Open AccessEfficacy and Safety of Strict Voltage‐based Substrate Mapping and Radiofrequency Catheter Ablation in Electrical Storms—Review of Substrate‐mapping Guided Ablation in Frequent Appropriate Shocks
Author(s) -
Arimoto Takanori,
Tada Hiroshi,
Sekiguchi Yukio,
Koyama Takashi,
Igarashi Miyako,
Yamasaki Hiro,
Machino Takeshi,
Kuroki Kenji,
Kuga Keisuke,
Aonuma Kazutaka
Publication year - 2009
Publication title -
journal of arrhythmia
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.463
H-Index - 21
eISSN - 1883-2148
pISSN - 1880-4276
DOI - 10.1016/s1880-4276(09)80003-3
Subject(s) - medicine , ablation , substrate (aquarium) , catheter ablation , ventricular tachycardia , cardiology , catheter , radiofrequency ablation , biomedical engineering , surgery , oceanography , geology
Background: We investigated the efficacy and safety of strict voltage‐based substrate mapping and radiofrequency catheter ablation (SV‐substrate‐map ablation) in patients with electrical storm. Methods and Results: SV‐substrate‐map ablation was performed in 15 patients suffering from multiple appropriate shocks (6.0 ± 3.8/day) from implantable cardioverter defibrillators (ICDs). Strict voltage criteria were defined as: non‐arrhythmogenic areas, >0.6mV; low voltage areas, >0.1 to ≤0.6 mV; and scar, ≤0.1 mV. Using an electroanatomic mapping system, catheter ablation was performed at every possible arrhythmogenic region inside the low voltage areas. Further, we presented a review of the literature and investigated the published data on substrate‐mapping guided ablation for electrical storm. After repeat endocardial ablation procedures in 4 patients and an epicardial approach in one, the targeted ventricular tachycardias (VTs) were successfully ablated, and the electrical storms were completely controlled in all. During a mean follow‐up period of 801 ± 409 days, only one VT followed by an appropriate ICD shock was observed. No potential complications occurred during the procedure or follow‐up. Our results were comparable or better than that of previous substrate‐mapping guided ablation studies. Conclusion: SV‐substrate‐mapping ablation may be effective and safe for resolving serious clinical situations and prolonging the longevity of ICD devices in patients with electrical storms.