Dr. Packer reports participation on research grants supported by Biosense Webster and Siemens and serving as a consultant or on their advisory boards; receiving honoraria relevant to this topic; owning a patent on 4-D, 5-D mapping.
Relevance of Endocavitary Structures in Ablation Procedures for Ventricular Tachycardia
Article first published online: 8 OCT 2009
© 2009 Wiley Periodicals, Inc.
Journal of Cardiovascular Electrophysiology
Volume 21, Issue 3, pages 245–254, March 2010
How to Cite
ABOUEZZEDDINE, O., SULEIMAN, M., BUESCHER, T., KAPA, S., FRIEDMAN, P. A., JAHANGIR, A., MEARS, J. A., LADEWIG, D. J., MUNGER, T. M., HAMMILL, S. C., PACKER, D. L. and ASIRVATHAM, S. J. (2010), Relevance of Endocavitary Structures in Ablation Procedures for Ventricular Tachycardia. Journal of Cardiovascular Electrophysiology, 21: 245–254. doi: 10.1111/j.1540-8167.2009.01621.x
- Issue published online: 22 FEB 2010
- Article first published online: 8 OCT 2009
- Manuscript received 20 February 2009; Revised manuscript received 20 August 2009; Accepted for publication 26 August 2009.
- ventricular tachycardia (VT);
- papillary muscle (PM);
- false tendon (FT);
- moderator band (MB);
- catheter ablation
Endocavitary Structures and Ventricular Tachycardia Ablation. Background: Radiofrequency (RF) ablation for ventricular tachycardia (VT) has high failure rates. Whether endocavitary structures (ECS) such as the papillary muscles (PMs), moderator bands (MBs), or false tendons (FTs) impact VT ablation is unknown.
Methods and Results: We retrospectively reviewed records of 190 consecutive patients presenting for VT ablation and identified 46 (24%) where ECS affected ablation. In 31 of 46 patients (67%), the ECS created difficulty with catheter manipulation (n = 20), interpretation of pace map data (n = 7), or with accurately defining a scar (n = 4). In 15 of 46 (33%), specific mapping and RF energy delivery targeting the ECS itself was necessary to eliminate the arrhythmia.
Detailed electroanatomic mapping was performed in 11 of 15 (73%), noncontact mapping in 3 of 15 (20%), multielectrode catheter mapping in 1 of 15 (7%), and intracardiac ultrasound in 14 of 15 (93%) patients. The ablated ECS was a PM in 5 of 15, the MB in 7 of 15, and an FT in 3 of 15. The arrhythmogenic substrate on the ECS was a focus of automatic tachycardia in 9 of 15 and the slow zone responsible for reentrant arrhythmia in the remaining 6 of 15. Successful elimination of tachycardia without recurrence was obtained in all 15 cases. There was no evidence of valvular damage or disruption of the valvular apparatus.
Conclusion: During VT ablation procedures, ECS should be considered for specific mapping and targeted ablation. Once recognized, these structures can be successfully targeted for ablation without valve damage. (J Cardiovasc Electrophysiol, Vol. 21, pp. 245–254, March 2010)