RT-192
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Role of the epicardial mapping
in identifying patients with postmyocardial infarction pleomorphic ventricular tachycardia
suitable for radiofrequency catheter ablation
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Claudio Tondo, Corrado
Carbucicchio, Stefania Riva, Gaetano Fassini, Paolo Della Bella.
Institute of Cardiology, University of Milan, CNR, Centro Cardiologico Fondazione Monzino,
IRCCS, Milan, Italy
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Abstract
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Radiofrequency catheter ablation (RFCA) is an
alternative and promising approach for treating post-myocardial recurrent ventricular
tachycardia (VT). Identification of critical areas of the reentry circuit (ie areas of
slow conduction) by an extensive and accurate mapping is crucial for choosing successful
ablation sites. Patients with multiple and fast VTs are not currently considered eligible
for catheter ablation. A more complex substrate, including possible epicardial location of
the reentry circuit, or insufficient lesion created by conventional RF current delivery
could account for this. In 16 patients with post infarction VT, retrospective analysis of
the results of simultaneous endocardial and epicardial mapping revealed epicardial
breakthrough in those patients with untolerated, pleomorphic arrhythmias related to
anterior myocardial infarction.
Although these findings identify patients currently not eligible for RFCA, on the
other hand, they should encourage the development of novel ablation approaches, such as
direct epicardial ablation, ablation from the venous system, or chemical ablation in which
epicardial mapping would provide a reliable guide.
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Key Words
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Cardiac arrhythmias - mapping
epicardial mapping, endocardial mapping, postmyocardial patients, pleomorphic ventricular
tachycardia, radiofrequency catheter ablation, OA
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