ULTRASOUND MAPPING FOR ABLATION OF POST-INFARCTION VENTRICULAR RE-ENTRY TACHYCARDIA: FIRST EXPERIENCE IN RUSSIA

To assess the results of mapping and radiofrequency ablation (RFA) of post-infarction ventricular re-entry tachycardia (VT) using the CartoSound program module, 20 patients aged 51.1±6.3 years were examined. In 8 patients of Group I, 9 procedures using the CartoSound system were performed. In 12 patients of Group II, 18 procedures using the commonly accepted mapping techniques were carried out. The SoundStar catheter was installed into the right ventricle to permit visualization of all parts of the left ventricle (LV). Ultrasound images were synchronized with the R-wave of surface ECG. Three-dimensional maps of LV and, separately, scar maps were constructed. The time required for the LV map construction considerably diminished from the first to the eighth patient: from 24.8 min (17.4 27.2 min) in the first four cases to 19.1 min (14.1 21.2 min; p=0.04) in the last cases. The number of recurrences in Group II was several times higher than in Group I; however, the difference was statistically insignificant, probably due to the small sample. In 2 of 6 recurrences in Group II and the only case of recurrence in Group I, repetitive procedures were performed using the CartoSound system and in other cases, using the amplitude mapping only. There were no adverse events in Group I. In Group II, one adverse event was observed, transitory ischemic attack during the primary ablation. As an alternative approach to the LV and scar assessment, magnetic resonance tomography can be considered; however, despite appropriate visualization properties, the latter has a number of significant limitations. The weakest point is a delay between tomography and RFA procedure which can be 24 hours or more. Thus, ultrasound mapping is a more effective, safe, and accurate technique of anatomical mapping of post-infarction tachycardia as compared with amplitude mapping.

intracardiac ultrasound mapping, three-dimensional mapping, ventricular tachycardia, postinfarction cardiosclerosis, radiofrequency catheter ablation

1. Arenal A., Hernandez J., Calvo D. Et al. Safety, longterm results, and predictors of recurrence after complete endocardial ventricular tachycardia substrate ablation in patients with previous myocardial infarction // Am. J. Cardiol. - 2013. - Vol. 111(4). - P. 499-505.

2. Callans D.J., Zado E., Sarter B.H. et al. Efficacy of radiofrequency catheter ablation for ventricular tachycardia in healed myocardial infarction // Am. J. Cardiol. - 1998. - Vol. 82. - P. 429-432.

3. Casella M. et al. Right ventricular substrate mapping using the Ensite Navx system: Accuracy of high-density voltage map obtained by automatic point acquisition during geometry reconstruction // Heart Rhythm. - 2009. - Vol.

4. - P. 1598-1605.

5. Kesteloot H., Sans S., Kromhout D. Dynamics of cardiovascular and all-cause mortality in Western and Eastern Europe between 1970 and 2000 // Eur. Heart J. - 2006. -Vol. 27(1). - P. 107-113.

6. Knackstedt C., Arndt M., Mischke K. et al. Depression, psychological distress, and quality of life in patients with cardioverter defibrillator with or without cardiac resynchronization therapy // Heart Vessels. - 2013. - Jun 4. [Epub ahead of print]

7. Kong M.H., Fonarow G.C., Peterson E.D. et al. Systematic review of the incidence of sudden cardiac death in the United States // J. Am. Coll. Cardiol. - 2011. - Vol. 57(7). - P. 794-801.

8. Morady F., Harvey M., Kalbfleisch S.J. et al. Radiofrequency ablation of ventricular tachycardia in patients with coronary artery disease // Circulation. - 1993. - Vol. 87. - P. 363-372.

9. Namboodiri N. Electroanatomic Contact Mapping: How to Use Optimally to Recognise the Arrhythmia Mechanism? // Indian Pacing Electrophysiol. J. - 2010. - Vol. 10(1). - P. 1-7.

10. Nichol G., Thomas E., Callaway C.W. et al. Regional variation in out-of-hospital cardiac arrest incidence and outcome // J.A.M.A. - 2008. - Vol. 300(12). - P. 1423-1431.

11. Patel A.M., Heist E.K., Chevalier J. et al. Effect of presenting rhythm on image integration to direct catheter ablation of atrial fibrillation // J. Interv. Card. Electrophysiol. - 2008. - Vol. 22. - P. 205-210.

12. Ponti R.D. Role of catheter ablation of ventricular tachycardia associated with structural heart disease // World J. Cardiol. - 2011. - Vol. 3(11). - P. 339-350.

13. Proclemer A., Dagres N., Marinskis G. et al. Current practice in Europe: how do we manage patients with ventricular tachycardia? European Heart Rhythm Association survey // Europace. - 2013. - Vol. 15(2). - P. 167-169.

14. Tops L.F., Schalij M.J., den Uijl D.W. et al. Image integration in catheter ablation of atrial fibrillation // Europace. - 2008. - Vol. 10, suppl. 3. - P. iii48-iii56.