Does the site of energy delivery (area of slow conduction vs earliest endocardial activation) and underlying etiology affect VT recurrence rates in patients undergoing DC catheter ablation for sustained monomorphic VT?
DC catheter ablation for sustained monomorphic VT is more successful in patients with coronary artery disease (prior MI) and when energy is delivered at the area of slow conduction rather than the earliest endocardial activation.
The role of DC catheter ablation (CA) to treat patients with sustained monomorphic ventricular tachycardia (VT) is still debated. To assess the efficacy of VT CA, we studied the follow‐up of 49 patients with VT who underwent CA. There were 33 patients with an old myocardial infarction MI (group G I) and 16 patients had noncoronary VT (group G II): CA was performed at the earliest endocardial activation (EEA)(20 patients in G I, 14 patients in G II) or at the area of slow conduction (ASC) (13 patients in GI, 2 patients in GII). During the mean follow‐up of 35 ± 25 (1–79) months, there were 17 patients in G I (52%) and 12 patients in G II (75%) with VT recurrences (P < 0.05). Recurrences of VT was observed in 4 of 15 patients (27%) when CA was performed at the ASC, compared to 25 of 34 patients (74%) with CA at the EEA (P < 0.01). These data show that DC CA is more successful in patients with coronary artery disease, particularly when CA is performed at the ASC.
Trappe et al. (1992) studied this question.