Entrainment/mapping criteria for the prediction of termination of ventricular tachycardia by single radiofrequency lesion in patients with coronary artery disease

Background-A variety of mapping criteria have been proposed to localize cri tical sites at which radiofrequency (RF) can predictably terminate reentran t ventricular tachycardia (VT) caused by coronary artery disease. The purpo se of this study was to determine the accuracy of using a combination of 3 mapping criteria in predicting termination of VT by a single RF lesion. Methods and Results-Fifteen consecutive patients with coronary artery disea se and recurrent sustained VT underwent an attempted RF ablation of 20 mono morphic VTs, Successful termination of VT by a single RF lesion was predict ed if all the following mapping criteria were met: (1) an exact QRS match i n the 12-lead ECG during entrainment; (2) a return cycle length less than o r equal to 10 ms of the VT cycle length; (3) presystolic potentials (<70% o f VT cycle length) with an activation time to the QRS within 10 ms of the s timulus to QRS. Inability to meet these 3 criteria was considered to predic t failure of VT termination by RF energy at that site. RF ablation was appl ied to 44 left ventricular sites in 20 VTs at which at least 1 of the mappi ng criteria was met. VT was terminated with a single RF lesion in 19 of 19 sites meeting all criteria; RF failed to terminate VT at 24 of 25 sites at which all 3 criteria were not met (P < 0.0005). Conclusions-To maximize success and minimize the number of RF lesions in pa tients with infarct-related VT, all the above 3 mapping criteria should be met before the application of RF energy.