Chest Pain Clinical Trial
Official title:
EPIcardial and Endocardial Mapping and Ablation Using Contact Force Catheter in Chagasic Patients With Sustained Ventricular Tachycardia
Ventricular tachycardia is one of the commonest cause of sudden death in chronic chagas
disease. As most ventricular tachycardias originate from scar in patients with heart
disease, catheter ablation is an important step in patient treatment. Identification of
fibrosis prior to ablation of sustained ventricular tachycardia (SVT) might reduce the time
of anesthesia, procedure time, radiation exposure and possibly the risk of complications.
Knowledge of arrhythmia circuit within scar allows planning strategies for each procedure.
Condreanu et al. stablished that voltages inferior to 6.52 mV (unipolar) and 1.54mV
(bipolar) are useful tools in detecting scar during electroanatomic mapping. Accuracy,
however when compared to magnetic resonance imaging is limited due to difficulties in
maintaining good contact between ablation catheter and ventricular wall. Contact force
catheters might help increase accuracy of voltage mapping because they allow detection of
poor contact areas. Although the threshold for identification of scar in ischemic and non
ischemic patients during electroanatomical mapping is already known, this parameters still
lacking for chronic chagasic individuals. A marked qualitative histological difference
between these fibrous scars supports the hypothesis that voltage scar in chagasics might be
different. Catheter ablation contact with endo and epicardial surface is an important issue
when ablating arrhythmias. Conventional catheter ablation is not equipped with sensors
capable of detecting degree of contact with the target. To our knowledge, the literature
lacks information in regard to late lesions produced by a known contact force pressure "in
vivo". The pattern of electrical activation in these patients and their relationship with
local coronary veins for resynchronization likely to approach through the coronary sinus can
be useful in defining chagasic that can benefit from resynchronization.
1. Compare endocardial and epicardial impedance and voltage using CARTO 3 with fibrosis on
3T MRI
2. Correlate areas of late activation within scar during activating mapping in sinus
rhythm with different signal intensity in 3T MRI
3. Evaluate the influence of contact pressure during application of radiofrequency in
making fibrosis analyzed 30 days after the procedure using a 3T MRI.
4. Assess the site of latest left ventricular activation in sinus rhythm and correlate
with the coronary veins location
n/a
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