Arrhythmias and conduction disturbance
Relation between site of origin of ventricular tachycardia and relative left ventricular myocardial perfusion and wall motion

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Abstract

To assess the relation between the site of origin of ventricular tachycardia (VT) and relative myocardial perfusion and wall motion, 18 patients with a history of recurrent sustained VT underwent cardiac catheterization, invasive electrophysiologic study with endocardial mapping, and resting radionuclide ventriculography. In addition, 6 patients had exercise and redistribution thallium-201 scintigraphy, whereas the remaining 12 patients had resting thallium scans. The site of origin of VT (determined by catheter and intraoperative endocardial mapping) was correlated with relative myocardial perfusion (thallium) and left ventricular (LV) wall motion. All patients had significant (>50% narrowing) coronary artery disease and 16 had LV aneurysms.

Twenty sites of origin of VT (28 morphologies) were identified in these 18 patients. Of the 9 patients with multiple VT morphologies, the VT originated at disparate sites in 2 patients. All 18 patients had thallium defects at rest and 3 patients had additional reversible (ischemic) defects on exercise. Of the 20 sites of origin of VT, 16 were at the periphery of the thallium defect, 1 was adjacent to it, and 3 were in the center of it. In the 16 patients with LV aneurysm, there were 18 sites of origin: 15 at the border of the aneurysm, 1 adjacent to it, and 2 within it.

The data suggest that in patients with VT and coronary artery disease the site of origin is usually the periphery of a resting thallium defect, and in patients with LV aneurysm the site is the border of the aneurysm.

References (28)

  • WB Ricks et al.

    Surgical management of life-threatening ventricular arrhythmias in patients with coronary artery disease

    Circulation

    (1977)
  • M Saml et al.

    Long term follow-up of aneurysmectomy for recurrent ventricular tachycardia or fibrillation

    Am Heart J

    (1978)
  • ME Josephson et al.

    Endocardial excision: a new surgical technique for the treatment of recurrent ventricular tachycardia

    Circulation

    (1979)
  • LN Horowitz et al.

    Ventricular resection guided by epicardial and endocardial mapping for treatment of recurrent ventricular tachycardia

    N Engl J Med

    (1980)
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    This study was supported in part by a grant (R01 HL24278) from the National Heart, Lung, and Blood Institute, Bethesda, Maryland, and a grant from the American Heart Association, Southeastern Pennsylvania Chapter, Philadelphia, Pennsylvania.

    Dr. Josephson is the Robinette Foundation Associate Professor of Medicine (Cardiovascular Diseases) and the recipient of a Research Career Development Award (K04 HL00361) from the National Heart, Lung, and Blood Institute, Bethesda, Maryland.

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