Circulation Journal
Online ISSN : 1347-4820
Print ISSN : 1346-9843
Arrhythmia/Electrophysiology
Efficacy of Intensive Radiofrequency Energy Delivery to the Localized Dense Scar Area in Post-Infarction Ventricular Tachycardia Ablation ― A Comparative Study With Standard Strategy Targeting the Infarcted Border Zone ―
Kenji KurokiAkihiko NogamiKentaro YoshidaMasahiko GoyaMasato FukunagaKazuaki KaitaniNaoaki OnishiTakanao MineTakashi KoyamaMasayuki IgawaTakeshi MachinoHiro YamasakiDongzhu XuMiyako IgarashiNobuyuki MurakoshiYukio SekiguchiKazutaka Aonuma
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2017 Volume 81 Issue 11 Pages 1603-1610

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Abstract

Background:Several reports have demonstrated the importance of severely low voltage areas as arrhythmogenic substrates of ventricular tachycardia (VT). However, a comparative study of dense scar-targeted and infarcted border zone-targeted strategies has not been reported.

Methods and Results:We divided 109 consecutive patients with VT post-infarction from 6 centers into 2 groups according to the ablation strategy used: dense scar-targeted ablation (DS ablation, 48%) or border zone-targeted ablation (BZ ablation, 52%). During DS ablation, we attempted to identify VT isthmuses in the dense scar areas (≤0.6 mV) using detailed pace mapping, and linear ablation lesions were applied mainly to those areas. During BZ ablation, linear ablation of standard low voltage areas (0.5–1.5 mV) was performed along with good pace map sites of the clinical VT. Acute success was defined as complete success (no VTs inducible) or partial success (clinical VT was noninducible). The acute complete success rate was significantly higher for DS ablation than for BZ ablation (62% vs. 42%, P=0.043). During a median follow-up of 37 months, the VT-free survival rate was significantly higher for DS ablation than for BZ ablation (80% vs. 58% at 48 months; log-rank P=0.038).

Conclusions:DS ablation may be a more effective therapy for post-infarction VT than BZ ablation in terms of the acute complete success rate and long-term follow-up.

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© 2017 THE JAPANESE CIRCULATION SOCIETY
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