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- W2180965322 abstract "Background Multiple strategies for ablation of monomorphic ventricular tachycardia (VT) remote after myocardial infarction have been proposed. Definition of the most relevant isthmus site remains a common therapeutic problem.Methods and Results 7 pts with documented recurrent and inducible or incessant monomorphic VT have been included in the study. Noncontact maps were obtained using the Ensite-Array® system during VT, programmed right ventricular stimulation (PVS) and sinus rhythm (SR). Geometry creation and ablation was performed with a 7F, 4mm irrigated tip catheter (50W, 60°, 17ml/s flow).In all pts multiple, median 4 (3-6), VT morphologies were inducible by PVS or overdrive stimulation. In 6 pts an endocardial origin was associated with the clinical VT. In 4 pts the clinical VT isthmus was identified by late activation during SR and concurrent left ventricular (LV) activation via the isthmus in addition to the septal activation wave during PVS (fig.). This was not the observed for any other than the clinical VT isthmus. Short ablation lines of 8 (5-12) radiofrequency current applications perpendicular to the direction of activation at the isthmus exit site rendered the clinical VT noninducible in all pts with endocardial reentries. Additional linear lesions were employed for the treatment of further inducible, predominantly faster, VTs.Conclusion Late and simultaneous activation of the LV can readily be identified by noncontact mapping and is indicative for the dominant isthmus. Short ablation lines at this site are effective for the treatment of the dominant VT. ![Graphic][1] [1]: /embed/graphic-1.gif" @default.
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- W2180965322 date "2005-10-01" @default.
- W2180965322 modified "2023-09-25" @default.
- W2180965322 title "15. Ventricular Arrhythmias" @default.
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!["Background Multiple strategies for ablation of monomorphic ventricular tachycardia (VT) remote after myocardial infarction have been proposed. Definition of the most relevant isthmus site remains a common therapeutic problem.Methods and Results 7 pts with documented recurrent and inducible or incessant monomorphic VT have been included in the study. Noncontact maps were obtained using the Ensite-Array® system during VT, programmed right ventricular stimulation (PVS) and sinus rhythm (SR). Geometry creation and ablation was performed with a 7F, 4mm irrigated tip catheter (50W, 60°, 17ml/s flow).In all pts multiple, median 4 (3-6), VT morphologies were inducible by PVS or overdrive stimulation. In 6 pts an endocardial origin was associated with the clinical VT. In 4 pts the clinical VT isthmus was identified by late activation during SR and concurrent left ventricular (LV) activation via the isthmus in addition to the septal activation wave during PVS (fig.). This was not the observed for any other than the clinical VT isthmus. Short ablation lines of 8 (5-12) radiofrequency current applications perpendicular to the direction of activation at the isthmus exit site rendered the clinical VT noninducible in all pts with endocardial reentries. Additional linear lesions were employed for the treatment of further inducible, predominantly faster, VTs.Conclusion Late and simultaneous activation of the LV can readily be identified by noncontact mapping and is indicative for the dominant isthmus. Short ablation lines at this site are effective for the treatment of the dominant VT. ![Graphic][1] [1]: /embed/graphic-1.gif"](?object=%22Background%20Multiple%20strategies%20for%20ablation%20of%20monomorphic%20ventricular%20tachycardia%20(VT)%20remote%20after%20myocardial%20infarction%20have%20been%20proposed.%20Definition%20of%20the%20most%20relevant%20isthmus%20site%20remains%20a%20common%20therapeutic%20problem.Methods%20and%20Results%207%20pts%20with%20documented%20recurrent%20and%20inducible%20or%20incessant%20monomorphic%20VT%20have%20been%20included%20in%20the%20study.%20Noncontact%20maps%20were%20obtained%20using%20the%20Ensite-Array%C2%AE%20system%20during%20VT%2C%20programmed%20right%20ventricular%20stimulation%20(PVS)%20and%20sinus%20rhythm%20(SR).%20Geometry%20creation%20and%20ablation%20was%20performed%20with%20a%207F%2C%204mm%20irrigated%20tip%20catheter%20(50W%2C%2060%C2%B0%2C%2017ml%2Fs%20flow).In%20all%20pts%20multiple%2C%20median%204%20(3-6)%2C%20VT%20morphologies%20were%20inducible%20by%20PVS%20or%20overdrive%20stimulation.%20In%206%20pts%20an%20endocardial%20origin%20was%20associated%20with%20the%20clinical%20VT.%20In%204%20pts%20the%20clinical%20VT%20isthmus%20was%20identified%20by%20late%20activation%20during%20SR%20and%20concurrent%20left%20ventricular%20(LV)%20activation%20via%20the%20isthmus%20in%20addition%20to%20the%20septal%20activation%20wave%20during%20PVS%20(fig.).%20This%20was%20not%20the%20observed%20for%20any%20other%20than%20the%20clinical%20VT%20isthmus.%20Short%20ablation%20lines%20of%208%20(5-12)%20radiofrequency%20current%20applications%20perpendicular%20to%20the%20direction%20of%20activation%20at%20the%20isthmus%20exit%20site%20rendered%20the%20clinical%20VT%20noninducible%20in%20all%20pts%20with%20endocardial%20reentries.%20Additional%20linear%20lesions%20were%20employed%20for%20the%20treatment%20of%20further%20inducible%2C%20predominantly%20faster%2C%20VTs.Conclusion%20Late%20and%20simultaneous%20activation%20of%20the%20LV%20can%20readily%20be%20identified%20by%20noncontact%20mapping%20and%20is%20indicative%20for%20the%20dominant%20isthmus.%20Short%20ablation%20lines%20at%20this%20site%20are%20effective%20for%20the%20treatment%20of%20the%20dominant%20VT.%20!%5BGraphic%5D%5B1%5D%20%5B1%5D%3A%20%2Fembed%2Fgraphic-1.gif%22){kind=link}