Idiopathic ventricular tachycardia--characterisation and radiofrequency ablation

Forty patients (14 women and 26 men; mean age 40 +/- 13 years, range 7 to 60) diagnosed to have idiopathic ventricular tachycardia (right ventricular 28, left ventricular 12) underwent electrophysiologic study and radiofrequency catheter ablation. Echocardiography, signal averaging, magnetic resonance imaging and cardiac catheterisation with angiography were used as indicated to rule out identifiable underlying etiologies. Gross localisation of the area of origin of the ventricular tachycardia from the surface electrocardiogram could be made in all cases. Accurate localisation of the site of origin was done by activation mapping and pace mapping. Radiofrequency application was successful in achieving a cure in 34 (85%) patients, with a mean of 8.3 +/- 4.7 energy applications and a fluoroscopy time of 38 +/- 19 minutes. Unsuccessful cases were characterised by wide and slurred QRS complexes during ventricular tachycardia, possibly indicating a deeper intramyocardial or epicardial site of origin of the tachycardia. Radiofrequency ablation appears to be the treatment of choice for symptomatic idiopathic ventricular tachycardia, having a high success and safety rate.