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Mapping and ablation of ventricular tachycardia with the aid of a non-contact mapping system
R J Schilling1, N S Peters, D W Davies
1St Mary's Hospital and Imperial College School of Medicine, London, UK. r.schilling@ic.ac.uk
Insights
A novel non-contact mapping system safely treats ventricular tachycardia (VT) with low recurrence rates. This technology aids catheter ablation for coronary heart disease patients, offering a potential cure for VT.
Area of Science:
- Cardiology
- Electrophysiology
- Medical Technology
Background:
- Conventional treatments for ventricular tachycardia (VT) in coronary heart disease (CHD) are often palliative.
- Catheter ablation for VT has been limited by difficulties in mapping complex VT substrates.
- Existing mapping techniques struggle to precisely identify the electrical circuits responsible for VT.
Purpose of the Study:
- To evaluate a new non-contact mapping system for identifying VT substrates.
- To assess the efficacy and safety of catheter ablation guided by this novel technology.
- To determine if this system can facilitate curative treatment for VT.
Main Methods:
- A non-contact mapping system, including a multielectrode array catheter and computer mapping, was used in 24 patients with VT.
- Patients included those with structural heart disease and those with normal ventricles experiencing fascicular or left ventricular ectopic tachycardia.
- Radiofrequency ablation was performed targeting identified diastolic activation sites.
Main Results:
- The non-contact system identified VT exit sites in 80/81 morphologies and complete circuits in 17.
- Successful ablation was achieved in 77% of radiofrequency applications targeting diastolic activation.
- At a mean follow-up of 1.5 years, 14 patients experienced no VT recurrence, with a low rate of target VT recurrence.
Conclusions:
- The non-contact mapping system is safe and effective for mapping and ablating hemodynamically stable VT.
- This technology is associated with low VT recurrence rates.
- Further investigation is needed to confirm its efficacy in hemodynamically unstable VT patients.
Objective:
Treatment of ventricular tachycardia (VT) in coronary heart disease has to date been limited to palliative treatment with drugs or implantable defibrillators. The results of curative treatment with catheter ablation have proved disappointing because the complexity of the VT mechanism makes identification of the substrate using conventional mapping techniques difficult. The use of a mapping technology that may address some of these issues, and thus make possible a cure for VT with catheter ablation, is reported.
Patients And Intervention:
The non-contact system, consisting of a multielectrode array catheter (MEA) and a computer mapping system, was used to map VT in 24 patients. Twenty two patients had structural heart disease, the remainder having "normal" left ventricles with either fasicular tachycardia or left ventricular ectopic tachycardia.
Results:
Exit sites were demonstrated in 80 of 81 VT morphologies by the non-contact system, and complete VT circuits were traced in 17. In another 37 morphologies of VT 36 (30)% (mean (SD)) of the diastolic interval was identified. Thirty eight VT morphologies were ablated using 154 radiofrequency energy applications. Successful ablation was achieved by 77% of radiofrequency within diastolic activation identified by the non-contact system and was significantly more likely to ablate VT than radiofrequency at the VT exit, or remote from diastolic activation. Over a mean follow up of 1.5 years, 14 patients have had no recurrence of VT and only two target VTs have recurred. Five patients have had recurrence of either slower non-sustained, undocumented or fast non-target VT. Five patients have died, one from tamponade from a pre-existing temporary pacing wire, and four from causes unrelated to the procedure.
Conclusion:
The non-contact system can safely be used to map and ablate haemodynamically stable VT with low VT recurrence rates. It is yet to be established whether this system may be applied with equal success to patients with haemodynamically unstable VT.
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