Radiofrequency catheter ablation of ventricular tachycardia in patients without structural heart disease

Lawrence S. Klein, Hue Teh Shih, F. Kevin Hackett, Douglas P. Zipes, William M. Miles

Research output: Contribution to journalArticle

421 Citations (Scopus)

Abstract

Background. Radiofrequency energy has been used safely and successfully to eliminate accessory pathways in patients with the Wolff-Parkinson-White syndrome and the substrate for atrioventricular nodal reentrant tachycardia. However, this form of ablation has had only limited success in eliminating ventricular tachycardia in patients with structural heart disease. In contrast, direct-current catheter ablation has been used successfully to eliminate ventricular tachycardia in patients with and without structural heart disease. The purpose of this study was to test whether radiofrequency energy can safely and effectively ablate ventricular tachycardia in patients without structural heart disease. Methods and Results. Sixteen patients (nine women and seven men; mean age, 38 years; range, 18-55 years) without structural heart disease who had ventricular tachycardia underwent radiofrequency catheter ablation to eliminate the ventricular tachycardia. Two patients presented with syncope, nine with presyncope, and five with palpitations only. Mean duration of symptoms was 6.7 years (range, 0.5-20 years). Radiofrequency catheter ablation successfully eliminated ventricular tachycardia in 15 of 16 patients (94%). Sites of ventricular tachycardia origin included the high right ventricular outflow tract (12 patients), the right ventricular septum near the tricuspid valve (three patients), and the left ventricular septum (one patient). The only ablation failure was in a patient whose ventricular tachycardia arose from a region near the His bundle. An accurate pace map, early local endocardial activation, and firm catheter contact with endocardium were associated with successful ablation. Radiofrequency ablation did not cause arrhythmias, produced minimal cardiac enzyme rise, and resulted in no detectable change in cardiac function by Doppler echocardiography. Conclusions. Radiofrequency catheter ablation of ventricular tachycardia in patients without structural heart disease is effective and safe and may be considered as early therapy in these patients.

Original languageEnglish (US)
Pages (from-to)1666-1674
Number of pages9
JournalCirculation
Volume85
Issue number5
StatePublished - May 1992
Externally publishedYes

Fingerprint

Catheter Ablation
Ventricular Tachycardia
Heart Diseases
Ventricular Septum
Syncope
Atrioventricular Nodal Reentry Tachycardia
Bundle of His
Endocardium
Wolff-Parkinson-White Syndrome
Tricuspid Valve
Doppler Echocardiography
Patient Rights
Secondary Prevention
Cardiac Arrhythmias
Catheters

Keywords

  • Ablation
  • Radiofrequency current
  • Ventricular tachycardia

ASJC Scopus subject areas

  • Physiology
  • Cardiology and Cardiovascular Medicine

Cite this

Klein, L. S., Shih, H. T., Hackett, F. K., Zipes, D. P., & Miles, W. M. (1992). Radiofrequency catheter ablation of ventricular tachycardia in patients without structural heart disease. Circulation, 85(5), 1666-1674.

Radiofrequency catheter ablation of ventricular tachycardia in patients without structural heart disease. / Klein, Lawrence S.; Shih, Hue Teh; Hackett, F. Kevin; Zipes, Douglas P.; Miles, William M.

In: Circulation, Vol. 85, No. 5, 05.1992, p. 1666-1674.

Research output: Contribution to journalArticle

Klein, LS, Shih, HT, Hackett, FK, Zipes, DP & Miles, WM 1992, 'Radiofrequency catheter ablation of ventricular tachycardia in patients without structural heart disease', Circulation, vol. 85, no. 5, pp. 1666-1674.
Klein LS, Shih HT, Hackett FK, Zipes DP, Miles WM. Radiofrequency catheter ablation of ventricular tachycardia in patients without structural heart disease. Circulation. 1992 May;85(5):1666-1674.
Klein, Lawrence S. ; Shih, Hue Teh ; Hackett, F. Kevin ; Zipes, Douglas P. ; Miles, William M. / Radiofrequency catheter ablation of ventricular tachycardia in patients without structural heart disease. In: Circulation. 1992 ; Vol. 85, No. 5. pp. 1666-1674.
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AB - Background. Radiofrequency energy has been used safely and successfully to eliminate accessory pathways in patients with the Wolff-Parkinson-White syndrome and the substrate for atrioventricular nodal reentrant tachycardia. However, this form of ablation has had only limited success in eliminating ventricular tachycardia in patients with structural heart disease. In contrast, direct-current catheter ablation has been used successfully to eliminate ventricular tachycardia in patients with and without structural heart disease. The purpose of this study was to test whether radiofrequency energy can safely and effectively ablate ventricular tachycardia in patients without structural heart disease. Methods and Results. Sixteen patients (nine women and seven men; mean age, 38 years; range, 18-55 years) without structural heart disease who had ventricular tachycardia underwent radiofrequency catheter ablation to eliminate the ventricular tachycardia. Two patients presented with syncope, nine with presyncope, and five with palpitations only. Mean duration of symptoms was 6.7 years (range, 0.5-20 years). Radiofrequency catheter ablation successfully eliminated ventricular tachycardia in 15 of 16 patients (94%). Sites of ventricular tachycardia origin included the high right ventricular outflow tract (12 patients), the right ventricular septum near the tricuspid valve (three patients), and the left ventricular septum (one patient). The only ablation failure was in a patient whose ventricular tachycardia arose from a region near the His bundle. An accurate pace map, early local endocardial activation, and firm catheter contact with endocardium were associated with successful ablation. Radiofrequency ablation did not cause arrhythmias, produced minimal cardiac enzyme rise, and resulted in no detectable change in cardiac function by Doppler echocardiography. Conclusions. Radiofrequency catheter ablation of ventricular tachycardia in patients without structural heart disease is effective and safe and may be considered as early therapy in these patients.

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