Predictors for successful ablation of right- and left-sided idiopathic ventricular tachycardia

This study reports on predictors for successful radiofrequency (RF) ablation of idiopathic ventricular tachycardia (VT) in 48 patients--35 with right ventricular (RV) outflow tract and 13 with left ventricular VT. In RV outflow tract idiopathic VT, RF ablation was successful in 29 of 35 patients (83%). The following information allowed differentiation between patients with and without a successful RF ablation: > 1 induced VT morphology (O vs 3); presence of delta wave-like beginning of the QRS (2 vs 3) and > or = 11 of 12 leads showing a "match" between the clinical VT and the pacemap (28 vs 1). Endocardial activation times were not different between both groups (-15 +/- 18 vs -4 +/- 5 ms). In left ventricle idiopathic VT, RF ablation was successful in 12 of 13 patients (92%). In patients who underwent successful ablation, 1 VT morphology was induced and no delta wave-like beginning of the QRS was present; a correlation between clinical VT and the pacemap > or = 11 of 12 leads was found and the endocardial activation time preceded the QRS (range of -5 to -58 ms [mean -30 +/- 14]). Purkinje activity was observed in 5 of 7 patients with an idiopathic VT originating from the inferoposterior region but not from the inferoapical region of the left ventricle. Four patients (14%) with RV outflow tract idiopathic VT had recurrence during a mean follow-up of 2 to 50 months (mean 30 +/- 12). Thus, (1) in RV outflow tract idiopathic VT a good pacemap was more important than an early endocardial activation time; (2) an optimal pacemap as well as an early endocardial activation time were important predictors for successful ablation of the left ventricle idiopathic VT; (3) Purkinje activity was recorded in VTs arising in the inferoposterior region of the left ventricle; and (4) factors for unsuccessful ablation for idiopathic VT were > 1 induced VT morphology, a delta wave-like beginning of the QRS, and a VT/pacemap correlation < 11 of 12 leads. Idiopathic VT can be successfully ablated with both immediate and long-term success.