Related Experiment Videos
Discrete systolic potentials during ventricular tachycardia in patients with prior myocardial infarction
1Department of Internal Medicine, University of Michigan Medical Center, Ann Arbor 48109-0022, USA.
Insights
Discrete systolic potentials, previously undescribed, are significant during ventricular tachycardia (VT) ablation in coronary artery disease patients. Matching these potentials to concealed entrainment intervals predicts successful radiofrequency ablation.
Area of Science:
- Cardiology
- Electrophysiology
- Medical Devices
Background:
- Isolated diastolic potentials aid ventricular tachycardia (VT) ablation in coronary artery disease.
- Discrete systolic potentials during VT in this population were previously undescribed.
Purpose of the Study:
- To determine the significance of discrete systolic potentials during VT in patients with coronary artery disease.
Main Methods:
- Radiofrequency catheter ablation was performed on 42 VTs in 27 patients with coronary artery disease.
- Target sites were selected based on concealed entrainment.
- Discrete systolic potentials were recorded during VT.
Main Results:
- A discrete systolic potential was recorded in 17% of VTs.
- The interval between the discrete systolic potential and the next QRS complex matched the stimulus-QRS interval during concealed entrainment.
- Successful VT ablation was achieved at all sites with recorded discrete systolic potentials.
Conclusions:
- Discrete systolic potentials occur in approximately 17% of VTs with concealed entrainment in coronary artery disease patients.
- Matching the discrete systolic potential to QRS interval with concealed entrainment predicts successful radiofrequency ablation.
Introduction:
Isolated diastolic potentials have been found to be helpful in identifying critical sites for ablation of ventricular tachycardia (VT) in patients with coronary artery disease. However, discrete potentials that occur during systole have not been previously described. The purpose of this study was to determine the significance of discrete systolic potentials during VT in patients with coronary artery disease.
Methods And Results:
Twenty-seven patients with a mean age of 66 +/- 12 years ( +/- standard deviation) who had coronary artery disease underwent radiofrequency catheter ablation of 42 VTs that had a mean cycle length of 486 +/- 78 msec. The only criterion used to select target sites for ablation was concealed entrainment, which was present at 92 sites. Thirty-five of the 42 VTs (83%) were successfully ablated. A discrete systolic potential was recorded during 7 of the 42 VTs (17%). In all cases, the interval between the discrete systolic potential and the next QRS complex was equal to the stimulus-QRS interval during concealed entrainment. At all seven sites where a discrete systolic potential was recorded, delivery of radiofrequency energy resulted in successful ablation of the VT.
Conclusion:
Discrete systolic potentials may be present in patients with coronary artery disease in approximately 17% of VTs in which there is concealed entrainment. If the interval between the discrete systolic potential and the next QRS complex matches the stimulus-QRS interval during concealed entrainment, delivery of radiofrequency energy is likely to result in successful ablation of the VT.