Feasibility of a Noncontact Catheter for Endocardial Mapping of Human Ventricular Tachycardia

BACKGROUND: Catheter ablation of ventricular tachycardia (VT) is limited by difficulty in identifying suitable sites for ablation. This study assesses use of a system capable of simultaneous endocardial mapping of the human left ventricle to map and guide radiofrequency (RF) catheter ablation of VT. METHODS AND RESULTS: A catheter-mounted noncontact multielectrode array was used to reconstruct 3360 electrograms, superimposed onto a computer-simulated endocardial model. Of 24 patients studied, 20 had ischemic heart disease. Exit sites were demonstrated by the noncontact system in 80 (99%) of 81 VTs, with complete VT circuits traced in 17 (21%). In another 37 VTs, 36+/-30% (mean+/-SD) of the diastolic interval was identified. Thirty-eight VT morphologies were ablated with 154 RF energy applications. Successful ablation was achieved by 77% of RF applications to relevant diastolic activity identified by the system and was significantly more likely (P<0.0001) than by RF at the VT exit or remote from diastolic activation. Over a mean follow-up of 1.5 years, 14 patients (64%) have had no recurrence of VT, and only 2 target VTs (5.3%) have recurred. Five patients have had recurrence of other VTs. CONCLUSIONS: This noncontact mapping system identified diastolic portions of the circuit in most VTs studied and can safely map and guide ablation of human VT.