Author + information
- Received September 19, 2005
- Revision received November 4, 2005
- Accepted December 5, 2005
- Published online May 16, 2006.
- Frank Bogun, MD, FACC⁎ (, )
- Eric Good, DO,
- Stephen Reich, MD,
- Darryl Elmouchi, MD,
- Petar Igic, MD,
- Kristina Lemola, MD,
- David Tschopp, MD,
- Krit Jongnarangsin, MD,
- Hakan Oral, MD, FACC1,
- Aman Chugh, MD,
- Frank Pelosi, MD, FACC and
- Fred Morady, MD, FACC1
- ↵⁎Reprint requests and correspondence:
Dr. Frank Bogun, Division of Cardiology, University of Michigan Health System, TC B1 140, 1500 East Medical Center Drive, Ann Arbor, Michigan 48109-0366.
Objectives The purpose of this study was to identify ventricular tachycardia (VT) isthmus sites by pace-mapping within scar tissue and to identify electrogram characteristics that are helpful in identifying VT isthmus sites during sinus rhythm (SR).
Background Pace-mapping has been used in the scar border zone to identify the exit site of post-infarction VT.
Methods In 19 consecutive patients (18 men, mean age 66 ± 9 years, mean ejection fraction 0.24 ± 0.12) with post-infarction VT, a left ventricular voltage map was generated during SR. Pace-mapping was performed at sites with abnormal electrograms or isolated potentials. Radiofrequency ablation was performed at isthmus sites as defined by pace-mapping (perfect pace-map = 12/12 matching electrocardiogram leads; good pace-map = 10/12 to 11/12 matching electrocardiogram leads) and/or entrainment mapping.
Results A total of 81 VTs (mean cycle length 396 ± 124 ms) were inducible. In 16 of the 19 patients, a total of 41 distinct isthmus areas of 41 distinct VTs were identified and successfully ablated. All but one displayed isolated potentials during SR. Furthermore, 22 of the 81 VTs (27%) for which no isthmus was identified became noninducible after ablation of a targeted VT. The 16 patients in whom ≥1 isthmus was identified and ablated were free of arrhythmic events during a mean follow-up of 10 months.
Conclusions During SR, excellent or good pace-maps at sites of isolated potentials within areas of scar identify areas of fixed block that are protected and part of the critical isthmus of post-infarction VT. Shared common pathways might explain why non-targeted VTs might become noninducible after ablation of other VTs.
- Received September 19, 2005.
- Revision received November 4, 2005.
- Accepted December 5, 2005.
- American College of Cardiology Foundation