Novel Ablation Strategy for Treatment of Multiple Ventricular Tachycardias after Anterior Wall Myocardial Infarction: Isolation of the Entire Substrate

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Background: Ventricular tachycardia (VT) may occur after anterior wall myocardial infarction. The best ablation strategy is unclear. We report about three patients in whom isolation oft the entire substrate was performed. Methods: Three patients (66±5 years, LVEF 29±14%) underwent catheter ablation for sustained VT after anterior wall myocardial infarction. All patients had recurrent ICD shocks (VT storm in two) despite amiodarone therapy. During electrophysiological-study, 4±2 VTs were induced including the clinical VT. 3D-mapping of the left ventricle (LV) was performed in SR (n=2) or during RV pacing (n=1) and revealed a low-voltage (<1.5 mV) area with fractionated electrograms and late-potentials in the antero-apical LV (mean area of 90±34 cm2). The entire low-voltage area was isolated with a circumferential isolation line along the low-voltage area border-zone. Isolation was defined as absence of all potentials within the isolated area demonstrated by detailed point-by-point mapping. Automaticity was demonstrated in 2/3 pts. Procedure and fluoroscopy time was 155±22 min and 10.3±0.7 min, respectively. At the end oft the procedure, there was no (n=2) or one fast non-clinical VT (n=1) inducible. No complications occurred. No clinical VT occurred during a follow-up of 5±7 months. Conclusions: Isolation of the entire substrate appears to be feasible in patients with antero-apical wall myocardial infarction.