1/193. Radiofrequency catheter ablation as primary therapy for symptomatic ventricular tachycardia.Most applications of radiofrequency (RF) catheter ablation for treatment of ventricular tachycardia (VT) have been as a treatment of last resort. The purpose of this study was to determine the efficacy and safety of RF catheter ablation as the primary treatment for symptomatic single morphology VT. Eleven of 81 patients (14%) with inducible sustained monomorphic VT underwent RF ablation as the primary treatment. One of these 11 patients had successful RF ablation of bundle branch reentry VT and was excluded from this series. The remaining 10 patients had a mean age of 58 /- 19 years (range 20 to 73 years), were mostly men (7 of 10 patients), and all presented with documented evidence of symptomatic sustained monomorphic VT, at a mean cycle length of 340 /- 60 milliseconds (ms) (range 250 to 430 ms). Six patients had coronary artery disease (CAD), one had surgical repair for tetralogy of fallot, one had surgical repair of a ventricular septal defect, and two had a normal cardiac substrate. The VT origin was mapped using a combination of activation mapping, mid-diastolic potentials, pace mapping, and concealed entrainment. A mean of 5 /- 3 (range 2 to 11) RF applications were administered to the putative VT foci. Eight of 10 (80%) clinical VTs were successfully ablated. There were no serious complications. patients with VT originating from the left ventricle were offered implantable cardioverter-defibrillator back-up; however, only one patient accepted this option. At a mean follow-up of 12 /- 7 months, only one patient had a possible arrhythmia recurrence.- - - - - - - - - - ranking = 1keywords = ablation (Clic here for more details about this article) |
2/193. Radiofrequency catheter ablation of coexistent atrioventricular reciprocating tachycardia and left ventricular tachycardia originating in the left anterior fascicle.Coexistence of supraventricular tachycardia and ventricular tachycardia is rare. A patient with no structural heart disease and wide QRS complex tachycardia with a right bundle block configuration and right-axis deviation underwent electrophysiological examination. A concealed left atrioventricular pathway (AP) was found, and atrioventricular reciprocating tachycardia (AVRT) and left ventricular tachycardia (VT) originating in or close to the anterior fascicle of the left ventricle were both induced. Radiofrequency (RF) catheter ablation of the concealed left AP was successfully performed. Ten months later, VT recurred and was successfully ablated using a local Purkinje potential as a guide. Coexistent AVRT and idiopathic VT originating from within or near the left anterior fascicle were successfully ablated.- - - - - - - - - - ranking = 0.625keywords = ablation (Clic here for more details about this article) |
3/193. Histopathologic effects of radiofrequency catheter ablation in previously infarcted human myocardium.INTRODUCTION: The use of catheter-based radiofrequency (RF) ablation for the treatment of ventricular tachyarrhythmias due to previous myocardial infarction has been steadily increasing. The histopathologic changes caused by this technique are not well described in humans. methods AND RESULTS: Three patients with hemodynamically tolerated ventricular tachycardias (VTs) due to previous myocardial infarction underwent endocardial mapping and catheter based RF ablation. All patients received between 5 and 11 RF lesions each of 60-second duration. One patient underwent myocardial resection of a left ventricular aneurysm 1 day following RF ablation, one expired 7 days after RF ablation, and one expired 9 months after RF ablation. None of the deaths occurred as a result of RF ablation. Pathologic specimens obtained early after RF ablation revealed areas of focal acute inflammation and fibrin deposition. Later specimens revealed several focal areas of fibrosis and granulation tissue. Specimens obtained late after RF ablation revealed a dense band of fibrosis, measuring 17 x 17 x 5 mm (1,250 mm3). CONCLUSION: Catheter-based RF ablation of ischemic VT in humans causes lesions that initially resemble coagulation necrosis. This is followed by the development of an inflammatory infiltrate and, finally, the development of fibrosis. Repeated application of RF ablation may result in much larger lesions than have been previously reported.- - - - - - - - - - ranking = 1.75keywords = ablation (Clic here for more details about this article) |
4/193. Left posterior fascicular tachycardia: a diagnostic and therapeutic challenge.A wide QRS complex tachycardia with right bundle-branch block morphology and left axis deviation observed in a young patient without structural heart disease may pose a diagnostic and therapeutic challenge. The surface ECG may provide several diagnostic clues to make a correct diagnosis of left posterior fascicular tachycardia and may help to differentiate it from both a supraventricular tachycardia with aberrant conduction and a typical ventricular tachycardia related to coronary artery disease. Although this tachycardia is sensitive to verapamil, this medication may probably cause transient infertility in males. The presence of a Purkinje potential preceding the QRS complex during tachycardia and optimal pace mapping may guide radio-frequency ablation resulting in a definite cure.- - - - - - - - - - ranking = 0.125keywords = ablation (Clic here for more details about this article) |
5/193. Electroanatomic mapping for radiofrequency ablation of cardiac arrhythmias.Radiofrequency catheter ablation is the current treatment of choice for several cardiac arrhythmias. The conventional approach utilizing intracardiac electrograms during sinus rhythm and during tachycardia has inherent limitations including limited two-dimensional fluoroscopic imaging and the ability to evaluate several potential sites for ablation and to go precisely to the most suitable site. Recently, a nonfluoroscopic three-dimensional electroanatomic system has been developed for mapping arrhythmias. We describe in this report the advantage of utilizing the system in facilitating a successful outcome in three patients with different arrhythmias.- - - - - - - - - - ranking = 0.75keywords = ablation (Clic here for more details about this article) |
6/193. Radiofrequency catheter ablation of idiopathic right ventricular tachycardia near the His bundle.There are only a few reports on successful radiofrequency catheter ablation of idiopathic right ventricular tachycardia (VT) originating from other sites than right ventricular outflow tract. We report here a case of VT which exhibited an inferior-axis and a left bundle branch block pattern and originated near the His bundle. Using the temperature-controlled ablation catheter, prudent observation of the fluoroscopy and intracardiac electrograms during pacemapping, we successfully ablated the origin of the VT without any conduction disturbance. However, further study is required to determine the effectiveness of catheter ablation and the long term prognosis for this type of VT.- - - - - - - - - - ranking = 0.875keywords = ablation (Clic here for more details about this article) |
7/193. Radiofrequency catheter ablation of left ventricular outflow tract tachycardia from the coronary cusp: a new approach to the tachycardia focus.INTRODUCTION: Idiopathic ventricular tachycardia (VT) originating from the left ventricular outflow tract (LVOT) is rare. Previously reported were two cases of LVOT tachycardia which were treated with radiofrequency (RF) catheter ablation through endocardial aortomitral continuity. We report here a case of a repetitive LVOT tachycardia in which the QRS morphology during VT exhibited an atypical left bundle branch block and inferior axis. Pace mapping revealed that the origin of this VT was very close to the left sinus of valsalva. Transcoronary cusp RF catheter ablation abolished the VT in this patient and is a new approach for the treatment of this kind of VT. The application of this approach to the other types of VT has yet to be determined.- - - - - - - - - - ranking = 0.75keywords = ablation (Clic here for more details about this article) |
8/193. epicardial mapping and radiofrequency catheter ablation of ischemic ventricular tachycardia using a three-dimensional nonfluoroscopic mapping system.Endocardial radiofrequency catheter ablation of ischemic left ventricular tachycardia has been of variable success due to multiple factors. Two such factors include the location of the reentrant circuit in the deep myocardium or on the epicardial surface and the inherent limitations of fluoroscopy as a guide for target localization. We report a patient in whom successful epicardial mapping and radiofrequency catheter ablation of an ischemic left ventricular tachycardia was performed using pericardial access and the CARTO electroanatomic mapping system.- - - - - - - - - - ranking = 0.75keywords = ablation (Clic here for more details about this article) |
9/193. Successful catheter ablation against ventricular tachycardia associated with myotonic dystrophy.myotonic dystrophy (MD) is characterized by myotonia and muscular dystrophy and cardiac involvement with tachy-arrhythmia is rarely encountered. We report a case of MD complicated with severe left ventricular hypofunction and incessant ventricular tachycardia (VT) with varying heart rates. The morphology of VT suggested that it originated from the right ventricular outflow tract, and electrophysiological study disclosed that the mechanism of VT was abnormal automaticity. catheter ablation was performed to treat this VT. The patient had a cardiomyopathy with normal coronary arteries. The specimen of RV biopsy showed moderate hypertrophy, mild fat infiltration and slight fibrosis. These findings are histologically consistent with myotonic dystrophy.- - - - - - - - - - ranking = 0.625keywords = ablation (Clic here for more details about this article) |
10/193. Incessant ventricular tachycardia early after acute myocardial infarction: efficacy of radiofrequency catheter ablation but not of optimal coronary revascularization.Incessant ventricular tachycardia is an arrhythmia refractory to conventional antiarrhythmic treatment. We describe the case of 55-year-old man who presented incessant ventricular tachycardia in the early post-acute phase of myocardial infarction. Optimal coronary revascularization was not effective, but radiofrequency catheter ablation was able to eliminate the anatomic substrate and clinical arrhythmic recurrence.- - - - - - - - - - ranking = 0.625keywords = ablation (Clic here for more details about this article) |
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