Angiographic and electrophysiological substrates for ventricular tachycardia mapping through the coronary veins

Objective-To study the value of epicardial mapping through the coronary venous system in patients with sustained ventricular tachycardia. Design-20 consecutive patients with sustained ventricular tachycardia who were candidates for radiofrequency ablation. Setting-Electrophysiological laboratory. Interventions-Coronary venous angiography was performed with a catheter, which provided coronary sinus occlusion during injection of contrast media. Multipolar microelectrode catheters were then manoeuvred into the tributaries of coronary sinus, using an over-wire system or an on-wire system. An endocardial ablation catheter was positioned in the left ventricle. Conventional programmed ventricular stimulation was performed for sustained ventricular tachycardia induction. Endocardial radiofrequency ablation was performed using impedance or temperature monitoring. Results-Coronary veins were catheterised in all patients; 20 had induction of sustained ventricular tachycardia, 14 were stable. Presystolic epicardial electrograms were recorded in six patients and concealed entrainment in two, helping as a landmark for endocardial ablation. After simultaneous epicardial and endocardial mapping, successful endocardial radiofrequency ablation was achieved in nine of 14 patients with stable ventricular tachycardia (64%). Conclusions-Epicardial mapping through the coronary veins in patients with ventricular tachycardia is feasible, safe, and can be a useful landmark for endocardial catheter mapping and ablation.