mapping. These mapping techniques were compared.
Results. Radiofrequency ablation was successful in all eight patients (100%) with left ventricular tachycardia. Tachycardia recurred in one patient. The ablation procedure was complicated by mild aortic insufficiency in one patient. Right ventricular outflow tract tachycardia was successfully ablated in 17 (85%) of 20 patients. The success rate at follow-up was 85%. In one patient, the ablation procedure was complicated by acute ventricular perforation and death. Pace maps from successful ablation sites were better than pace maps from unsuccessful sites (p < 0.004). Endocardial activation times at successful ablation sites were not different from unsuccessful sites (p < 0.13).
Conclusions. Radiofrequency catheter ablation is an effective treatment for idiopathic ventricular tachycardia. The site of origin of tachycardia is best identified using pace mapping. Significant complications can occur and should be considered in the risk/ benefit analysis for each patient.
↵1 Drs. Epstein and Lesh serve on the scientific advisory board of EP Technologies, Sunnyvale, California and receive honoraria for their participation.
☆ All editorial decisions for this article, including selection of referees, were made by a Guest Editor. This policy applies to all articles with authors from the University of California San Francisco.
- Received June 21, 1993.
- Revision received November 15, 1993.
- Accepted December 9, 1993.