• Frank Bogun, Yi-Gang Li, Gerian Groenefeld, Stefan H Hohnloser, Claudio Schuger, Hakan Oral, Frank Pelosi, Bradley Knight, S Adam Strickberger, and Fred Morady.
• Division of Cardiology, Henry Ford Hospital, Detroit, Michigan 48202-9888, USA. bogun@eudormail.com
• J. Cardiovasc. Electrophysiol. 2002 Mar 1; 13 (3): 237-41.

IntroductionMultiple forms of ventricular tachycardia (VT) after myocardial infarction may result from multiple reentrant circuits that share an isthmus or from separate reentrant circuits. The prevalence of a shared isthmus in patients with multiple hemodynamically tolerated VTs has not been determined.Methods And ResultsCriteria for a shared isthmus consisted of (1) concealed entrainment of >1 VT at a single pacing site; (2) concealed entrainment during VT and a perfect pace map of another VT at the same pacing site; or (3) concealed entrainment of VT of a given morphology that had at least two cycle lengths that varied by at least 100 msec. In a series of 19 patients (16 men and 3 women; age 65+/-14 years, ejection fraction 0.25+/-0.09) with 54 VTs (mean cycle length 494+/-98 msec), there was evidence of a shared isthmus in 23 VTs (43%) at 11 sites in 9 patients. Concealed entrainment of two different VTs was observed at 4 of 11 sites. At 5 of 11 sites there was concealed entrainment of one VT and a perfect pace map of another VT. At the remaining 2 of 11 sites, there was concealed entrainment of a VT that had two different cycle lengths. Nineteen of the 23 VTs were ablated successfully with radiofrequency energy applications at 11 sites.ConclusionIn postinfarction patients with pleiomorphic, hemodynamically stable VT, a shared isthmus may be present in approximately 40% of VTs.

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