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Pattern of endocardial activation during sustained ventricular tachycardia
Journal of the American College of Cardiology
|December 1, 1985
Summary
Most ventricular tachycardias after myocardial infarction spread centrifugally from a small origin site. Mapping-guided surgery effectively targets these circuits, improving patient outcomes.
Area of Science:
- Cardiology
- Electrophysiology
- Cardiac Surgery
Background:
- Sustained ventricular tachycardia (VT) is a significant complication following myocardial infarction.
- Endocardial activation mapping is crucial for understanding VT mechanisms and guiding surgical intervention.
Purpose of the Study:
- To analyze endocardial activation patterns during VT in patients with prior myocardial infarction.
- To correlate mapping findings with surgical outcomes of subendocardial resection.
Main Methods:
- Intraoperative endocardial activation mapping during VT in 55 patients.
- Analysis of 122 tachycardias to determine activation patterns (centrifugal spread vs. continuous loop).
- Comparison of tachycardia cycle length and activation duration between patterns.
Main Results:
- 90% of analyzed tachycardias exhibited centrifugal spread from a small origin (<6 cm²).
- 10% showed a continuous loop pattern around an aneurysm, with shorter cycle lengths.
- No significant differences in patient characteristics, survival, or VT cure rates between patterns.
Conclusions:
- The majority of VT in this cohort originates from a small area with centrifugal activation.
- Mapping-guided subendocardial resection is effective for VT ablation, addressing both centrifugal and loop patterns.
- Surgical success is achievable despite differing VT circuit mechanisms.