Ventricular Tachycardia Originating from Moderator Band: New Perspective on Catheter Ablation

A 59-year-old woman was referred to the institution with burdens of idiopathic ventricular tachycardia (IVT). Electroanatomic mapping revealed a complex fractionated, high frequency potential with long duration preceding the QRS onset of the IVT. The real end point of ablation was the disappearance of the conduction block of Purkinje potential during the sinus rhythm besides the disappearance of the inducible tachycardia. Location of distal catheter was at the moderator band (MB) by transthoracic echocardiography (TTE). Only irrigated radiofrequency current was delivered at both insertions of the MB which can completely eliminate the IVT.

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Catheter ablation of ventricular tachycardia using radiofrequency current

Developments in Cardiovascular Medicine - Interventional Techniques in Cardiovascular Medicine ◽

10.1007/978-94-011-3802-4_32 ◽

1991 ◽

pp. 279-297 ◽

Cited By ~ 1

Author(s):

G. Breithardt ◽

G. Hindricks ◽

W. Haverkamp ◽

M. Borggrefe ◽

A. Martinez-Rubio ◽

...

Keyword(s):

Ventricular Tachycardia ◽

Catheter Ablation ◽

Radiofrequency Current

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Radiofrequency current catheter ablation for ventricular tachycardia.

Japanese Circulation Journal ◽

10.1253/jcj.58.315 ◽

1994 ◽

Vol 58 (5) ◽

pp. 315-325 ◽

Cited By ~ 4

Author(s):

MASAOMI CHINUSHI ◽

YOSHIFUSA AIZAWA ◽

YORIKO KUSANO ◽

TAKASHI WASHIZUKA ◽

TAKEFUMI MIYAJIMA ◽

...

Keyword(s):

Ventricular Tachycardia ◽

Catheter Ablation ◽

Radiofrequency Current

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Target sites for catheter ablation of unmappable ventricular tachycardia during sinus rhythm

Heart Rhythm ◽

10.1016/j.hrthm.2006.02.001 ◽

2006 ◽

Vol 3 (5) ◽

pp. 513-515

Author(s):

Etienne Delacrétaz

Keyword(s):

Ventricular Tachycardia ◽

Catheter Ablation ◽

Sinus Rhythm ◽

Target Sites

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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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