Comparison of endocardial catheter mapping with intraoperative mapping of ventricular tachycardia

M E Josephson, L N Horowitz, S R Spielman, A M Greenspan, C VandePol, A H Harken
1980 Circulation  
To validate the accuracy of catheter endocardial mapping to localize the origin of ventricular tachycardia (VT), we compared catheter endocardial mapping with intraoperative epicardial and endocardial mapping of 24 morphologically distinct VTs in 18 patients undergoing surgery. Twelve had VT with left bundle branch block morphology and 12 had VT with right bundle branch block morphology. Catheter endocardial mapping localized 23 VT morphologies to the border of a left ventricular aneurysm or
more » ... cardial infarction and one VT to a right ventriculotomy scar. Intraoperative epicardial mapping showed epicardial breakthrough on the right ventricle in 10 VTs with left bundle branch block morphology and on the left ventricle in two. In 12 VTs with right bundle branch block morphology, intraoperative epicardial mapping showed epicardial breakthrough at the border of a left ventricular aneurysm. Intraoperative endocardial mapping revealed the earliest site of VT with left bundle branch block morphology (11 patients) and VT with right bundle branch block morphology (12 patients) at the border of a left ventricular aneurysm, and one VT with left bundle branch block morphology in the right ventricle. Catheter endocardial mapping predicted the origin of VT within 4-8 cm' of that determined by intraoperative endocardial mapping, which always identified the earliest site. These data validate the accuracy of catheter endocardial mapping in localizing the origin of VT. WE HAVE RECENTLY DEVELOPED the technique of mapping ventricular tachycardia (VT) using an endocardial catheter.' This technique has allowed us to analyze the sites of origin of 51 morphologically distinct VTs in 32 patients, including 24 with ventricular aneurysms. We used mapping to localize the origin of the tachycardias to aneurysms or regions of the heart considered to be ischemic, providing a rational basis for either aneurysmectomy or coronary artery bypass grafting for the management of drugresistant VT. The success of catheter mapping in this endeavor, however, depends on the accuracy of the catheter recordings. We compared the origin of VT predicted by catheter endocardial mapping with the results of intraoperative epicardial and endocardial mapping in 18 patients. This report details our experience, which validates the ability of catheter recordings to locate the origin of VT, and further stresses the limitations of the surface ECG and epicardial mapping for this purpose.
doi:10.1161/01.cir.61.2.395 pmid:7351066 fatcat:rq4auavkuvcdtglx2xxtua6ioe