| HOME | HELP | FEEDBACK | SUBSCRIPTIONS | ARCHIVE | SEARCH | TABLE OF CONTENTS | REGISTER |
|
|
|
|
|||||||||||||
|
|
|||||||||||||||
St Mary's Hospital
and Imperial College School of Medicine, London, UK
Correspondence to: Dr R J Schilling, Waller Department of Cardiology, St Mary's Hospital, Praed Street, London W2 1NY, UK email: r.schilling{at}ic.ac.uk
Accepted for publication 18 December 1998
OBJECTIVE
Treatment
of ventricular tachycardia (VT) in coronary heart disease has to date
been limited to palliative treatment with drugs or implantable
defibrillators. The results of curative treatment with catheter
ablation have proved disappointing because the complexity of the VT
mechanism makes identification of the substrate using conventional
mapping techniques difficult. The use of a mapping technology that may
address some of these issues, and thus make possible a cure for VT with
catheter ablation, is reported.
PATIENTS AND
INTERVENTIONThe non-contact system, consisting of
a multielectrode array catheter (MEA) and a computer mapping system,
was used to map VT in 24 patients. Twenty two patients had structural
heart disease, the remainder having "normal" left ventricles with
either fasicular tachycardia or left ventricular ectopic tachycardia.
RESULTSExit sites
were demonstrated in 80 of 81 VT morphologies by the non-contact
system, and complete VT circuits were traced in 17. In another 37 morphologies of VT 36 (30)% (mean (SD)) of the diastolic interval was
identified. Thirty eight VT morphologies were ablated using 154 radiofrequency energy applications. Successful ablation was achieved by
77% of radiofrequency within diastolic activation identified by the
non-contact system and was significantly more likely to ablate VT than
radiofrequency at the VT exit, or remote from diastolic activation.
Over a mean follow up of 1.5 years, 14 patients have had no recurrence
of VT and only two target VTs have recurred. Five patients have had
recurrence of either slower non-sustained, undocumented or fast
non-target VT. Five patients have died, one from tamponade from a
pre-existing temporary pacing wire, and four from causes unrelated to
the procedure.
CONCLUSIONThe
non-contact system can safely be used to map
and ablate haemodynamically stable VT with low VT recurrence rates. It
is yet to be established whether this system may be applied with equal
success to patients with haemodynamically unstable VT.
This article has been cited by other articles:
|
|
 |
|
  M. W. Kimmel, N. D. Skadsberg, C. L. Byrd, D. J. Wright, T. G. Laske, and P. A. Iaizzo Single-site ventricular and biventricular pacing: investigation of latest depolarization strategy Europace, December 1, 2007; 9(12): 1163 - 1170. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 J. W H Fung, J. Y S Chan, G. W K Yip, H. C K Chan, W. W L Chan, Q. Zhang, and C.-M. Yu Effect of left ventricular endocardial activation pattern on echocardiographic and clinical response to cardiac resynchronization therapy Heart, April 1, 2007; 93(4): 432 - 437. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 T. H. Everett IV, E. E. Wilson, S. Foreman, and J. E. Olgin Mechanisms of Ventricular Fibrillation in Canine Models of Congestive Heart Failure and Ischemia Assessed by In Vivo Noncontact Mapping Circulation, September 13, 2005; 112(11): 1532 - 1541. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 P. Della Bella, S. Riva, G. Fassini, F. Giraldi, M. Berti, C. Klersy, and N. Trevisi Incidence and significance of pleomorphism in patients with postmyocardial infarction ventricular tachycardia: Acute and long-term outcome of radiofrequency catheter ablation Eur. Heart J., July 1, 2004; 25(13): 1127 - 1138. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
J W-H Fung, C-M Yu, G Yip, Y Zhang, H Chan, C-C Kum, and J E Sanderson Variable left ventricular activation pattern in patients with heart failure and left bundle branch block Heart, January 1, 2004; 90(1): 17 - 19. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
P D Lambiase, A Rinaldi, J Hauck, M Mobb, D Elliott, S Mohammad, J S Gill, and C A Bucknall Non-contact left ventricular endocardial mapping in cardiac resynchronisation therapy Heart, January 1, 2004; 90(1): 44 - 51. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 P. A. Friedman, S. J. Asirvatham, S. Grice, M. Glikson, T. M. Munger, R. F. Rea, W. K. Shen, A. Jahanghir, D. L. Packer, and S. C. Hammill Noncontact mapping to guide ablation of right ventricular outflow tract tachycardia J. Am. Coll. Cardiol., June 5, 2002; 39(11): 1808 - 1812. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
P. Della Bella, A. Pappalardo, S. Riva, C. Tondo, G. Fassini, and N. Trevisi Non-contact mapping to guide catheter ablation of untolerated ventricular tachycardia Eur. Heart J., May 1, 2002; 23(9): 742 - 752. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
T. Paul, B. Windhagen-Mahnert, T. Kriebel, H. Bertram, R. Kaulitz, T. Korte, M. Niehaus, and J. Tebbenjohanns Atrial Reentrant Tachycardia After Surgery for Congenital Heart Disease : Endocardial Mapping and Radiofrequency Catheter Ablation Using a Novel, Noncontact Mapping System Circulation, May 8, 2001; 103(18): 2266 - 2271. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
T. R. Betts, P. R. Roberts, S. A. Allen, A. P. Salmon, B. R. Keeton, M. P. Haw, and J. M. Morgan Electrophysiological Mapping and Ablation of Intra-Atrial Reentry Tachycardia After Fontan Surgery With the Use of a Noncontact Mapping System Circulation, July 25, 2000; 102(4): 419 - 425. [Abstract] [Full Text] [PDF]
|
|
| HOME | HELP | FEEDBACK | SUBSCRIPTIONS | ARCHIVE | SEARCH | TABLE OF CONTENTS | REGISTER |
