J Korean Med Sci.  2010 Jun;25(6):868-874. 10.3346/jkms.2010.25.6.868.

The Significance of Repetitive Ventricular Responses Induced by Radiofrequency Energy Application for Idiopathic Left Ventricular Tachycardia

• Shin WS
• Lee MY
• Jang SW
• Kim JH
• Yoon HJ
• Jin SW
• Oh YS
• Seung KB
• Rho TH

• KMID: 2150865
• DOI: http://doi.org/10.3346/jkms.2010.25.6.868

Abstract

In radiofrequency (RF) ablation for idiopathic left ventricular tachycardia (ILVT), the termination of tachycardia during RF ablation is considered a hallmark of success. However, in cases of patients with difficulty of induction of ventricular tachycardia (VT), the evaluation of procedural success can be problematic. We have observed thermal responses reflected as ventricular rhythm change to RF energy delivered on sinus rhythm for ILVT. We therefore describe the significance of repetitive ventricular responses. The study subjects were 11 ILVT patients for whom RF energy was delivered during sinus rhythm because of difficulty in re-induction of tachycardia. During each energy delivery, we focused on the occurrence of repetitive ventricular responses especially exhibiting a similar morphology to clinical VT. The repetitive ventricular responses were noted in 10 of 11 patients. Two patients received a second procedure due to the recurrence of ILVT. The mean follow-up period was 36.2+/-12.8 months. The clinical course of the remaining patients was favorable and without recurrence of ILVT. Based on the favorable clinical outcomes, ablation-induced repetitive ventricular responses with similar QRS morphology to clinical ILVT are useful markers for selecting an ablation site and could be used as an additional mapping method, termed as "thermal mapping".

Keyword

Tachycardia, Ventricular; Catheter Ablation; Purkinje Potential

Figure

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  Fig. 1 Twelve-lead surface electrocardiograms of induced ventricular tachycardia for patients No. 4 and No. 10, showing RBBB and superior axis. RBBB, Right bundle branch block.

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  Fig. 2 An example of local electrocardiogram from an ablation catheter shows both the P-potential (↓) and sinus rhythm changes to wide QRS tachycardia with radiofrequency energy delivery. P-potential, Purkinje-potential.

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  Fig. 3 During the repetitive ventricular response which occurred during radiofrequency energy delivery in patient No. 4, the P-potentials (↓) preceding wide QRS were noted. These repetitive ventricular responses were repeated during radiofrequency energy delivery. P-potential, Purkinje-potential.

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  Fig. 4 The eletrocardiograms from patients No. 4 and No. 10 showing sudden rhythm change with the start of radiofrequency energy delivery (arrow).

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  Fig. 5 The 12-lead eletrocardiograms showing repetitive ventricular response which occurred during radiofrequency energy delivery to patients No. 4 and No. 10. The morphology of these repetitive ventricular responses was quite similar to that of clinical idiopathic left ventricular tachycardia.

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