[Rhythm and conduction disorders immediately after ventricular fulguration]

Forty-four patients with ventricular tachycardias (VT) refractory to medical treatment underwent 73 sessions of endocavitary electrode catheter ablation. The clinical series included 16 cases of post-infarction VT, 14 cases of arrhythmogenic right ventricular dysplasia, 6 cases of dilated cardiomyopathy, 6 cases of idiopathic VT, 1 case of sequela of myocarditis and 1 case of VT consecutive to surgical repair of a congenital cardiopathy. Cardiomegaly was present in 30 patients, and 16 patients had an ejection fraction of less than 30 p. 100. None of the patients were receiving digitalis or class I antiarrhythmic drugs when ablation was performed. A total of 235 shocks of 100 to 320 J (mean 221 +/- 42 J) were delivered. 115 shocks (49 p. 100) were complicated by dysrhythmia and/or disorders of conduction; 29 shocks (12 p. 100) induced 13 ventricular fibrillations and 16 ventricular tachycardias. No relation was found between energy delivered, shock synchronization, haemodynamic status, heart cavity treated, underlying heart disease, CK MB levels and these arrhythmias. On the other hand, ablations performed while the patients were experiencing VT increased the risk of arrhythmia (p less than 0.02). 36 AV blocks, 21 left bundle branch blocks, 12 right bundle branch blocks and 11 sinus bradycardia were observed. With the exception of one right bundle branch block and one left posterior hemi-block, all blocks were transient.

(1) electrode catheter ablation may be complicated by disorders of cardiac rhythm or conduction in 50 p. 100 of the cases; (2) these disorders can easily be corrected by stimulation or defibrillation.(ABSTRACT TRUNCATED AT 250 WORDS)