Radiofrequency ablation of haemodynamically unstable ventricular tachycardia after myocardial infarction

Abstract

OBJECTIVE To determine whether radiofrequency (RF) ablation might have a role in haemodynamically unstable ventricular tachycardia. METHODS 10 patients with a history of ventricular tachycardia producing haemodynamic collapse in whom drug treatment had failed and device therapy was rejected underwent RF ablation of ventricular tachycardia in sinus rhythm. The arrhythmogenic zone was defined on the basis of abnormal systolic movement, the presence of fragmentation (low amplitude, prolonged multiphasic electrograms), and pace mapping. RF lesions were delivered in power mode in linear fashion within the defined arrhythmogenic zone. RESULTS Success (no ventricular tachycardia inducible postablation or at retest) was achieved in six patients, possible success (a different ventricular tachycardia inducible at more aggressive stimulation) in three. In one patient, the procedure was abandoned because of poor catheter stability. There were no clinical events during a mean (SD) follow up period of 23 (10) months in any of the nine patients defined as definite or possible successes. CONCLUSIONS RF ablation for addressing haemodynamically unstable ventricular tachycardia opens the door for the wider use of catheter ablation for treating this arrhythmia.