Radiofrequency catheter ablation of ventricular tachycardia in patients with coronary artery disease

Background. Radiofrequency (RF) ablation of idiopathic ventricular tachycardia (VT) has been demonstrated to be highly efficacious, but the efficacy of RF ablation of VT in patients with coronary artery disease has been unknown. Therefore, the purpose of this study was to determine the feasibility of RF ablation of VT in patients with coronary artery disease. Methods and Results. Fifteen consecutive patients with coronary artery disease and a history of myocardial infarction underwent an attempt at RF ablation of 16 hemodynamically stable monomorphic VTs that had been documented clinically on a 12-lead ECG and that had not been successfully managed by pharmacological or device therapy. One VT was incessant, five occurred more than 25 times, and the remainder occurred two to 20 times. An additional four VTs that had not been documented clinically also were targeted for ablation. The mean age of the patients was 68±7 years (±SD), and their mean left ventricular ejection fraction was 0.27+0.08. The mean cycle length of the 20 VTs targeted for ablation was 438±82 msec. Ablation sites were selected based on endocardial activation mapping, pace mapping, identification of an isolated middiastolic potential, or concealed entrainment. Sixteen of the 20 VTs (80%) were successfully ablated in 11 of 15 patients (73%), using a mean of 4.2±3 applications of RF energy, and no recurrences of the ablated VTs occurred during 9.1±3.3 months of follow-up. The mean duration of the ablation procedures was 128±30 minutes. No complications occurred in any of the patients. Conclusions. The results of this study demonstrate that RF ablation of hemodynamically stable VT is feasible as adjunctive therapy in selected patients with coronary artery disease.