Pace-mapping conduction delay at reentry circuit sites of ventricular tachycardia after myocardial infarction

This study was carried out to determine the relationship of conduction delay during pace-mapping, as indicated by the stimulus to QRS interval to different reentry circuit sites and bystanders, as identified by entrainment criteria, in patients with ventricular tachycardia late after myocardial infarction. Catheter mapping and ablation were performed in 40 patients with ventricular tachycardia after myocardial infarction. Data were retrospectively analyzed from 122 endocardial sites which met the following the criteria: a 12-lead electrocardiogram was recorded during pace-mapping, ventricular tachycardia was then induced and entrained by pacing to classify the type of the site relative to the reentry circuit exit. By entrainment criteria 77 sites were in the reentry circuit (28 exit sites, 49 other circuit sites) and 45 sites were bystanders not in the reentry circuit. The average stimulus conduction delay at central/proximal sites was 103 +/- 43 ms, which was significantly longer than at exit (57 +/- 31 ms), outer loop sites (57 +/- 32 ms), and bystander sites (57 +/- 37 ms); P0.05. Pace-mapping revealed evidence of greater conduction delay at sites proximal to the reentry circuit exit, consistent with slow conduction between these regions and the border of the infarct. Exit sites and outer loop sites were more likely to be located along the border of the infarct, with less conduction delay evident during pace-mapping.