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Mapping techniques and catheter ablation of ventricular tachycardia due to coronary artery disease
1Harvard Thorndike Electrophysiology Institute, Beth Israel Deaconess Medical Center, Boston, MA 02215, USA.
Insights
Radiofrequency ablation for ventricular tachycardia in coronary artery disease shows variable success. Direct mapping techniques, particularly entrainment mapping with specific criteria, are crucial for improving success rates in this challenging patient group.
Area of Science:
- Cardiology
- Electrophysiology
- Medical Devices
Background:
- Catheter ablation for focal ventricular tachycardia (VT) is highly successful.
- Radiofrequency ablation for VT due to coronary artery disease (CAD) has limited and variable success rates.
- Effective mapping techniques are critical for successful VT ablation in CAD patients.
Purpose of the Study:
- To classify mapping techniques for VT ablation in CAD.
- To highlight the importance of direct mapping methods.
- To detail criteria for successful entrainment mapping.
Main Methods:
- Classification of mapping techniques into indirect (ECG, pace-mapping, sinus rhythm electrograms) and direct (activation sequence, entrainment mapping).
- Emphasis on direct mapping methods for VT in CAD.
- Detailed criteria for entrainment mapping: concealed fusion, post-pacing interval, and stimulus-to-QRS/electrogram-to-QRS intervals.
Main Results:
- Direct mapping techniques are more critical for VT in CAD.
- Successful entrainment mapping, defined by specific criteria, leads to a high success rate in terminating VT.
- Meeting entrainment mapping criteria (concealed fusion, PPI within 10 ms, equal intervals) is associated with high tachycardia termination rates.
Conclusions:
- Appropriate selection and application of mapping techniques significantly impact VT ablation success in CAD.
- Entrainment mapping, when performed with precise criteria, is a powerful tool for guiding ablation in CAD-related VT.
- Optimizing mapping strategies is essential for improving outcomes in radiofrequency ablation for VT in patients with coronary artery disease.
Abstract:
In contrast to the high success rates for catheter ablation of focal ventricular tachycardia, radiofrequency ablation for ventricular tachycardia due to coronary artery disease has met with limited to variable success. In performing catheter ablation for ventricular tachycardia due to coronary disease, mapping techniques used to locate the isthmus of the reentrant circuit are crucial. Appropriate use of mapping techniques determines the success rate of the procedure. We classify different methods of mapping into indirect and direct. The indirect methods include analysis of the 12-lead electrocardiogram, endocardial pace-mapping, and analysis of electrograms recorded from different parts of the heart during sinus rhythm. The direct methods include activation sequence mapping and entrainment mapping. The direct methods are more important in evaluating ventricular tachycardia due to coronary disease. While using the technique of entrainment mapping, three criteria are important: a) entrainment with concealed fusion; b) post pacing interval within or less than 10 ms of tachycardia cycle length; c) stimulus-to-QRS interval should equal electrogram-to-QRS interval. A high success rate in terminating the tachycardia is seen if these criteria are met.