Feasibility of Targeting Catheter Ablation to the Markedly Low-Voltage Area Surrounding Infarct Scars in Patients With Post-Infarction Ventricular Tachycardia

Kentaro Yoshida; Yukio Sekiguchi; Kazuyuki Tanoue; Masae Endo; Akihiro Suzuki; Miyako Kanemoto; Hiro Yamasaki; Yasuteru Yamauchi; Atsushi Takahashi; Keisuke Kuga; Iwao Yamaguchi; Kazutaka Aonuma

doi:10.1253/circj.72.1112

Clinical Investigation

Feasibility of Targeting Catheter Ablation to the Markedly Low-Voltage Area Surrounding Infarct Scars in Patients With Post-Infarction Ventricular Tachycardia

Kentaro Yoshida, Yukio Sekiguchi, Kazuyuki Tanoue, Masae Endo, Akihiro Suzuki, Miyako Kanemoto, Hiro Yamasaki, Yasuteru Yamauchi, Atsushi Takahashi, Keisuke Kuga, Iwao Yamaguchi, Kazutaka Aonuma

Author information

Kentaro Yoshida
Cardiovascular Division, Institute of Clinical Medicine, University of Tsukuba
Yukio Sekiguchi
Cardiovascular Division, Institute of Clinical Medicine, University of Tsukuba
Kazuyuki Tanoue
Cardiovascular Division, Institute of Clinical Medicine, University of Tsukuba
Masae Endo
Cardiovascular Division, Institute of Clinical Medicine, University of Tsukuba
Akihiro Suzuki
Cardiovascular Division, Institute of Clinical Medicine, University of Tsukuba
Miyako Kanemoto
Cardiovascular Division, Institute of Clinical Medicine, University of Tsukuba
Hiro Yamasaki
Cardiovascular Division, Institute of Clinical Medicine, University of Tsukuba
Yasuteru Yamauchi
Cardiovascular Division, Musashino Red Cross Hospital
Atsushi Takahashi
Cardiovascular Center, Yokosuka Kyousai Hospital
Keisuke Kuga
Cardiovascular Division, Institute of Clinical Medicine, University of Tsukuba
Iwao Yamaguchi
Cardiovascular Division, Institute of Clinical Medicine, University of Tsukuba
Kazutaka Aonuma
Cardiovascular Division, Institute of Clinical Medicine, University of Tsukuba

Keywords: Catheter ablation, Mapping, Myocardial infarction, Ventricular tachycardia

JOURNAL FREE ACCESS

2008 Volume 72 Issue 7 Pages 1112-1119

DOI https://doi.org/10.1253/circj.72.1112

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Abstract

Background In routine substrate mapping of the left ventricle, an abnormal area is defined as having an amplitude <1.5 mV. However, that is usually too large for catheter ablation in post-infarction ventricular tachycardia (VT) and the use of strict voltage criteria may produce better outcomes. Methods and Results Twenty patients with post-infarction VT underwent substrate mapping using an electroanatomic mapping system. Strict voltage criteria were defined as: non-arrhythmogenic area, >0.6 mV; low-voltage area (LVA), >0.1 to ≤0.6 mV; scar, ≤0.1 mV. Radiofrequency applications targeted the LVA only, which was 48±26 cm², 55% smaller than that of the generally targeted area with an amplitude ≤1.5 mV. The prevalence of delayed electrograms (duration ≥150 ms) was significantly higher in the LVAs than in the border areas with an amplitude of >0.6 to ≤1.5 mV (33.2% vs 3.7%, p<0.001). With the exception of 2 instances of peri-mitral VT, all VT isthmuses resided within the LVA. During follow-up of 24±13 months, 16 patients (80%) have been free of any VT episodes. Conclusions Catheter ablation targeting LVAs with an amplitude ≤0.6 mV appears to be useful for efficient and effective treatment of post-infarction VT. (Circ J 2008; 72: 1112 - 1119)

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