April 1, 2000
View Full PaperCatheter Ablation of Mitral Isthmus Ventricular Tachycardia Using Electroanatomically Guided Linear Lesions
Key Result
Electroanatomically guided linear lesion placement successfully eliminated mitral isthmus ventricular tachycardia in a patient with a wide isthmus after focal ablation had failed.
Study Design
Type
Case Report (n=1)
Structured PICO
Does catheter ablation using electroanatomically guided linear lesions eliminate tachycardia in patients with mitral isthmus ventricular tachycardia?
P
Population
1 patient with mitral isthmus ventricular tachycardia and a wide tachycardia isthmus, with previously unsuccessful focal ablation
I
Intervention
Catheter ablation using electroanatomically guided linear lesions from the edge of the inferior infarct to the base of the mitral valve
O
Outcome
Elimination of tachycardia
Electroanatomic mapping can guide the placement of linear lesions to successfully eliminate tachycardia in patients with mitral isthmus VT and a wide isthmus.
Abstract
Mitral isthmus ventricular tachycardia uses a reentrant circuit with a critical isthmus of conduction bounded by the mitral valve proximally and a remote inferior infarction scar distally. Successful catheter ablation requires placement of a lesion to transect the isthmus so as to prevent wavefront propagation. We report a case with previously unsuccessful ablation in which focal isthmus ablation failed to eliminate arrhythmia. Electroanatomic mapping demonstrated a wide tachycardia isthmus, and a linear lesion placed from the edge of the inferior infarct (as demonstrated on the three-dimensional voltage electroanatomic map) to the base of the mitral valve successfully eliminated tachycardia. In some patients with mitral isthmus VT, a wide isthmus requires linear lesion placement to fully transect the isthmus and eliminate tachycardia. Electroanatomic mapping can be used to define isthmus boundaries and thus guide successful ablation.