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LIMITED LINEAR ABLATION FOR REGIONAL SCAR ENCIRCLING TO TREAT POST-INFARCTION VENTRICULAR TACHYCARDIA USING A STANDARDIZED MAPPING AND ABLATION APPROACH
A11.E111 JACC March 9, 2010 Volume 55, issue 10A
CARDIAC ARRHYTHMIAS LIMITED LINEAR ABLATION FOR REGIONAL SCAR ENCIRCLING TO TREAT POST-INFARCTION VENTRICULAR TACHYCARDIA USING A STANDARDIZED MAPPING AND ABLATION APPROACH ACC Poster Contributions Georgia World Congress Center, Hall B5 Monday, March 15, 2010, 3:30 p.m.-4:30 p.m.
Session Title: Mapping and Ablation of Ventricular Tachycardia: New Insights Abstract Category: Clinical Electrophysiology--Ventricular Arrhythmias Presentation Number: 1190-142 Authors: Thomas Deneke, Thomas Lawo, Dong-In Shin, Marc Horlitz, Andreas Mügge, Leif Bösche, Bernd Lemke, Academic Heart Center Cologne, Cologne, Germany Background: Ablation of ventricular tachycardia (VT) can be achieved using anatomically guided approaches using differentiated mapping and ablation techniques. We attempted to evaluate the efficacy of limited linear ablation in the VT exit region identified using a simplified sinus rhythm (SR) mapping protocol. Methods: Patients with frequent clinical post-myocardial infarction VT were included. Left ventricular substrate mapping during SR to identify scar and border zone based on endocardial bipolar voltage was performed. The exit site of the target VT was regionalized by a simplified vector-pacemapping approach and targeted using limited linear ablation within the scar border zone. During ablation all inducible VTs were targeted. Results: 145 patients with a mean number of 2.6(±1.5) inducible VTs were included and the clinical VT was identified. Pace-mapping to regionalize the exit site of each VT by correspondence of QRS-vectors. A median of 9 pacing sites were tested to determine the site with best pace-map match. A mean of 780 (±460)seconds ablation energy was applied to perform regional limited scar encircling ablation. In 141 patients (91%) the clinical VT was successfully ablated. In these patients a total of 247 VTs (68%) were successfully ablated producing complete success (no sustained VT inducible at the end of the procedure) was achieved in 88 patients (61%) whereas in 53 VTs were still inducible. During a median follow-up of 13 months (9 - 48) 109 patients (75%) remained free from any sustained ventricular arrhythmia as indicated in ICD-holter recordings. The number of episodes detected in patients with ventricular arrhythmia during follow-up was significantly reduced compared to pre-ablation. Patients with complete success had a significantly lower number of ventricular arrhythmia episodes than patients with incomplete ablation success (11% versus 37%, p=0.002). Conclusions: Post-infarct VT can effectively be ablated in 97% without mapping during ongoing VT using a simplified regional linear ablation approach targeting the scar border zone. Freedom from any ventricular arrhythmia can be achieved in 77% of patients during mid-term follow-up.
CARDIAC ARRHYTHMIAS LIMITED LINEAR ABLATION FOR REGIONAL SCAR ENCIRCLING TO TREAT POST-INFARCTION VENTRICULAR TACHYCARDIA USING A STANDARDIZED MAPPING AND ABLATION APPROACH ACC Poster Contributions Georgia World Congress Center, Hall B5 Monday, March 15, 2010, 3:30 p.m.-4:30 p.m.
Session Title: Mapping and Ablation of Ventricular Tachycardia: New Insights Abstract Category: Clinical Electrophysiology--Ventricular Arrhythmias Presentation Number: 1190-142 Authors: Thomas Deneke, Thomas Lawo, Dong-In Shin, Marc Horlitz, Andreas Mügge, Leif Bösche, Bernd Lemke, Academic Heart Center Cologne, Cologne, Germany Background: Ablation of ventricular tachycardia (VT) can be achieved using anatomically guided approaches using differentiated mapping and ablation techniques. We attempted to evaluate the efficacy of limited linear ablation in the VT exit region identified using a simplified sinus rhythm (SR) mapping protocol. Methods: Patients with frequent clinical post-myocardial infarction VT were included. Left ventricular substrate mapping during SR to identify scar and border zone based on endocardial bipolar voltage was performed. The exit site of the target VT was regionalized by a simplified vector-pacemapping approach and targeted using limited linear ablation within the scar border zone. During ablation all inducible VTs were targeted. Results: 145 patients with a mean number of 2.6(±1.5) inducible VTs were included and the clinical VT was identified. Pace-mapping to regionalize the exit site of each VT by correspondence of QRS-vectors. A median of 9 pacing sites were tested to determine the site with best pace-map match. A mean of 780 (±460)seconds ablation energy was applied to perform regional limited scar encircling ablation. In 141 patients (91%) the clinical VT was successfully ablated. In these patients a total of 247 VTs (68%) were successfully ablated producing complete success (no sustained VT inducible at the end of the procedure) was achieved in 88 patients (61%) whereas in 53 VTs were still inducible. During a median follow-up of 13 months (9 - 48) 109 patients (75%) remained free from any sustained ventricular arrhythmia as indicated in ICD-holter recordings. The number of episodes detected in patients with ventricular arrhythmia during follow-up was significantly reduced compared to pre-ablation. Patients with complete success had a significantly lower number of ventricular arrhythmia episodes than patients with incomplete ablation success (11% versus 37%, p=0.002). Conclusions: Post-infarct VT can effectively be ablated in 97% without mapping during ongoing VT using a simplified regional linear ablation approach targeting the scar border zone. Freedom from any ventricular arrhythmia can be achieved in 77% of patients during mid-term follow-up.