Ablation of Ventricular Tachycardia in Patients with Ischemic Heart Disease Using Rotational Angiography (DynaCT) Guided Substrate Mapping Exclusively: Intermediate Term Results

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Aim: We evaluated the safety, procedural efficacy and outcomes of ablation of Ventricular Tachycardia (VT) in Ischemic Heart Disease patients using Rotational Angiography and Electroanatomical 3D based substrate mapping strategy exclusively. Methods: Six consecutive patients with a history of MI and hemodynamically unstable drug resistant VT were studied. High-density electroanatomic mapping was performed during sinus rhythm using the NavX velocity (SJM) system. In four patients real time 3D reconstruction of Left Ventricle was done using DynaCT system (Seimens). The scar tissue (Local Voltage- 0.2–0.5 mV) and Low Voltage Areas (Local voltage- 0.5–1.5 mV) were identified. The RF ablation was performed using a 4 mm ablation catheter and the isthmus ablated in 4 patients whereas scar tissue isolation was done in 2 patients. VT induction was done only after RF ablation. Result: Post ablation the no VT was inducible. During the follow-up (18±3.9 months), spontaneous VT was not recorded in any patient on regular ICD interrogation. Conclusion: Substrate mapping can be used to identify the arrhythmogenic tissue and guide VT ablation. This therapeutic strategy may be considered routinely/increasingly in the management of patients with multiple hemodynamically unstable VTs. The use of real time 3D reconstruction (DynaCT) can increase the safety of the procedure.