Entrainment mapping and radiofrequency catheter ablation of ventricular tachycardia in right ventricular dysplasia

Objectives. The purpose of this study was to determine if entrainment mapping techniques and predictors of successful ablation sites previously tested in coronary artery disease can be applied to ventricular tachycardia (VT) in arrhythmogenic right ventricular dysplasia (ARVD). Background. VT in ARV...

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Bibliographic Details
Published in:Journal of the American College of Cardiology 1998-09, Vol.32 (3), p.724-728
Main Authors: Ellison, KristinE, Friedman, PeterL, Ganz, LeonardI, Stevenson, WilliamG
Format: Article
Language:English
Subjects:
Adult
Aged
Arrhythmogenic Right Ventricular Dysplasia - physiopathology
Arrhythmogenic Right Ventricular Dysplasia - surgery
Cardiac Pacing, Artificial
Catheter Ablation
Electrocardiography
Female
Heart Ventricles - physiopathology
Heart Ventricles - surgery
Humans
Male
Middle Aged
Postoperative Complications - physiopathology
Tachycardia, Ventricular - physiopathology
Tachycardia, Ventricular - surgery
Treatment Outcome
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Summary:Objectives. The purpose of this study was to determine if entrainment mapping techniques and predictors of successful ablation sites previously tested in coronary artery disease can be applied to ventricular tachycardia (VT) in arrhythmogenic right ventricular dysplasia (ARVD). Background. VT in ARVD has not been well characterized. Reentry circuits in areas of abnormal myocardium are the likely cause, but these circuits have not been well defined. Methods. Mapping of 19 VTs in 5 patients with ARVD was performed. At 58 sites pacing entrained VT and radiofrequency current (RF) was applied to assess acute termination of VT. Results. Sites classified as exits, central/proximal, inner loop, outer loop, remote bystander and adjacent bystander were identified by entrainment criteria. The reentrant circuit sites were clustered predominantly around the tricuspid annulus and in the right ventricular outflow tract (RVOT). RF ablation acutely terminated VT at 13 sites or 22% of the applications. Of the 19 VTs, eight were rendered noninducible and three were modified to a longer cycle length. In 2 patients ablation at a single site abolished two VTs. Conclusion. VT in ARVD shows many of the characteristics of VT due to myocardial infarction. Entrainment mapping techniques can be used to characterize reentry circuits in ARVD. The use of entrainment mapping to guide ablation is feasible.
ISSN:0735-1097
1558-3597
DOI:10.1016/S0735-1097(98)00292-7