First lessons from radiofrequency catheter ablation in patients with ventricular tachycardia

Fourteen patients (12 men, 2 women; 61 +/- 9 years) with ventricular tachycardia and underlying heart disease underwent an attempt at radiofrequency energy catheter ablation. Twelve patients had coronary disease and two patients had dilated cardiomyopathy. Two patients had two clinical tachycardias, the ejection fraction was 38% +/- 11%. All tachycardias were inducible and hemodynamically well tolerated (cycle length = 357 +/- 56 msec). Ablation was initially successful in nine patients (no tachycardia inducible after ablation and before discharge). Two patients had recurrences (in-hospital and 4 months) and one patient had a tachycardia of a different morphology, which was also successfully ablated. Ablation was overall successful in seven patients and unsuccessful in seven patients (including all patients with cardiomyopathy). Mid-diastolic potentials were observed in all the patients in whom ablation was successful but not observed in four of seven unsuccessful patients. The successful patients remain free of recurrences at 9 +/- 8 months follow-up.

(1) in ventricular tachycardia following an old infarction radiofrequency energy ablation is possible with a high success rate if a critical component of the tachycardia circuit can be localized. Localizing isolated mid-diastolic potentials and ensuring these potentials are part of the reentrant circuit with concealed entrainment can help to enhance the results. (2) A negative predischarge electrophysiological study may be predictive of success.