RADIOFREQUENCY CATHETER ABLATION OF VENTRICULAR-TACHYCARDIA IN PATIENTS WITHOUT STRUCTURAL HEART-DISEASE

被引:415
作者
KLEIN, LS [1 ]
SHIH, HT [1 ]
HACKETT, FK [1 ]
ZIPES, DP [1 ]
MILES, WM [1 ]
机构
[1] RICHARD L ROUDEBUSH VET ADM MED CTR,INDIANAPOLIS,IN 46202
关键词
VENTRICULAR TACHYCARDIA; ABLATION; RADIOFREQUENCY CURRENT;
D O I
10.1161/01.CIR.85.5.1666
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Background. Radiofrequency energy has been used safely and successfully to eliminate accessory pathways in patients with the Wolff-Parkinson-White syndrome and the substrate for atrioventricular nodal reentrant tachycardia. However, this form of ablation has had only limited success in eliminating ventricular tachycardia in patients with structural heart disease. In contrast, direct-current catheter ablation has been used successfully to eliminate ventricular tachycardia in patients with and without structural heart disease. The purpose of this study was to test whether radiofrequency energy can safely and effectively ablate ventricular tachycardia in patients without structural heart disease. Methods and Results. Sixteen patients (nine women and seven men; mean age, 38 years; range, 18-55 years) without structural heart disease who had ventricular tachycardia underwent radiofrequency catheter ablation to eliminate the ventricular tachycardia. Two patients presented with syncope, nine with presyncope, and five with palpitations only. Mean duration of symptoms was 6.7 years (range, 0.5-20 years). Radiofrequency catheter ablation successfully eliminated ventricular tachycardia in 15 of 16 patients (94%). Sites of ventricular tachycardia origin included the high right ventricular outflow tract (12 patients), the right ventricular septum near the tricuspid valve (three patients), and the left ventricular septum (one patient). The only ablation failure was in a patient whose ventricular tachycardia arose from a region near the His bundle. An accurate pace map, early local endocardial activation, and firm catheter contact with endocardium were associated with successful ablation. Radiofrequency ablation did not cause arrhythmias, produced minimal cardiac enzyme rise, and resulted in no detectable change in cardiac function by Doppler echocardiography. Conclusions. Radiofrequency catheter ablation of ventricular tachycardia in patients without structural heart disease is effective and safe and may be considered as early therapy in these patients.
引用
收藏
页码:1666 / 1674
页数:9
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