July 1, 1998Pacing and Clinical Electrophysiology128 citationsOpen Access
View Full PaperIdentification and Ablation of Macroreentrant Ventricular Tachycardia with the CARTO Electroanatomical Mapping System
Key Result
Three-dimensional electroanatomical mapping using the CARTO system successfully identified and guided the ablation of a large macroreentrant ventricular tachycardia circuit in 1 patient.
Study Design
Type
Case Report (n=1)
Structured PICO
Does 3D electroanatomical mapping with the CARTO system facilitate the identification and ablation of macroreentrant ventricular tachycardia in a patient with repaired tetralogy of Fallot?
P
Population
38-year-old patient with ventricular tachycardia 28 years after surgical correction of tetralogy of Fallot (n=1)
I
Intervention
Three-dimensional right ventricular endocardial mapping using the CARTO electroanatomical system combined with entrainment mapping, followed by radiofrequency ablation creating a line of block
O
Outcome
Identification and interruption of the macroreentrant circuit
The CARTO electroanatomical mapping system can effectively identify and guide the ablation of large macroreentrant ventricular tachycardia circuits by creating a line of block.
Abstract
Monomorphic ventricular tachycardias associated with regions of scar are most commonly due to reentry. Catheter based techniques have recently been described for mapping of reentry circuits. Fluoroscopic methods have obvious limitations when attempting to map large ventricular reentry circuit and localize target-sites of radiofrequency ablation. Three-dimensional right ventricular endocardial mapping was performed in a 38-year-old patient with ventricular tachycardia 28 years after surgical correction of tetralogy of Fallot by using the CARTO electroanatomical system. The map of electrogram voltage showed low amplitude electrograms over the anterior wall of the right ventricle extending into the right ventricular outflow tract, consistent with the location of the ventriculotomy scar. Recording of local activation time was combined with entrainment mapping to define the macroreentrant circuit during ventricular tachycardia. Since the activation propagated through a broad path around the right ventriculotomy scar, ablation was performed by creating a line of block, which was facilitated by tagging of the lesion sites on the endocardial activation map. Large ventricular reentry circuits can be identified and interrupted by creation of a line of block to interrupt a broad path. A practical approach to mapping combining analysis of electrogram voltage, activation sequence, and entrainment is presented.