Recording of low-amplitude diastolic electrograms through the coronary veins: a guide for epicardial ventricular tachycardia ablation

The purpose of the study was to evaluate the role of coronary venous mapping to identify epicardial ventricular tachycardia (VT) in patients with structural heart disease.

Epicardial mapping of the electrophysiological substrate through the coronary vein branches using a 2.2F, 16-pole microelectrode catheter was performed in 33 consecutive patients undergoing VT ablation. Twenty-six patients had a history of myocardial infarction and seven had a non-ischaemic cardiomyopathy. Endocardial ablation was successful in 19 of the 33 patients (58%). Low-amplitude fractionated diastolic electrograms with an electrogram–QRS interval amounting to 30–70% of the VT cycle length were recorded during the VT in the coronary vein branches in eight patients (24%). Endocardial ablation failed in seven of the eight patients with diastolic electrograms in the coronary veins, suggesting an epicardial involvement of the VT re-entry circuit. Among the patients with a suspected epicardial VT origin, four patients underwent epicardial ablation using a pericardial access after unsuccessful endocardial ablation which eliminated mappable VTs in all.

Recording of low-amplitude fractionated diastolic electrograms through the coronary veins facilitates the identification of VTs with an epicardial origin requiring mapping and ablation through a pericardial access.