© 2000 by European Society of Cardiology
CASE REPORT
Ablation of idiopathic ventricular tachycardia by bipolar radiofrequency current application between the left aortic sinus and the left ventricle
Laboratory of Clinical Cardiac Electrophysiology, U.M.Q. Cardiología, Hospital La Paz, Universidad Autónoma, Madrid, Spain
BACKGROUND: Failure to ablate idiopathic ventricular outflow tract tachycardia by radiofrequency current is not uncommon and suggests that non-standard approaches may be required to map and suppress idiopathic ventricular tachyarrhythmias in some patients.
METHODS AND RESULTS: Left and right ventricular activation and pace mapping proved inadequate for radiofrequency application in a patient with idiopathic ventricular outflow tract tachycardia. Presystolic activity was recorded at the left aortic sinus of Valsalva, and the QRS complex recorded at this location during pacing showed few differences compared with that recorded during tachycardia. Radiofrequency current application at this site transiently suppressed the tachycardia. Following new mapping of the left ventricle outflow tract, radiofrequency application just below the aortic valve in close proximity to the previous aortic application site transiently abolished the arrhythmia. Finally, bipolar radiofrequency application between the distal electrode of the aortic catheter and the distal electrode of a second catheter placed in the left ventricular subaortic area permanently suppressed the tachycardia.
CONCLUSION: Bipolar radiofrequency application between the aortic sinus of Valsalva and the left ventricle could be an alternative approach in occasional patients with idiopathic ventricular outflow tract tachycardia resistant to conventional left ventricular and aortic root unipolar radiofrequency application.
Key Words: Ventricular tachycardia, catheter ablation, electrophysiology, sinus of Valsalva, bipolar radiofrequency ablation
Correspondence: Dr J. L. Merino, Laboratorio de Electrofisiología Cardíaca (1aPl. Diagonal), Hospital General ‘La Paz’, P. de la Castellana 261, E-28046 Madrid, Spain.
[1] Chen SA, Chiang CE, Tai CT, Lee SH, Chang MS. Future ablation concepts of tachyarrhythmias. J Cardiovasc Electrophysiol 1995; 6: 852–862.[Medline]
[2] Coggins DL, Lee RJ, Sweeney J, et al. Radiofrequency catheter ablation as a cure of idiopathic tachycardia of both left and right ventricular origin. J Am Coll Cardiol 1994; 23: 1333–1341.[Abstract]
[3] Rodriguez LM, Smeets JLRM, Timmermans C, Wellens HJJ. Predictors for successful ablation of right- and left-sided idiopathic ventricular tachycardia. Am J Cardiol 1997; 79: 309–314.[CrossRef][Web of Science][Medline]
[4] Calkins H, Yong P, Miller JM, et al. Catheter ablation of accessory pathways, atrioventricular nodal reentrant tachycardia, and the atrioventricular junction: final results of a prospective, multicenter clinical study. Circulation 1999; 99: 262–270.
[5] Peinado R, Arenal A, Almendral J, et al. Ablación con catéter mediante radiofrecuencia de taquicardias ventriculares en pacientes sin cardiopatia estructural aparente. Rev Esp Cardiol 1994; 47: 803–810.[Medline]
[6] Merino JL, Jimenez-Borreguero J, Peinado R, Merino S, Sobrino JA. Unipolar mapping and magnetic resonance imaging of ‘idiopathic’ right ventricular outflow tract ectopy. J Cardiovasc Electrophysiol 1998; 9: 84–87.[Medline]
[7] Callans DJ, Menz V, Schwartzman D, Gottlieb CD, Marchlinski FE. Repetitive monomorphic tachycardia from the left ventricular outflow tract: electrocardiographic patterns consistent with a left ventricular site origin. J Am Coll Cardiol 1997; 29: 1023–1027.[Abstract]
[8] Yeh SJ, Wen MS, Wang CC, Lin FC, Wu D. Adenosine-sensitive ventricular tachycardia from the anterobasal left ventricle. J Am Coll Cardiol 1997; 30: 1339–1345.[Abstract]
[9] Shimoike E, Ohba Y, Yanagi N, et al. Radiofrequency catheter ablation of left ventricular outflow tract tachycardia: report of two cases. J Cardiovasc Electrophysiol 1998; 9: 196–202.[Medline]
[10] Shimoike E, Ohnishi Y, Ueda N, Maruyama T, Kaji Y. Radiofrequency catheter ablation of left ventricular outflow tract tachycardia from the coronary cusp: a new approach to the tachycardia focus. J Cardiovasc Electrophysiol 1999; 10: 1005–1009.[Web of Science][Medline]
[11] Sadanaga T, Saeki K, Funatsu Y, Miyazaki T. Repetitive monomorphic ventricular tachycardia of left coronary cusp origin. Pacing Clin Electrophysiol 1999; 22: 1553–1556.[CrossRef][Medline]
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