Abstract：
BACKGROUND: Recurrent ventricular tachycardia (VT) can be treated by substrate modification of the myocardial scar by catheter ablation during sinus rhythm without VT induction. Better defining this arrhythmic substrate could help improve outcome and reduce ablation burden.
OBJECTIVE: The study aimed to limit ablation within postinfarction scar to conduction channels within the scar to reduce VT recurrence.
METHODS: Patients undergoing catheter ablation for recurrent implantable cardioverter-defibrillator therapy for postinfarction VT were recruited at 5 centers. Left ventricular maps were collected on CARTO using a Pentaray catheter. Ripple mapping was used to categorize infarct scar potentials (SPs) by timing. Earliest SPs were ablated sequentially until there was loss of the terminal SPs without their direct ablation. The primary outcome measure was sustained VT episodes as documented by device interrogations at 1 year, which was compared with VT episodes in the year before ablation.
RESULTS: The study recruited 50 patients (mean left ventricular ejection fraction, 33% ± 9%), and 37 patients (74%) met the channel ablation end point with successful loss of latest SPs without direct ablation. There were 16 recurrences during 1-year follow-up. There was a 90% reduction in VT burden from 30.2 ± 53.9 to 3.1 ± 7.5 (P < .01) per patient, with a concomitant 88% reduction in appropriate shocks from 2.1 ± 2.7 to 0.2 ± 0.9 (P < .01). There were 8 deaths during follow-up. Those who met the channel ablation end point had no significant difference in mortality, recurrence, or VT burden but had a significantly lower ablation burden of 25.7 ± 4.2 minutes vs 39.9 ± 6.1 minutes (P = .001).
CONCLUSIONS: Scar channel ablation is feasible by ripple mapping and can be an alternative to more extensive substrate modification techniques.
OBJECTIVE: The study aimed to limit ablation within postinfarction scar to conduction channels within the scar to reduce VT recurrence.
METHODS: Patients undergoing catheter ablation for recurrent implantable cardioverter-defibrillator therapy for postinfarction VT were recruited at 5 centers. Left ventricular maps were collected on CARTO using a Pentaray catheter. Ripple mapping was used to categorize infarct scar potentials (SPs) by timing. Earliest SPs were ablated sequentially until there was loss of the terminal SPs without their direct ablation. The primary outcome measure was sustained VT episodes as documented by device interrogations at 1 year, which was compared with VT episodes in the year before ablation.
RESULTS: The study recruited 50 patients (mean left ventricular ejection fraction, 33% ± 9%), and 37 patients (74%) met the channel ablation end point with successful loss of latest SPs without direct ablation. There were 16 recurrences during 1-year follow-up. There was a 90% reduction in VT burden from 30.2 ± 53.9 to 3.1 ± 7.5 (P < .01) per patient, with a concomitant 88% reduction in appropriate shocks from 2.1 ± 2.7 to 0.2 ± 0.9 (P < .01). There were 8 deaths during follow-up. Those who met the channel ablation end point had no significant difference in mortality, recurrence, or VT burden but had a significantly lower ablation burden of 25.7 ± 4.2 minutes vs 39.9 ± 6.1 minutes (P = .001).
CONCLUSIONS: Scar channel ablation is feasible by ripple mapping and can be an alternative to more extensive substrate modification techniques.
摘要：
背景：复发性室性心动过速（VT）可以通过在窦性心律无室性心动过速诱导期间通过导管消融对心肌瘢痕进行基质修饰来治疗。更好地定义这种心律失常基质可以帮助改善结果并减少消融负担。
目的：限制梗死后瘢痕内消融至瘢痕内传导通道以减少室性心动过速复发。
方法：在5个中心招募接受导管消融术治疗复发性植入式除颤器（ICD）治疗梗死后室性心动过速的患者。使用Pentaray™导管在CARTO™上收集左心室图。使用纹波作图对梗死瘢痕电位（SP）进行定时分类。最早的SP被依次消融，直到末端瘢痕电位丧失，而没有直接消融。主要结局指标为1年时器械询问记录的持续VT发作，并与消融前一年的VT发作进行比较。
结果：招募了50名患者（平均LVEF33%±9）和37名患者（74%）达到了通道消融终点，成功丢失了最新的SP，而没有直接消融。1年随访期间有16例复发。室性心动过速负担从30.2±53.9减少到3.1±7.5(p<0.01),减少90%,适当的电击减少了88%，从2.1±2.7减少到0.2±0.9(p<0.01)。随访期间有8人死亡。符合通道消融终点的患者死亡率无显著差异，复发或室性心动过速负担,但消融负担显著低于25.7±4.2和39.9±6.1分钟(p=0.001).
结论：使用纹波映射进行疤痕通道消融是可行的，并且可以替代更广泛的衬底修饰技术。
目的：限制梗死后瘢痕内消融至瘢痕内传导通道以减少室性心动过速复发。
方法：在5个中心招募接受导管消融术治疗复发性植入式除颤器（ICD）治疗梗死后室性心动过速的患者。使用Pentaray™导管在CARTO™上收集左心室图。使用纹波作图对梗死瘢痕电位（SP）进行定时分类。最早的SP被依次消融，直到末端瘢痕电位丧失，而没有直接消融。主要结局指标为1年时器械询问记录的持续VT发作，并与消融前一年的VT发作进行比较。
结果：招募了50名患者（平均LVEF33%±9）和37名患者（74%）达到了通道消融终点，成功丢失了最新的SP，而没有直接消融。1年随访期间有16例复发。室性心动过速负担从30.2±53.9减少到3.1±7.5(p<0.01),减少90%,适当的电击减少了88%，从2.1±2.7减少到0.2±0.9(p<0.01)。随访期间有8人死亡。符合通道消融终点的患者死亡率无显著差异，复发或室性心动过速负担,但消融负担显著低于25.7±4.2和39.9±6.1分钟(p=0.001).
结论：使用纹波映射进行疤痕通道消融是可行的，并且可以替代更广泛的衬底修饰技术。
