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The significance of repetitive ventricular responses induced by radiofrequency energy application for idiopathic left ventricular tachycardia.

Shin WS, Lee MY, Jang SW, Kim JH, Yoon HJ, Jin SW, Oh YS, Seung KB, Rho TH - J. Korean Med. Sci. (2010)

Bottom Line: Two patients received a second procedure due to the recurrence of ILVT.The mean follow-up period was 36.2+/-12.8 months.The clinical course of the remaining patients was favorable and without recurrence of ILVT.

View Article: PubMed Central - PubMed

Affiliation: Division of Cardiology, Department of Internal Medicine, The Catholic University of Korea, School of Medicine, Seoul, Korea.

ABSTRACT
In radiofrequency (RF) ablation for idiopathic left ventricular tachycardia (ILVT), the termination of tachycardia during RF ablation is considered a hallmark of success. However, in cases of patients with difficulty of induction of ventricular tachycardia (VT), the evaluation of procedural success can be problematic. We have observed thermal responses reflected as ventricular rhythm change to RF energy delivered on sinus rhythm for ILVT. We therefore describe the significance of repetitive ventricular responses. The study subjects were 11 ILVT patients for whom RF energy was delivered during sinus rhythm because of difficulty in re-induction of tachycardia. During each energy delivery, we focused on the occurrence of repetitive ventricular responses especially exhibiting a similar morphology to clinical VT. The repetitive ventricular responses were noted in 10 of 11 patients. Two patients received a second procedure due to the recurrence of ILVT. The mean follow-up period was 36.2+/-12.8 months. The clinical course of the remaining patients was favorable and without recurrence of ILVT. Based on the favorable clinical outcomes, ablation-induced repetitive ventricular responses with similar QRS morphology to clinical ILVT are useful markers for selecting an ablation site and could be used as an additional mapping method, termed as "thermal mapping".

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An example of local electrocardiogram from an ablation catheter shows both the P-potential (↓) and sinus rhythm changes to wide QRS tachycardia with radiofrequency energy delivery.P-potential, Purkinje-potential.
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Figure 2: An example of local electrocardiogram from an ablation catheter shows both the P-potential (↓) and sinus rhythm changes to wide QRS tachycardia with radiofrequency energy delivery.P-potential, Purkinje-potential.

Mentions: The attempted site of RF ablation was selected as the area in which the tachycardia was presumed to be mechanically terminated with catheter manipulation and which showed Purkinje-potential (P-potential). In cases of difficulty of VT re-induction, we searched for sites with P-potential (Fig. 2) and attempted to start ablation from the site closest to the apical septum.


The significance of repetitive ventricular responses induced by radiofrequency energy application for idiopathic left ventricular tachycardia.

Shin WS, Lee MY, Jang SW, Kim JH, Yoon HJ, Jin SW, Oh YS, Seung KB, Rho TH - J. Korean Med. Sci. (2010)

An example of local electrocardiogram from an ablation catheter shows both the P-potential (↓) and sinus rhythm changes to wide QRS tachycardia with radiofrequency energy delivery.P-potential, Purkinje-potential.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC2877221&req=5

Figure 2: An example of local electrocardiogram from an ablation catheter shows both the P-potential (↓) and sinus rhythm changes to wide QRS tachycardia with radiofrequency energy delivery.P-potential, Purkinje-potential.
Mentions: The attempted site of RF ablation was selected as the area in which the tachycardia was presumed to be mechanically terminated with catheter manipulation and which showed Purkinje-potential (P-potential). In cases of difficulty of VT re-induction, we searched for sites with P-potential (Fig. 2) and attempted to start ablation from the site closest to the apical septum.

Bottom Line: Two patients received a second procedure due to the recurrence of ILVT.The mean follow-up period was 36.2+/-12.8 months.The clinical course of the remaining patients was favorable and without recurrence of ILVT.

View Article: PubMed Central - PubMed

Affiliation: Division of Cardiology, Department of Internal Medicine, The Catholic University of Korea, School of Medicine, Seoul, Korea.

ABSTRACT
In radiofrequency (RF) ablation for idiopathic left ventricular tachycardia (ILVT), the termination of tachycardia during RF ablation is considered a hallmark of success. However, in cases of patients with difficulty of induction of ventricular tachycardia (VT), the evaluation of procedural success can be problematic. We have observed thermal responses reflected as ventricular rhythm change to RF energy delivered on sinus rhythm for ILVT. We therefore describe the significance of repetitive ventricular responses. The study subjects were 11 ILVT patients for whom RF energy was delivered during sinus rhythm because of difficulty in re-induction of tachycardia. During each energy delivery, we focused on the occurrence of repetitive ventricular responses especially exhibiting a similar morphology to clinical VT. The repetitive ventricular responses were noted in 10 of 11 patients. Two patients received a second procedure due to the recurrence of ILVT. The mean follow-up period was 36.2+/-12.8 months. The clinical course of the remaining patients was favorable and without recurrence of ILVT. Based on the favorable clinical outcomes, ablation-induced repetitive ventricular responses with similar QRS morphology to clinical ILVT are useful markers for selecting an ablation site and could be used as an additional mapping method, termed as "thermal mapping".

Show MeSH
Related in: MedlinePlus