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European Journal of Echocardiography 2004 5(1):34-40; doi:10.1016/S1525-2167(03)00051-9
© 2004 by European Society of Cardiology
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Copyright © 2003, The European Society of Cardiology

Radiofrequency catheter ablation of ventricular tachycardia guided by intracardiac echocardiography

M.R.M Jongbloed, J.J Bax*, A.E Borger van der Burg, E.E Van der Wall and M.J Schalij

Department of Cardiology, Leiden University Medical Center, Albinusdreef 2, 2300 RC Leiden, The Netherlands

Received 20 February 2003; received in revised form 2 June 2003; accepted after revision 4 June 2003.

* Corresponding author. Tel.: +31-71-5262020; fax: +31-71-5266809. jbax{at}knoware.nl


  Abstract

Aims: Ventricular tachycardia (VT) frequently has an anatomical substrate. Identification of areas prone to arrhythmogenicity facilitates radiofrequency catheter ablation (RFCA). Furthermore, direct monitoring of complications potentially increases safety of RFCA. The aim of this study was to evaluate the feasibility of guiding RFCA of VT with intracardiac echocardiography (ICE), in order to improve outcome and procedural safety.

Methods and Results: Eleven patients (age 59 ± 15) with drug-refractory VT of various etiologies were studied. VT mapping and ablation were performed using standard techniques. ICE was performed with a multifrequency (5–10 MHz) phased-array transducer positioned in the right ventricle. Twenty different VTs were treated (CL 352 ± 120 ms, 2.0±0.9 VT per patient). LV a- or dyskinesia was identified in all post-infarct patients. In patients with arrhythmogenic right ventricular dysplasia, right ventricular aneurysms and dyskinesia could be identified. In all patients catheter position and tip-tissue contact could easily be monitored with ICE. Procedural success (non-inducibility of hemodynamically stable VT) was achieved in all patients. Complications did not occur.

Conclusion: ICE is feasible in guiding RFCA of VT of different etiologies. The use of ICE in adjunction with fluoroscopy and mapping procedures will facilitate treatment of VT and may contribute to the safety of the procedure.

Keywords: intracardiac echocardiography; ventricular tachycardia; radiofrequency catheter ablation


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