Catheter Ablation of Idiopathic Left Ventricular Tachycardia
Identifieur interne : 004065 ( Main/Exploration ); précédent : 004064; suivant : 004066Catheter Ablation of Idiopathic Left Ventricular Tachycardia
Auteurs : Marco Zardini [Canada] ; Ranjan K. Thakur [Canada] ; George J. Klein [Canada] ; Raymond Yee [Canada]Source :
- Pacing and Clinical Electrophysiology [ 0147-8389 ] ; 1995-06.
English descriptors
Abstract
ZARDINI, M., etal.: Catheter Ablation of Idiopathic Left Ventricular Tachycardia. Idiopathic left ventricular tachycardia (ILVT) characterized by right bundle branch block, left axis morphology, response to verapamil and inducibility from the atrium in patients without structural heart disease may represent a distinct clinical entity. We report our experience with catheter ablation of this uncommon arrhythmia using radiofrequency energy (RF) and/or direct current (DC) shocks. Six men and 2 women, aged 16–50 years (mean ± SD, 32 ± 13), had recurrent VT for 16 ± 16 years with a mean frequency of 4 ± 3 episodes/ year. Three patients had syncope during VT. None had identifiable structural heart disease. Catheter ablation was guided by earliest endocardial activation, presence of a high frequency presystolic potential and/or pacemapping of the left ventricle. The left ventricle was accessed via a retrograde aortic approach in 6 patients, a transeptal approach in 1 patient, and a combined approach in the remaining patient. All patients had inducible right bundle branch block morphology, left axis VT with a mean cycle length (CL) of 361 ± 61 ms. A presystolic potential preceding ventricular activation and the His potential during VT was identified in 4 patients. All ablation sites were identified in a relatively uniform location, in the inferoapical left ventricle. Noninducibility of VT was obtained with RF in 3 patients and with DC in 5 patients. In 1 patient, DC delivery after unsuccessful RF prevented further inducibility. Similarly, RF was successful in 1 patient in whom an initial DC attempt was ineffective. Mean total procedure time was 282 ± 51 minutes and mean total fluoroscopy time was 40 ± 15 minutes. There were no complications. One patient treated with DC shock had recurrence of VT during treadmill test the day after ablation and refused repeat ablation. During a mean follow‐up of 17 ± 13 months, no VT recurrences or other cardiovascular events occurred. In conclusion, catheter ablation in the inferoapical left ventricle is an effective treatment for this type of ILVT. RF energy can be safely complemented by low energy DC shocks when the former is ineffective.
Url:
DOI: 10.1111/j.1540-8159.1995.tb06965.x
Affiliations:
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Klein</name><affiliation wicri:level="1"><country xml:lang="fr">Canada</country><wicri:regionArea>Arrhythmia Service, University Hospital, London, Ontario</wicri:regionArea><wicri:noRegion>Ontario</wicri:noRegion></affiliation></author><author><name sortKey="Yee, Raymond" sort="Yee, Raymond" uniqKey="Yee R" first="Raymond" last="Yee">Raymond Yee</name><affiliation wicri:level="1"><country xml:lang="fr">Canada</country><wicri:regionArea>Arrhythmia Service, University Hospital, London, Ontario</wicri:regionArea><wicri:noRegion>Ontario</wicri:noRegion></affiliation></author></analytic><monogr></monogr><series><title level="j">Pacing and Clinical Electrophysiology</title><idno type="ISSN">0147-8389</idno><idno type="eISSN">1540-8159</idno><imprint><publisher>Blackwell Publishing Ltd</publisher><pubPlace>Oxford, UK</pubPlace><date type="published" when="1995-06">1995-06</date><biblScope unit="volume">18</biblScope><biblScope unit="issue">6</biblScope><biblScope unit="page" from="1255">1255</biblScope><biblScope unit="page" to="1265">1265</biblScope></imprint><idno type="ISSN">0147-8389</idno></series><idno type="istex">4BE06660817071410A32C585D8D8E13393BE2810</idno><idno type="DOI">10.1111/j.1540-8159.1995.tb06965.x</idno><idno type="ArticleID">PACE1255</idno></biblStruct></sourceDesc><seriesStmt><idno type="ISSN">0147-8389</idno></seriesStmt></fileDesc><profileDesc><textClass><keywords scheme="KwdEn" xml:lang="en"><term>arrhythmias</term><term>catheter ablation</term><term>radiofrequency ablation</term><term>ventricular tachycardia</term></keywords></textClass><langUsage><language ident="en">en</language></langUsage></profileDesc></teiHeader><front><div type="abstract">ZARDINI, M., etal.: Catheter Ablation of Idiopathic Left Ventricular Tachycardia. Idiopathic left ventricular tachycardia (ILVT) characterized by right bundle branch block, left axis morphology, response to verapamil and inducibility from the atrium in patients without structural heart disease may represent a distinct clinical entity. We report our experience with catheter ablation of this uncommon arrhythmia using radiofrequency energy (RF) and/or direct current (DC) shocks. Six men and 2 women, aged 16–50 years (mean ± SD, 32 ± 13), had recurrent VT for 16 ± 16 years with a mean frequency of 4 ± 3 episodes/ year. Three patients had syncope during VT. None had identifiable structural heart disease. Catheter ablation was guided by earliest endocardial activation, presence of a high frequency presystolic potential and/or pacemapping of the left ventricle. The left ventricle was accessed via a retrograde aortic approach in 6 patients, a transeptal approach in 1 patient, and a combined approach in the remaining patient. All patients had inducible right bundle branch block morphology, left axis VT with a mean cycle length (CL) of 361 ± 61 ms. A presystolic potential preceding ventricular activation and the His potential during VT was identified in 4 patients. All ablation sites were identified in a relatively uniform location, in the inferoapical left ventricle. Noninducibility of VT was obtained with RF in 3 patients and with DC in 5 patients. In 1 patient, DC delivery after unsuccessful RF prevented further inducibility. Similarly, RF was successful in 1 patient in whom an initial DC attempt was ineffective. Mean total procedure time was 282 ± 51 minutes and mean total fluoroscopy time was 40 ± 15 minutes. There were no complications. One patient treated with DC shock had recurrence of VT during treadmill test the day after ablation and refused repeat ablation. During a mean follow‐up of 17 ± 13 months, no VT recurrences or other cardiovascular events occurred. In conclusion, catheter ablation in the inferoapical left ventricle is an effective treatment for this type of ILVT. RF energy can be safely complemented by low energy DC shocks when the former is ineffective.</div></front></TEI><affiliations><list><country><li>Canada</li></country></list><tree><country name="Canada"><noRegion><name sortKey="Zardini, Marco" sort="Zardini, Marco" uniqKey="Zardini M" first="Marco" last="Zardini">Marco Zardini</name></noRegion><name sortKey="Klein, George J" sort="Klein, George J" uniqKey="Klein G" first="George J." last="Klein">George J. Klein</name><name sortKey="Thakur, Ranjan K" sort="Thakur, Ranjan K" uniqKey="Thakur R" first="Ranjan K." last="Thakur">Ranjan K. Thakur</name><name sortKey="Yee, Raymond" sort="Yee, Raymond" uniqKey="Yee R" first="Raymond" last="Yee">Raymond Yee</name></country></tree></affiliations></record>Pour manipuler ce document sous Unix (Dilib)
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