ABSTRACT
INTRODUCTION: Radiofrequency catheter ablation of atrial tachycardia guided by bipolar activation mapping has been reported in the last years. This article reports the use of radiofrequency catheter ablation for the treatment of atrial tachycardia using simultaneous bipolar and unipolar activation mapping at our institution. METHODS: Nine patients (7 male and 2 female, mean age 37.2 +/- 24.1 years), were selected for radiofrequency catheter ablation of drug refractory atrial tachycardia. Mapping procedure included an investigation of the local earliest bipolar and unipolar activity and unipolar morphology analysis. RESULTS: Atrial tachycardia was successfully ablated in 7 patients (78%) with an average number of 6.8 +/- 3.1 RF pulses. Procedure related complications and tachycardia follow-up recurrences were not observed in any patient. Bipolar local activation time was significantly shorter at successful than at unsuccessful ablation sites (-30 +/- 21.1 ms vs -18.3 +/- 20.6 ms; p = 0.01). No difference was observed in unipolar local activation time between successful and unsuccessful sites (-22.5 +/- 26.2 ms vs -19.8 +/- 21.5 ms; p = 0.56). Accurate localization of the successful ablation site by unipolar electrogram analysis was not feasible because a "QS" pattern was found at both 21 unsuccessful and 2 successful ablation sites. Finally, a fast slope of the negative deflection of the unipolar electrogram was found at 2 out of 45 unsuccessful and 3 out of 6 successful ablation sites. CONCLUSIONS: Radiofrequency catheter ablation of atrial tachycardia is feasible without complications in most patients. Bipolar activation mapping accurately localizes the successful ablation site. A "QS" pattern is not predictive of successful radiofrequency application.
Subject(s)
Catheter Ablation , Tachycardia, Ectopic Atrial/surgery , Adolescent , Adult , Electrocardiography , Female , Humans , Male , Middle Aged , Tachycardia, Ectopic Atrial/physiopathologyABSTRACT
BACKGROUND AND PURPOSE: It has been suggested that the efficacy of radiofrequency ablation of idiopathic ventricular tachycardia (VT) is dependent on the site of VT origin, with the efficacy being greater for VTs originating from right ventricle. The electrophysiologic characteristic and the results of radiofrequency catheter ablation of ventricular tachycardia in patients without structural heart disease are reported. Special emphasis was focused to the differences observed in the pace and activating mapping between VTs originating in the right ventricle and those originating from the left ventricle and its possible implications for radiofrequency efficacy. METHODS AND RESULTS: 14 consecutive patients with idiopathic VT (7 women and 7 men, mean age 35 +/- 16 years), 8 originating in the right ventricle (RV) and 6 in the left ventricle (LTV), underwent catheter ablation using radiofrequency energy. The observation of entrainment with fusion in all LV VT suggested that the electrophysiologic mechanism was a reentry, meanwhile the RV VT were due to focal non-reentrant mechanisms. Sites for radiofrequency energy delivery were selected on the basis of pace and activation mapping in all patients less in two patients with incessant VT in whom only activation mapping was performed. 14 VT were mapped. The activation mapping demonstrated isolated presystolic electrograms in the point of origin in all VT arising from the LV. However in RV tachycardias there was continuous activity between presystolic and systolic electrograms, although the prematurity of these electrograms was similar (31 +/- 16 ms vs 33 +/- 9 ms; p = 0.77). Radiofrequency was successful in eliminating 93% of TV (100% RV TV vs 83% LV TV; p = 0.23). No complications were observed. CONCLUSIONS: The results of this study suggest that radiofrequency ablation is highly successful either in right and left ventricles idiopathic tachycardias when pace and activation mapping are used complementary.
