ENTRAINMENT MAPPING AND RADIOFREQUENCY CATHETER ABLATION OF VENTRICULAR-TACHYCARDIA IN RIGHT-VENTRICULAR DYSPLASIA

Objectives. The purpose of this study was to determine if entrainment mapping techniques and predictors of successful ablation sites previou sly tested in coronary artery disease can be applied to ventricular ta chycardia (VT) in arrhythmogenic right ventricular dysplasia (ARVD). B ackground. VT in ARVD has not been well characterized. Reentry circuit s in areas of abnormal myocardium are the likely cause, but these circ uits have not been well defined. Methods. Mapping of 19 VTs in 5 patie nts with ARVD was performed. At 58 sites pacing entrained VT and radio frequency current (RF) was applied to assess acute termination of VT. Results. Sites classified as exits, central/proximal, inner loop, oute r loop, remote bystander and adjacent bystander were identified by ent rainment criteria. The reentrant circuit sites were clustered predomin antly around the tricuspid annulus and in the right ventricular outflo w tract (RVOT). RF ablation acutely terminated VT at 13 sites or 22% o f the applications. Of the 19 VTs, eight were rendered noninducible an d three were modified to a longer cycle length. In 2 patients ablation at a single site abolished two VTs. Conclusion. VT in ARVD shows many of the characteristics of VT due to myocardial infarction, Entrainmen t mapping techniques can be used to characterize reentry circuits in A RVD. The use of entrainment mapping to guide ablation is feasible. (J Am Coll Cardiol 1998;32:724-8) (C)1998 by the American College of Card iology.