Transcatheter subendocardial infusion. A novel technique for mapping and ablation of ventricular myocardium

Circulation
A GoetteJ J Langberg

Abstract

Catheter ablation with radiofrequency energy is feasible in a limited subset of patients with ventricular tachycardia. The purpose of this study was to evaluate a technique for mapping and ablation of ventricular myocardium with the use of transcatheter subendocardial infusion. A needle-tipped deflectable electrode catheter was used to deliver reagents to endocardial target sites. This was equipped with two central lumens to allow sequential administration of mapping and ablation injectants with minimal admixture. The mapping injectant consisted of a mixture of lidocaine, iohexal, and glycerin; the ablation injectant contained ethanol, iohexal, and glycerin. Infusion of the mapping injectant (1 cm3 over 3 or 5 seconds, n = 14) produced a stain on fluoroscopy and increased local capture threshold by 61%. No lesions resulted from mapping infusions. Infusion of the ethanol-containing injectant (n = 48) produced discrete lesions, with a mean volume ranging from 0.6 to 1.5 cm3. There was a direct relationship between infusion volume, infusion duration, and resultant lesion volume. Fibrosis in a region of healed myocardial infarction did not impair diffusion of the injectant or affect lesion dimensions. Microscopic analysis of chroni...Continue Reading

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Citations

Oct 1, 1990·Pacing and Clinical Electrophysiology : PACE·J J LangbergM Rosenqvist
Jan 1, 1992·Journal of the American College of Cardiology·G N KayV J Plumb
Dec 1, 1991·European Heart Journal·B D GonskaH Kreuzer
Aug 15, 1991·The American Journal of Cardiology·H de SwartH J Wellens
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Related Concepts

Ethanol
Left Ventricular Structure
Bulla
Isolated Noncompaction of the Ventricular Myocardium
Myocardium
Myocardial Infarction
Fluoroscopy
Cardiac Surgery Procedures
Endocardium
Tachycardia, Ventricular

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