A37-3 Linear ablation during sinus rhythm for life-threatening ventricular tachycardia in patients with ischemic cardiomyopathy using CARTO system

Ventricular tachycardia (VT) & ventricular fibrillation (VF) are the most common immediate life threatening complications after acute myocardial infarction. These complications occur in about 5-10% of patients who admitted in hospital and are thought to the major causes of death who die before reaching hospital and to take medical attention. Immediate defibrillation will usually restore sinus rhythm. Prompt pre-hospital resuscitation and defibrillation can save many more lives. Our patient, Mr. Abdul Malek, aged about 55years, hailing from west Naodoba, Jajira, Sariotpur, non-hypertensive, non-diabetic, smoker was admitted in MMW, FMCH on 23/03/10 with the complaints of chest discomfort, shortness of breath, sweating and vomiting. During admission his pulse and BP was non-recordable, ECG shows VT. Immediately the patient was transferred to CCU from MMW. Patient was kept in cardiac monitor and arranged for DC shock. After giving 200 joules DC shock patient reverted to sinus rhythm .His pulse was recordable and reasonable blood-pressure was regained. Then the patient was treated with antiplatelets, anti-coagulant, nitrates and prophylactic iv Lignocaine. Subsequently oral anti-arrhythmic drug Amiodarone was started. The recovery of the patient was un-eventful and was discharged after 10 days without any further complication. DOI: 10.3329/fmcj.v5i2.6828Faridpur Med. Coll. J. 2010;5(2):72-73

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Usefulness of a Limited Linear Ablation of Post-Myocardial Infarction Ventricular Tachycardia Using a Standardized Approach Based on Sinus Rhythm Mapping

The American Journal of Cardiology ◽

10.1016/j.amjcard.2009.12.038 ◽

2010 ◽

Vol 105 (9) ◽

pp. 1235-1239 ◽

Cited By ~ 11

Author(s):

Thomas Deneke ◽

Thomas Lawo ◽

Peter H. Grewe ◽

Bernd Calcum ◽

Ricarda Rausse ◽

...

Keyword(s):

Myocardial Infarction ◽

Ventricular Tachycardia ◽

Sinus Rhythm ◽

Post Myocardial Infarction ◽

Linear Ablation

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Abstract 4090: Substrate Modification Using Electroanatomically-guided Linear Ablation During Sinus Rhythm To Treat Post-infarction Ventricular Tachycardia

Circulation ◽

10.1161/circ.118.suppl_18.s_826-b ◽

2008 ◽

Vol 118 (suppl_18) ◽

Author(s):

Thomas Deneke ◽

Bernd Lemke ◽

Leif-Ilja Boesche ◽

Bernd Calcum ◽

Andreas Muegge ◽

...

Keyword(s):

Ventricular Tachycardia ◽

Catheter Ablation ◽

Ventricular Arrhythmia ◽

Sinus Rhythm ◽

Border Zone ◽

Ablation Procedure ◽

Substrate Modification ◽

Linear Ablation ◽

Partial Success

Catheter ablation of ventricular tachycardia (VT) in the setting of ischemic cardiomyopathy can be performed to modify the underlying substrate. We evaluated the efficacy of a linear VT ablation procedure based on sinus rhythm (SR) substrate maps to treat ischemic VT in consecutive patients. Methods: In 110 consecutive patients with ischemic VT (56% not tolerated) catheter ablation was attempted. During SR left ventricular scar mapping was performed identifying scar tissue (bipolar voltages 1.5mV). Regionalization of VT-exit regions was performed based on pace-mapping within the scar border zone. Ablation was directed towards the identified exit region performing linear ablation along the scar border. ICD-holter interrogation was performed during follow-up. Results: A mean of 2.7±1.6 different VTs were inducible per patient (total 286). In 97% (107) of all patients (74% of all inducible VTs ablated: 213/286) the clinical VT was successfully ablated. In 68 patients (62%) no sustained monomorphic VT (complete success) was inducible at the end of the ablation procedure whereas in 39 patients (35%) VTs (partial success) were still inducible. Over a median follow-up of 12 months (6 –39) 88 (80%) patients were free from any ventricular arrhythmia. 19 successfully ablated patients had recurrences in between 6 to 36 months post intervention but the number of episodes treated by the ICD was significantly reduced (16±4 within 3 months (3±2) (p=0.02). No difference in patients with tolerated compared to non-tolerated VTs were detected (recurrences in 7/48 (15%) tolerated and 15/62 (24%) non-tolerated; p=0.13). There was a significant difference in freedom from any VT in patients with complete (88%) versus partial success (72%) (p=0.04). Conclusions: Substrate modification targeting only the scar-border zone including the VT exit site based on SR-maps is highly effective in suppressing the occurrence of a clinical VT in patients with remote myocardial infarction (97%). Based on the electro-anatomical findings complete freedom from any ventricular arrhythmia over a median of 1 year can be achieved in 80% of all patients. No difference in regard to freedom from any ventricular arrhythmia can be documented in patients with tolerated and non-tolerated VTs.

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Abstract 4088: Isolated Potentials and Pace-Mapping to Guide Ablation for Ventricular Tachycardia in Patients with Non-Ischemic Cardiomyopathy

Circulation ◽

10.1161/circ.118.suppl_18.s_826 ◽

2008 ◽

Vol 118 (suppl_18) ◽

Author(s):

Michael Kuhne ◽

Jean-Francois Sarrazin ◽

Darryl Wells ◽

Nagib Chalfoun ◽

Thomas Crawford ◽

...

Keyword(s):

Ventricular Tachycardia ◽

Sinus Rhythm ◽

Ischemic Cardiomyopathy ◽

Low Voltage ◽

Radiofrequency Energy ◽

Target Sites ◽

Group A ◽

Group B ◽

Pace Mapping

Background : Isolated potentials (IPs) during sinus rhythm are indicators of fixed scar in patients with prior infarcts. IPs in conjunction with pace-mapping (PM) have been helpful to guide ablation of post-infarction ventricular tachycardia (VT). The purpose of this study was to determine the value of IPs in conjunction with PM to guide VT ablation in patients with non-ischemic cardiomyopathy. Methods : 32 consecutive patients (23 male, age 56±13 years, ejection fraction 0.30±0.14) with VT and non-ischemic cardiomyopathy were analyzed. Thirty/32 patients had an implanted cardioverter defibrillator (ICD). Electroanatomic maps of the left (n=21) and right ventricle (n=13), the coronary sinus (n=3), and the epicardium (n=4) were obtained during baseline rhythm. PM was performed at sites with low voltage (<1.5mV). Radiofrequency energy was delivered at sites with concealed entrainment or matching pace-maps. Mean follow-up time was 10±9 months. Results : 173 VTs (cycle length 359±86 ms) were induced. Appropriate ablation sites with IPs during sinus rhythm were recorded in 19/32 patients (59%) (group A). In these patients, a total of 195 appropriate target sites were identified for 56/100 induced VTs (56%); 136/195 sites (70%) displayed IPs. In the remaining 13 patients, no target sites with IPs were identified (group B) despite combined endocardial and transcutaneous epicardial mapping in 3/13 patients. In these 13 patients, a total of 96 appropriate target sites were identified for 25/73 induced VTs (34%). Fifteen/19 patients (79%) in group A were non-inducible at the end of the procedure compared to 2/13 patients (15%) in group B. During a mean follow-up of 10±9 months, 15/19 patients (79%) in group A compared to 1/13 patients (8%) in group B remained arrhythmia free (p=0.0002). Conclusion : IPs in conjunction with PM are helpful in identifying critical isthmus areas for ablation of VT in patients with non-ischemic cardiomyopathy. Differences in the extent of fixed scar tissue may be the reason for differences in the prevalence of IPs, and this might explain better ablation results in some patients with non-ischemic cardiomyopathy.

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