[Ventricular tachycardia ablation guided by LocaLisa system in patients with structural heart disease].

INTRODUCTION

The ablation of ventricular tachycardia is limited by a number of factors that reduce the effectiveness of this intervention in patients with structural heart disease compared to other types of arrhythmia. Recent years have seen the development of several nonfluoroscopic navigation techniques that facilitate the mapping of complex arrhythmogenic substrates. One such technique, the LocaLisa system, has not previously been tested for the ablation of ventricular tachycardia.

PATIENTS AND METHOD

A total of 32 patients with structural heart disease were treated at our center with ablation for sustained ventricular tachycardia. In 10 patients the LocaLisa system was used to visualize the catheters during the procedure. We compared the results in the LocaLisa group with those in a control group of 22 patients treated with conventional fluoroscopy-guided ablation.

RESULTS

The success rate of ablation was 75% (9/12 procedures) in the LocaLisa group and 68% (17/25 procedures) in the control group (P=NS). In the LocaLisa group, mean total duration of the procedure (243 +/- 84), duration of ablation (86 +/- 56) and fluoroscopy time (46 +/- 19) did not differ significantly from those in the control group (244 +/- 72 min, 79 +/- 58 min, and 43 +/- 27 min, respectively). In the LocaLisa group the trend toward greater hemodynamic intolerance in ventricular tachycardia approached significance (42% in the LocaLisa group vs 24% in the control group, P=.05) and the number of mapping procedures performed during sinus rhythm was significantly higher in the former (33% in the LocaLisa group vs 4% in the control group, P=.03). With the LocaLisa system it was possible to locate and reposition the ablation catheter accurately at the target endocardial sites, as confirmed by electrographic recordings and fluoroscopic verification.

CONCLUSIONS

The LocaLisa system helps to delineate the reentry circuit and facilitates accurate catheter repositioning in patients with structural heart disease and ventricular tachycardia.