Author + information
- Received January 15, 1993
- Revision received March 2, 1994
- Accepted April 25, 1994
- Published online September 1, 1994.
- Lloyd M. Davis, MBBS, PhD, FRACP∗,
- Mark Cooper, MBBS, PhD, FRACP,
- David C. Johnson, MBBS, FRACS,
- John B. Uther, MBBS, BSc(Med), MD, FRACP,
- David A.B. Richards, MBBS, BSc(MED), MD, FRACP, FACC and
- David L. Ross, MBBS, FRACP, FACC∗
- ↵∗Address for correspondence: Professor David L. Ross, Department of Cardiology, Westmead Hospital, Hawkesburg Road, Westmead, New South Wales 2145, Australia.
Objectives. We developed a new approach for mapping ventricular tachycardia at electrophysiologic study using simultaneous recordings from up to 60 catheter electrodes.
Background. Good results for surgical or catheter ablation of ventricular tachycardia are limited by the ability to detect and completely map all of the underlying arrhythmogenic areas. Currently, catheter mapping of all configurations of ventricular tachycardia is impossible or unsatisfactory in at least 60% of patients because of poorly tolerated rapid rates, nonsustained ventricular tachycardia or multiple configurations.
Methods. Twenty-four patients with recurrent ventricular tachycardia refractory to antiarrhythmic drugs were studied using up to six percutaneous decapolar catheters introduced into the ventricles. Left ventricular maps of ventricular tachycardia were achieved by two to three transseptal catheters, two to three transaortic catheters, a coronary sinus catheter and right ventricular catheters. Simultaneous endocardial maps of either right or left ventricles were possible with a resolution of ~1 to 2 cm. Up to 60 electrograms were digitized and recorded simultaneously using a custom-computerized mapping system.
Results. Successful maps of 73 ventricular tachycardia configurations were obtained in 22 patients. The mapping procedure failed in two patients because of inability to catheterize the left ventricle in one and inability to induce monomorphic ventricular tachycardia in the other. The mean (±SD) ventricular tachycardia cycle length was 285 ± 53 ms (range 215 to 470). A total of 39 separate arrhythmogenic areas (median 1, interquartile [25% to 75%] range 1 to 3/patient) were detected, of which 21 (54%) were in the left ventricular free wall, 17 (44%) were in the ventricular septum, and 1 (2%) was in the right ventricular outflow tract. Ten patients (45%) had at least two arrhythmogenic areas. Thirteen patients subsequently underwent operation. All but one of the arrhythmogenic areas found at surgical mapping had been identified at preoperative catheter mapping. Complications of the preoperative mapping procedure occurred in four patients, with complete resolution in three and minor long-term sequelae in the other.
Conclusions. This technique permits detailed catheter mapping of all types of monomorphic ventricular tachycardias, including those leading to hemodynamic collapse, and should enable better choice and direction of surgical or catheter ablation.
↵∗ Present address: Department of Pediatrics and Hematology, Room 1050 Children's Hospital, 1 Children's Place, St. Louis, Missouri, 63110.
☆ This work was supported by National Heart Foundation Grant PM 100 and Grant in Aid G 90S3026 from the National Heart Foundation of Australia, Woden, Australian Capital Territory, Australia.
- Received January 15, 1993.
- Revision received March 2, 1994.
- Accepted April 25, 1994.