DEVELOPMENT OF AN INTERACTIVE COMPUTER-GUIDED METHOD FOR RADIOFREQUENCY CATHETER ABLATION OF VENTRICULAR-TACHYCARDIA

The purpose of this study was to develop a simple computer-guided appr oach to localizing ventricular tachycardias during ventricular mapping . Six patients with sustained mon om orphic ventricular tachycardia we re connected to a 32-lead computer body surface mapping system. Isoare a maps of induced ventricular tachycardia were recorded. Then a pacing probe was placed in either She right or left ventricle, and maps were generated from a variety of sites. Differences between ventricular ta chycardia and pace map maxima X,Y coordinates were utilized to guide c atheter manipulation and localization. In 6 of a patients (100%) this method appeared to provide a systematic approach to ventricular tachyc ardia localization. Computer-generated correlations as well as the X,Y coordinates of the QRS isoarea maxima were used to determine proximit y to the ventricular tachycardia foci and direct catheter manipulation . In the next three patients this method was applied prospectively to help guide catheter manipulation during ventricular tachycardia (two r ight ventricular outflow tract tachycardias, and one left ventricular tachycardia). After a mean of 4.0 +/- 1.7 radiofrequency applications, ventricular tachycardia was no longer inducible, and at 7 +/- 0 month s follow-up there have been no arrhythmia recurrences. We conclude tha t online computerized body surface mapping can assist in localizing ve ntricular tachycardia. Differences in maxima during pace maps and in-s itu ventricular tachycardias can help with catheter manipulation as we ll as with more precise identification of focal tachycardias. This tec hnique appears to hold the promise of a simple computer-guided method that may facilitate radiofrequency catheter ablation.