[Endocardial ablation of substrate of postinfarction ventricular tachycardia during sinus rhythm]

Radiofrequency ablation of ventricular tachycardia requires good tachycardia tolerance during mapping and entrainment, and this limits its application. We present our initial experience with ventricular tachycardia ablation during sinus rhythm in 7 patients with previous inferior myocardial infarction.

Seven men, 56-70 years old (mean +/- SD, 65 +/- 4.5) were included in the study. Ventricular tachycardia was unstable in 6 and in 1 it was induced non-sustained. The scar was localized by recording low-voltage, fragmented electrograms (< 2 mV). Ventricular tachycardia "exit" was localized by pace-mapping in sinus rhythm. Radiofrequency lines were made radially, point by point, from normal to scarred tissue. One of the lines crossed the exit area. The objective was to achieve non-inducibility.

Sustained clinical ventricular tachycardia was induced in 6 and non-sustained in 1. Two-four lines were performed per patient with 11-28 (21 +/- 5.4) radio frequency applications. The procedure duration was of 130-280 min (230 +/- 61) and being 49-75 min (63 +/- 7.9) for fluoroscopy. There were no complications. Clinical ventricular tachycardia became non-inducible in 6, although in 4 a rapid (cycle < or = 250 ms), non-clinical ventricular tachycardia remained inducible. Defibrillators were implanted in the patient remaining inducible for clinical ventricular tachycardia and another with > 60 tachycardia episodes the previous week. During 3-22 months (13.8 +/- 5.9) of follow-up, 1 patient died of heart failure at 20 months and another received 3 defibrillator shocks for VT at 13 months. There were no other episodes of ventricular tachycardia, syncope or sudden death.

This preliminary experience suggests that radiofrequency ablation of post-infarction ventricular tachycardia substrate is possible during sinus rhythm, suggesting that radiofrequency ablation may be applicable in a large proportion of patients with post-infarction sustained ventricular tachycardia.