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Nayyar S, Downar E, Bhaskaran AP, Massé S, Nanthakumar K. Signature signal strategy: Electrogram-based ventricular tachycardia mapping. Heart Rhythm 2020; 17:2000-2009. [PMID: 32590152 DOI: 10.1016/j.hrthm.2020.06.022] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Revised: 06/16/2020] [Accepted: 06/19/2020] [Indexed: 11/16/2022]
Abstract
Multiple decades of work have recognized complexities of substrates responsible for ventricular tachycardia (VT). There is sufficient evidence that 3 critical components of a re-entrant VT circuit, namely, region of slow conduction, zone of unidirectional block, and exit site, are located in spatial vicinity to each other in the ventricular scar. Each of these components expresses characteristic electrograms in sinus rhythm, at initiation of VT, and during VT, respectively. Despite this, abnormal electrograms are widely targeted without appreciation of these signature electrograms during contemporary VT ablation. Our aim is to stimulate physiology-based VT mapping and a targeted ablation of VT. In this article, we focus on these 3 underappreciated aspects of the physiology of ischemic scar-related VT circuits that have practical applications during a VT ablation procedure. We explore the anatomic and functional elements underlying these distinctive bipolar electrograms, specifically the contribution of tissue branching, conduction restitution, and wave curvature to the substrate, as they pertain to initiation and maintenance of VT. We propose a VT ablation approach based on these 3 electrogram features that can be a potential practical means to recognize critical elements of a VT circuit and target ablation.
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Affiliation(s)
- Sachin Nayyar
- The Hull Family Cardiac Fibrillation Management Laboratory, Toronto General Hospital, Toronto, Ontario, Canada; Division of Cardiology, Townsville University Hospital, Townsville, Queensland, Australia; Department of Medicine, James Cook University, Townsville, Queensland, Australia.
| | - Eugene Downar
- The Hull Family Cardiac Fibrillation Management Laboratory, Toronto General Hospital, Toronto, Ontario, Canada
| | - Abhishek P Bhaskaran
- The Hull Family Cardiac Fibrillation Management Laboratory, Toronto General Hospital, Toronto, Ontario, Canada
| | - Stéphane Massé
- The Hull Family Cardiac Fibrillation Management Laboratory, Toronto General Hospital, Toronto, Ontario, Canada
| | - Kumaraswamy Nanthakumar
- The Hull Family Cardiac Fibrillation Management Laboratory, Toronto General Hospital, Toronto, Ontario, Canada
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Ladas TP, Sugrue A, Nan J, Vaidya VR, Padmanabhan D, Venkatachalam KL, Asirvatham SJ. Fundamentals of Cardiac Mapping. Card Electrophysiol Clin 2020; 11:433-448. [PMID: 31400868 DOI: 10.1016/j.ccep.2019.05.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
To characterize cardiac activity and arrhythmias, electrophysiologists can record the electrical activity of the heart in relation to its anatomy through a process called cardiac mapping (electroanatomic mapping, EAM). A solid understanding of the basic cardiac biopotentials, called electrograms, is imperative to construct and interpret the cardiac EAM correctly. There are several mapping approaches available to the electrophysiologist, each optimized for specific arrhythmia mechanisms. This article provides an overview of the fundamentals of EAM.
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Affiliation(s)
- Thomas P Ladas
- Department of Cardiovascular Medicine, Division of Heart Rhythm Services, Mayo Clinic, Rochester, MN, USA
| | - Alan Sugrue
- Department of Cardiovascular Medicine, Division of Heart Rhythm Services, Mayo Clinic, Rochester, MN, USA
| | - John Nan
- Department of Cardiovascular Medicine, Division of Heart Rhythm Services, Mayo Clinic, Rochester, MN, USA
| | - Vaibhav R Vaidya
- Department of Cardiovascular Medicine, Division of Heart Rhythm Services, Mayo Clinic, Rochester, MN, USA
| | - Deepak Padmanabhan
- Department of Cardiovascular Medicine, Division of Heart Rhythm Services, Mayo Clinic, Rochester, MN, USA
| | - K L Venkatachalam
- Department of Cardiovascular Medicine, Division of Heart Rhythm Services, Mayo Clinic, Jacksonville, Florida, USA
| | - Samuel J Asirvatham
- Department of Cardiovascular Medicine, Division of Heart Rhythm Services, Mayo Clinic, Rochester, MN, USA; Department of Pediatric and Adolescent Medicine, Division of Pediatric Cardiology, Mayo Clinic, Rochester, MN, USA; Physiology and Biomedical Engineering, Mayo Clinic, Rochester, MN, USA.
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Trayanova NA, Doshi AN, Prakosa A. How personalized heart modeling can help treatment of lethal arrhythmias: A focus on ventricular tachycardia ablation strategies in post-infarction patients. WILEY INTERDISCIPLINARY REVIEWS-SYSTEMS BIOLOGY AND MEDICINE 2020; 12:e1477. [PMID: 31917524 DOI: 10.1002/wsbm.1477] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/12/2019] [Revised: 12/16/2019] [Accepted: 12/17/2019] [Indexed: 12/18/2022]
Abstract
Precision Cardiology is a targeted strategy for cardiovascular disease prevention and treatment that accounts for individual variability. Computational heart modeling is one of the novel approaches that have been developed under the umbrella of Precision Cardiology. Personalized computational modeling of patient hearts has made strides in the development of models that incorporate the individual geometry and structure of the heart as well as other patient-specific information. Of these developments, one of the potentially most impactful is the research aimed at noninvasively predicting the targets of ablation of lethal arrhythmia, ventricular tachycardia (VT), using patient-specific models. The approach has been successfully applied to patients with ischemic cardiomyopathy in proof-of-concept studies. The goal of this paper is to review the strategies for computational VT ablation guidance in ischemic cardiomyopathy patients, from model developments to the intricacies of the actual clinical application. To provide context in describing the road these computational modeling applications have undertaken, we first review the state of the art in VT ablation in the clinic, emphasizing the benefits that personalized computational prediction of ablation targets could bring to the clinical electrophysiology practice. This article is characterized under: Analytical and Computational Methods > Computational Methods Models of Systems Properties and Processes > Organ, Tissue, and Physiological Models Translational, Genomic, and Systems Medicine > Translational Medicine.
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Affiliation(s)
- Natalia A Trayanova
- Alliance for Cardiovascular Diagnostic and Treatment Innovation, Johns Hopkins University, Baltimore, Maryland.,Department of Biomedical Engineering, Johns Hopkins University, Baltimore, Maryland
| | - Ashish N Doshi
- Alliance for Cardiovascular Diagnostic and Treatment Innovation, Johns Hopkins University, Baltimore, Maryland
| | - Adityo Prakosa
- Alliance for Cardiovascular Diagnostic and Treatment Innovation, Johns Hopkins University, Baltimore, Maryland
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de Bakker JM. Electrogram recording and analyzing techniques to optimize selection of target sites for ablation of cardiac arrhythmias. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2019; 42:1503-1516. [PMID: 31609005 PMCID: PMC6916598 DOI: 10.1111/pace.13817] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/04/2019] [Revised: 10/03/2019] [Accepted: 10/09/2019] [Indexed: 12/27/2022]
Abstract
The extracellular electrogram is caused by transmembrane currents that flow into extracellular space during propagation of the electrical impulse. Electrograms are usually recorded in unipolar or bipolar mode that have different characteristics, but provide complementary information. Both recording modes have specific advantages, but also suffer from disadvantages. Techniques to circumvent some of the weaknesses are reviewed. The origin of remote and fractionated deflections and their relation with electrode characteristics are discussed. Epicardial and endocardial sites of origin and breakthrough sites as well as the effect of fatty tissue on extracellular electrograms are presented. Induction of tachycardia to assess the arrhythmogenic area is not always possible because of hemodynamic instability of the patient. Techniques to assess sites with high reentry vulnerability without induction of arrhythmias are outlined such as activation‐repolarization mapping and decremental stimulation. Pitfalls of substrate mapping and techniques to avoid them as omnipolar mapping and characterization of complex electrograms by entropy are presented. Technical aspects that influence electrogram morphology as electrode size, filtering, contact force, and catheter position are delineated. Data from the various publications suggest that a combination of unipolar and bipolar electrogram analysis techniques is helpful to optimize determination of target sites for ablation.
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Affiliation(s)
- Jacques Mt de Bakker
- Heart Center, Department of Experimental Cardiology, Academic Medical Center, Amsterdam, The Netherlands
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Evaluation of the reentry vulnerability index to predict ventricular tachycardia circuits using high-density contact mapping. Heart Rhythm 2019; 17:576-583. [PMID: 31751771 PMCID: PMC7105818 DOI: 10.1016/j.hrthm.2019.11.013] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2019] [Indexed: 11/24/2022]
Abstract
Background Identifying arrhythmogenic sites to improve ventricular tachycardia (VT) ablation outcomes remains unresolved. The reentry vulnerability index (RVI) combines activation and repolarization timings to identify sites critical for reentrant arrhythmia initiation without inducing VT. Objective The purpose of this study was to provide the first assessment of RVI’s capability to identify VT sites of origin using high-density contact mapping and comparison with other activation-repolarization markers of functional substrate. Methods Eighteen VT ablation patients (16 male; 72% ischemic) were studied. Unipolar electrograms were recorded during ventricular pacing and analyzed offline. Activation time (AT), activation–recovery interval (ARI), and repolarization time (RT) were measured. Vulnerability to reentry was mapped based on RVI and spatial distribution of AT, ARI, and RT. The distance from sites identified as vulnerable to reentry to the VT site of origin was measured, with distances <10 mm and >20 mm indicating accurate and inaccurate localization, respectively. Results The origins of 18 VTs (6 entrainment, 12 pace-mapping) were identified. RVI maps included 1012 (408–2098) (median, 1st–3rd quartiles) points per patient. RVI accurately localized 72.2% VT sites of origin, with median distance of 5.1 (3.2–10.1) mm. Inaccurate localization was significantly less frequent for RVI than AT (5.6% vs 33.3%; odds ratio 0.12; P = .035). Compared to RVI, distance to VT sites of origin was significantly larger for sites showing prolonged RT and ARI and were nonsignificantly larger for sites showing highest AT and ARI gradients. Conclusion RVI identifies vulnerable regions closest to VT sites of origin. Activation-repolarization metrics may improve VT substrate delineation and inform novel ablation strategies.
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Mapping and Ablation of Unmappable Ventricular Tachycardia, Ventricular Tachycardia Storm, and Those in Acute Myocardial Infarction. Card Electrophysiol Clin 2019; 11:675-688. [PMID: 31706474 DOI: 10.1016/j.ccep.2019.08.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
In stable ventricular tachycardia (VT), activation mapping and entrainment mapping are the most important strategies to describe the reentrant circuit and its critical components. In many patients, however, VT is noninducible or hemodynamically unstable and unmappable. Several technological advances have broadened ablation options in unmappable VTs. Preprocedural imaging and intraprocedural imaging play an important role in location and extent of the substrate. Electroanatomic mapping with several technological improvements allows more precise electrical assessment of the substrate. A combination of imaging and electroanatomic mapping allows substantial modification of arrhythmogenic substrate in sinus rhythm or during device pacing without hemodynamic compromise.
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Abstract
Ventricular tachycardia is typically hemodynamically unstable. Strategies to target the arrhythmogenic substrate during sinus rhythm are essential for therapeutic ablation. Electroanatomic mapping is the cornerstone of substrate-based strategies; ablation can be directed within a delineated scar region defined by low voltage. Bipolar voltage mapping has inherent limitations. Specific electrogram characteristics may improve the specificity of localizing the most arrhythmogenic regions within the substrate. Deceleration zones during sinus rhythm are niduses for reentry and can be identified by isochronal late activation mapping, which is a functional analysis of substrate propagation with local annotation to electrogram offset.
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Affiliation(s)
- Roderick Tung
- Department of Medicine, Section of Cardiology, The University of Chicago Medicine, Center for Arrhythmia Care, Pritzker School of Medicine, 5841 South Maryland Avenue, MC 6080, Chicago, IL 60637, USA.
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58
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Martin CA, Martin R, Maury P, Meyer C, Wong T, Dallet C, Shi R, Gajendragadkar P, Takigawa M, Frontera A, Cheniti G, Thompson N, Kitamura T, Vlachos K, Wolf M, Bourier F, Lam A, Duchâteau J, Massoullié G, Pambrun T, Denis A, Derval N, Dubois R, Hocini M, Haïssaguerre M, Jaïs P, Sacher F. Effect of Activation Wavefront on Electrogram Characteristics During Ventricular Tachycardia Ablation. Circ Arrhythm Electrophysiol 2019; 12:e007293. [DOI: 10.1161/circep.119.007293] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Affiliation(s)
- Claire A. Martin
- IHU Liryc, Electrophysiology and Heart Modeling Institute, Fondation Bordeaux Université, F-/Bordeaux University Hospital (CHU), Electrophysiology and Ablation Unit, University of Bordeaux, Centre de recherche Cardio-Thoracique de Bordeaux, France/Pessac–Bordeaux, France (C.A.M., R.M., C.D., M.T., A.F., G.C., N.T., T.K., K.V., M.W., F.B., A.L., J.D., G.M., T.P., A.D., N.D., R.D., M. Hocini, M. Haïssaguerre, P.J., F.S.)
- Royal Papworth Hospital NHS Foundation Trust, Cambridge, United Kingdom (C.A.M., P.G.)
| | - Ruairidh Martin
- IHU Liryc, Electrophysiology and Heart Modeling Institute, Fondation Bordeaux Université, F-/Bordeaux University Hospital (CHU), Electrophysiology and Ablation Unit, University of Bordeaux, Centre de recherche Cardio-Thoracique de Bordeaux, France/Pessac–Bordeaux, France (C.A.M., R.M., C.D., M.T., A.F., G.C., N.T., T.K., K.V., M.W., F.B., A.L., J.D., G.M., T.P., A.D., N.D., R.D., M. Hocini, M. Haïssaguerre, P.J., F.S.)
- Newcastle University, United Kingdom (R.M.)
| | | | | | - Tom Wong
- Brompton Hospital, London, United Kingdom (T.W., R.S.)
| | - Corentin Dallet
- IHU Liryc, Electrophysiology and Heart Modeling Institute, Fondation Bordeaux Université, F-/Bordeaux University Hospital (CHU), Electrophysiology and Ablation Unit, University of Bordeaux, Centre de recherche Cardio-Thoracique de Bordeaux, France/Pessac–Bordeaux, France (C.A.M., R.M., C.D., M.T., A.F., G.C., N.T., T.K., K.V., M.W., F.B., A.L., J.D., G.M., T.P., A.D., N.D., R.D., M. Hocini, M. Haïssaguerre, P.J., F.S.)
| | - Rui Shi
- Brompton Hospital, London, United Kingdom (T.W., R.S.)
| | - Parag Gajendragadkar
- Royal Papworth Hospital NHS Foundation Trust, Cambridge, United Kingdom (C.A.M., P.G.)
| | - Masateru Takigawa
- IHU Liryc, Electrophysiology and Heart Modeling Institute, Fondation Bordeaux Université, F-/Bordeaux University Hospital (CHU), Electrophysiology and Ablation Unit, University of Bordeaux, Centre de recherche Cardio-Thoracique de Bordeaux, France/Pessac–Bordeaux, France (C.A.M., R.M., C.D., M.T., A.F., G.C., N.T., T.K., K.V., M.W., F.B., A.L., J.D., G.M., T.P., A.D., N.D., R.D., M. Hocini, M. Haïssaguerre, P.J., F.S.)
| | - Antonio Frontera
- IHU Liryc, Electrophysiology and Heart Modeling Institute, Fondation Bordeaux Université, F-/Bordeaux University Hospital (CHU), Electrophysiology and Ablation Unit, University of Bordeaux, Centre de recherche Cardio-Thoracique de Bordeaux, France/Pessac–Bordeaux, France (C.A.M., R.M., C.D., M.T., A.F., G.C., N.T., T.K., K.V., M.W., F.B., A.L., J.D., G.M., T.P., A.D., N.D., R.D., M. Hocini, M. Haïssaguerre, P.J., F.S.)
| | - Ghassen Cheniti
- IHU Liryc, Electrophysiology and Heart Modeling Institute, Fondation Bordeaux Université, F-/Bordeaux University Hospital (CHU), Electrophysiology and Ablation Unit, University of Bordeaux, Centre de recherche Cardio-Thoracique de Bordeaux, France/Pessac–Bordeaux, France (C.A.M., R.M., C.D., M.T., A.F., G.C., N.T., T.K., K.V., M.W., F.B., A.L., J.D., G.M., T.P., A.D., N.D., R.D., M. Hocini, M. Haïssaguerre, P.J., F.S.)
| | - Nathaniel Thompson
- IHU Liryc, Electrophysiology and Heart Modeling Institute, Fondation Bordeaux Université, F-/Bordeaux University Hospital (CHU), Electrophysiology and Ablation Unit, University of Bordeaux, Centre de recherche Cardio-Thoracique de Bordeaux, France/Pessac–Bordeaux, France (C.A.M., R.M., C.D., M.T., A.F., G.C., N.T., T.K., K.V., M.W., F.B., A.L., J.D., G.M., T.P., A.D., N.D., R.D., M. Hocini, M. Haïssaguerre, P.J., F.S.)
| | - Takeshi Kitamura
- IHU Liryc, Electrophysiology and Heart Modeling Institute, Fondation Bordeaux Université, F-/Bordeaux University Hospital (CHU), Electrophysiology and Ablation Unit, University of Bordeaux, Centre de recherche Cardio-Thoracique de Bordeaux, France/Pessac–Bordeaux, France (C.A.M., R.M., C.D., M.T., A.F., G.C., N.T., T.K., K.V., M.W., F.B., A.L., J.D., G.M., T.P., A.D., N.D., R.D., M. Hocini, M. Haïssaguerre, P.J., F.S.)
| | - Konstantinos Vlachos
- IHU Liryc, Electrophysiology and Heart Modeling Institute, Fondation Bordeaux Université, F-/Bordeaux University Hospital (CHU), Electrophysiology and Ablation Unit, University of Bordeaux, Centre de recherche Cardio-Thoracique de Bordeaux, France/Pessac–Bordeaux, France (C.A.M., R.M., C.D., M.T., A.F., G.C., N.T., T.K., K.V., M.W., F.B., A.L., J.D., G.M., T.P., A.D., N.D., R.D., M. Hocini, M. Haïssaguerre, P.J., F.S.)
| | - Michael Wolf
- IHU Liryc, Electrophysiology and Heart Modeling Institute, Fondation Bordeaux Université, F-/Bordeaux University Hospital (CHU), Electrophysiology and Ablation Unit, University of Bordeaux, Centre de recherche Cardio-Thoracique de Bordeaux, France/Pessac–Bordeaux, France (C.A.M., R.M., C.D., M.T., A.F., G.C., N.T., T.K., K.V., M.W., F.B., A.L., J.D., G.M., T.P., A.D., N.D., R.D., M. Hocini, M. Haïssaguerre, P.J., F.S.)
| | - Felix Bourier
- IHU Liryc, Electrophysiology and Heart Modeling Institute, Fondation Bordeaux Université, F-/Bordeaux University Hospital (CHU), Electrophysiology and Ablation Unit, University of Bordeaux, Centre de recherche Cardio-Thoracique de Bordeaux, France/Pessac–Bordeaux, France (C.A.M., R.M., C.D., M.T., A.F., G.C., N.T., T.K., K.V., M.W., F.B., A.L., J.D., G.M., T.P., A.D., N.D., R.D., M. Hocini, M. Haïssaguerre, P.J., F.S.)
| | - Anna Lam
- IHU Liryc, Electrophysiology and Heart Modeling Institute, Fondation Bordeaux Université, F-/Bordeaux University Hospital (CHU), Electrophysiology and Ablation Unit, University of Bordeaux, Centre de recherche Cardio-Thoracique de Bordeaux, France/Pessac–Bordeaux, France (C.A.M., R.M., C.D., M.T., A.F., G.C., N.T., T.K., K.V., M.W., F.B., A.L., J.D., G.M., T.P., A.D., N.D., R.D., M. Hocini, M. Haïssaguerre, P.J., F.S.)
| | - Josselin Duchâteau
- IHU Liryc, Electrophysiology and Heart Modeling Institute, Fondation Bordeaux Université, F-/Bordeaux University Hospital (CHU), Electrophysiology and Ablation Unit, University of Bordeaux, Centre de recherche Cardio-Thoracique de Bordeaux, France/Pessac–Bordeaux, France (C.A.M., R.M., C.D., M.T., A.F., G.C., N.T., T.K., K.V., M.W., F.B., A.L., J.D., G.M., T.P., A.D., N.D., R.D., M. Hocini, M. Haïssaguerre, P.J., F.S.)
| | - Grégoire Massoullié
- IHU Liryc, Electrophysiology and Heart Modeling Institute, Fondation Bordeaux Université, F-/Bordeaux University Hospital (CHU), Electrophysiology and Ablation Unit, University of Bordeaux, Centre de recherche Cardio-Thoracique de Bordeaux, France/Pessac–Bordeaux, France (C.A.M., R.M., C.D., M.T., A.F., G.C., N.T., T.K., K.V., M.W., F.B., A.L., J.D., G.M., T.P., A.D., N.D., R.D., M. Hocini, M. Haïssaguerre, P.J., F.S.)
| | - Thomas Pambrun
- IHU Liryc, Electrophysiology and Heart Modeling Institute, Fondation Bordeaux Université, F-/Bordeaux University Hospital (CHU), Electrophysiology and Ablation Unit, University of Bordeaux, Centre de recherche Cardio-Thoracique de Bordeaux, France/Pessac–Bordeaux, France (C.A.M., R.M., C.D., M.T., A.F., G.C., N.T., T.K., K.V., M.W., F.B., A.L., J.D., G.M., T.P., A.D., N.D., R.D., M. Hocini, M. Haïssaguerre, P.J., F.S.)
| | - Arnaud Denis
- IHU Liryc, Electrophysiology and Heart Modeling Institute, Fondation Bordeaux Université, F-/Bordeaux University Hospital (CHU), Electrophysiology and Ablation Unit, University of Bordeaux, Centre de recherche Cardio-Thoracique de Bordeaux, France/Pessac–Bordeaux, France (C.A.M., R.M., C.D., M.T., A.F., G.C., N.T., T.K., K.V., M.W., F.B., A.L., J.D., G.M., T.P., A.D., N.D., R.D., M. Hocini, M. Haïssaguerre, P.J., F.S.)
| | - Nicolas Derval
- IHU Liryc, Electrophysiology and Heart Modeling Institute, Fondation Bordeaux Université, F-/Bordeaux University Hospital (CHU), Electrophysiology and Ablation Unit, University of Bordeaux, Centre de recherche Cardio-Thoracique de Bordeaux, France/Pessac–Bordeaux, France (C.A.M., R.M., C.D., M.T., A.F., G.C., N.T., T.K., K.V., M.W., F.B., A.L., J.D., G.M., T.P., A.D., N.D., R.D., M. Hocini, M. Haïssaguerre, P.J., F.S.)
| | - Rémi Dubois
- IHU Liryc, Electrophysiology and Heart Modeling Institute, Fondation Bordeaux Université, F-/Bordeaux University Hospital (CHU), Electrophysiology and Ablation Unit, University of Bordeaux, Centre de recherche Cardio-Thoracique de Bordeaux, France/Pessac–Bordeaux, France (C.A.M., R.M., C.D., M.T., A.F., G.C., N.T., T.K., K.V., M.W., F.B., A.L., J.D., G.M., T.P., A.D., N.D., R.D., M. Hocini, M. Haïssaguerre, P.J., F.S.)
| | - Mélèze Hocini
- IHU Liryc, Electrophysiology and Heart Modeling Institute, Fondation Bordeaux Université, F-/Bordeaux University Hospital (CHU), Electrophysiology and Ablation Unit, University of Bordeaux, Centre de recherche Cardio-Thoracique de Bordeaux, France/Pessac–Bordeaux, France (C.A.M., R.M., C.D., M.T., A.F., G.C., N.T., T.K., K.V., M.W., F.B., A.L., J.D., G.M., T.P., A.D., N.D., R.D., M. Hocini, M. Haïssaguerre, P.J., F.S.)
| | - Michel Haïssaguerre
- IHU Liryc, Electrophysiology and Heart Modeling Institute, Fondation Bordeaux Université, F-/Bordeaux University Hospital (CHU), Electrophysiology and Ablation Unit, University of Bordeaux, Centre de recherche Cardio-Thoracique de Bordeaux, France/Pessac–Bordeaux, France (C.A.M., R.M., C.D., M.T., A.F., G.C., N.T., T.K., K.V., M.W., F.B., A.L., J.D., G.M., T.P., A.D., N.D., R.D., M. Hocini, M. Haïssaguerre, P.J., F.S.)
| | - Pierre Jaïs
- IHU Liryc, Electrophysiology and Heart Modeling Institute, Fondation Bordeaux Université, F-/Bordeaux University Hospital (CHU), Electrophysiology and Ablation Unit, University of Bordeaux, Centre de recherche Cardio-Thoracique de Bordeaux, France/Pessac–Bordeaux, France (C.A.M., R.M., C.D., M.T., A.F., G.C., N.T., T.K., K.V., M.W., F.B., A.L., J.D., G.M., T.P., A.D., N.D., R.D., M. Hocini, M. Haïssaguerre, P.J., F.S.)
| | - Frédéric Sacher
- IHU Liryc, Electrophysiology and Heart Modeling Institute, Fondation Bordeaux Université, F-/Bordeaux University Hospital (CHU), Electrophysiology and Ablation Unit, University of Bordeaux, Centre de recherche Cardio-Thoracique de Bordeaux, France/Pessac–Bordeaux, France (C.A.M., R.M., C.D., M.T., A.F., G.C., N.T., T.K., K.V., M.W., F.B., A.L., J.D., G.M., T.P., A.D., N.D., R.D., M. Hocini, M. Haïssaguerre, P.J., F.S.)
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59
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Qian P, Tedrow U. Scar Anisotropy: What Can Varying Wavefronts of Ventricular Activation Tell Us About the Physiology of Reentry Circuits? Circ Arrhythm Electrophysiol 2019; 12:e007457. [PMID: 31122053 DOI: 10.1161/circep.119.007457] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Pierre Qian
- Cardiovascular Division, Brigham and Women's Hospital, Boston, MA
| | - Usha Tedrow
- Cardiovascular Division, Brigham and Women's Hospital, Boston, MA
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60
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Cronin EM, Bogun FM, Maury P, Peichl P, Chen M, Namboodiri N, Aguinaga L, Leite LR, Al-Khatib SM, Anter E, Berruezo A, Callans DJ, Chung MK, Cuculich P, d'Avila A, Deal BJ, Della Bella P, Deneke T, Dickfeld TM, Hadid C, Haqqani HM, Kay GN, Latchamsetty R, Marchlinski F, Miller JM, Nogami A, Patel AR, Pathak RK, Saenz Morales LC, Santangeli P, Sapp JL, Sarkozy A, Soejima K, Stevenson WG, Tedrow UB, Tzou WS, Varma N, Zeppenfeld K. 2019 HRS/EHRA/APHRS/LAHRS expert consensus statement on catheter ablation of ventricular arrhythmias: Executive summary. Heart Rhythm 2019; 17:e155-e205. [PMID: 31102616 PMCID: PMC8459311 DOI: 10.1016/j.hrthm.2019.03.014] [Citation(s) in RCA: 53] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2019] [Indexed: 12/16/2022]
Abstract
Ventricular arrhythmias are an important cause of morbidity and mortality and come in a variety of forms, from single premature ventricular complexes to sustained ventricular tachycardia and fibrillation. Rapid developments have taken place over the past decade in our understanding of these arrhythmias and in our ability to diagnose and treat them. The field of catheter ablation has progressed with the development of new methods and tools, and with the publication of large clinical trials. Therefore, global cardiac electrophysiology professional societies undertook to outline recommendations and best practices for these procedures in a document that will update and replace the 2009 EHRA/HRS Expert Consensus on Catheter Ablation of Ventricular Arrhythmias. An expert writing group, after reviewing and discussing the literature, including a systematic review and meta-analysis published in conjunction with this document, and drawing on their own experience, drafted and voted on recommendations and summarized current knowledge and practice in the field. Each recommendation is presented in knowledge byte format and is accompanied by supportive text and references. Further sections provide a practical synopsis of the various techniques and of the specific ventricular arrhythmia sites and substrates encountered in the electrophysiology lab. The purpose of this document is to help electrophysiologists around the world to appropriately select patients for catheter ablation, to perform procedures in a safe and efficacious manner, and to provide follow-up and adjunctive care in order to obtain the best possible outcomes for patients with ventricular arrhythmias.
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Affiliation(s)
| | | | | | - Petr Peichl
- Institute for Clinical and Experimental Medicine, Prague, Czech Republic
| | - Minglong Chen
- Jiangsu Province Hospital, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Narayanan Namboodiri
- Sree Chitra Institute for Medical Sciences and Technology, Thiruvananthapuram, India
| | | | | | | | - Elad Anter
- Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | | | | | | | | | - Andre d'Avila
- Hospital Cardiologico SOS Cardio, Florianopolis, Brazil
| | - Barbara J Deal
- Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | | | | | | | - Claudio Hadid
- Hospital General de Agudos Cosme Argerich, Buenos Aires, Argentina
| | - Haris M Haqqani
- University of Queensland, The Prince Charles Hospital, Chermside, Australia
| | - G Neal Kay
- University of Alabama at Birmingham, Birmingham, Alabama
| | | | | | - John M Miller
- Indiana University School of Medicine, Krannert Institute of Cardiology, Indianapolis, Indiana
| | | | - Akash R Patel
- University of California San Francisco Benioff Children's Hospital, San Francisco, California
| | | | | | | | - John L Sapp
- Queen Elizabeth II Health Sciences Centre, Halifax, Canada
| | - Andrea Sarkozy
- University Hospital Antwerp, University of Antwerp, Antwerp, Belgium
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61
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Cronin EM, Bogun FM, Maury P, Peichl P, Chen M, Namboodiri N, Aguinaga L, Leite LR, Al-Khatib SM, Anter E, Berruezo A, Callans DJ, Chung MK, Cuculich P, d'Avila A, Deal BJ, Della Bella P, Deneke T, Dickfeld TM, Hadid C, Haqqani HM, Kay GN, Latchamsetty R, Marchlinski F, Miller JM, Nogami A, Patel AR, Pathak RK, Saenz Morales LC, Santangeli P, Sapp JL, Sarkozy A, Soejima K, Stevenson WG, Tedrow UB, Tzou WS, Varma N, Zeppenfeld K. 2019 HRS/EHRA/APHRS/LAHRS expert consensus statement on catheter ablation of ventricular arrhythmias. Heart Rhythm 2019; 17:e2-e154. [PMID: 31085023 PMCID: PMC8453449 DOI: 10.1016/j.hrthm.2019.03.002] [Citation(s) in RCA: 186] [Impact Index Per Article: 37.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2019] [Indexed: 01/10/2023]
Abstract
Ventricular arrhythmias are an important cause of morbidity and mortality and come in a variety of forms, from single premature ventricular complexes to sustained ventricular tachycardia and fibrillation. Rapid developments have taken place over the past decade in our understanding of these arrhythmias and in our ability to diagnose and treat them. The field of catheter ablation has progressed with the development of new methods and tools, and with the publication of large clinical trials. Therefore, global cardiac electrophysiology professional societies undertook to outline recommendations and best practices for these procedures in a document that will update and replace the 2009 EHRA/HRS Expert Consensus on Catheter Ablation of Ventricular Arrhythmias. An expert writing group, after reviewing and discussing the literature, including a systematic review and meta-analysis published in conjunction with this document, and drawing on their own experience, drafted and voted on recommendations and summarized current knowledge and practice in the field. Each recommendation is presented in knowledge byte format and is accompanied by supportive text and references. Further sections provide a practical synopsis of the various techniques and of the specific ventricular arrhythmia sites and substrates encountered in the electrophysiology lab. The purpose of this document is to help electrophysiologists around the world to appropriately select patients for catheter ablation, to perform procedures in a safe and efficacious manner, and to provide follow-up and adjunctive care in order to obtain the best possible outcomes for patients with ventricular arrhythmias.
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Affiliation(s)
| | | | | | - Petr Peichl
- Institute for Clinical and Experimental Medicine, Prague, Czech Republic
| | - Minglong Chen
- Jiangsu Province Hospital, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Narayanan Namboodiri
- Sree Chitra Institute for Medical Sciences and Technology, Thiruvananthapuram, India
| | | | | | | | - Elad Anter
- Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | | | | | | | | | - Andre d'Avila
- Hospital Cardiologico SOS Cardio, Florianopolis, Brazil
| | - Barbara J Deal
- Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | | | | | | | - Claudio Hadid
- Hospital General de Agudos Cosme Argerich, Buenos Aires, Argentina
| | - Haris M Haqqani
- University of Queensland, The Prince Charles Hospital, Chermside, Australia
| | - G Neal Kay
- University of Alabama at Birmingham, Birmingham, Alabama
| | | | | | - John M Miller
- Indiana University School of Medicine, Krannert Institute of Cardiology, Indianapolis, Indiana
| | | | - Akash R Patel
- University of California San Francisco Benioff Children's Hospital, San Francisco, California
| | | | | | | | - John L Sapp
- Queen Elizabeth II Health Sciences Centre, Halifax, Canada
| | - Andrea Sarkozy
- University Hospital Antwerp, University of Antwerp, Antwerp, Belgium
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62
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Kitamura T, Martin CA, Vlachos K, Martin R, Frontera A, Takigawa M, Thompson N, Cheniti G, Massouille G, Lam A, Bourier F, Duchateau J, Pambrun T, Denis A, Derval N, Hocini M, HaÏssaguerre M, Cochet H, JaÏs P, Sacher F. Substrate Mapping and Ablation for Ventricular Tachycardia in Patients with Structural Heart Disease: How to Identify Ventricular Tachycardia Substrate. J Innov Card Rhythm Manag 2019; 10:3565-3580. [PMID: 32477720 PMCID: PMC7252795 DOI: 10.19102/icrm.2019.100302] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2018] [Accepted: 08/20/2018] [Indexed: 01/02/2023] Open
Abstract
Catheter ablation for ventricular tachycardia (VT) has been increasingly used over the past two decades in patients with structural heart disease (SHD). In these individuals, a substrate mapping strategy is being more commonly applied to identify targets for VT ablation, which has been shown to be more effective versus targeting mappable VTs alone. There are a number of substrate mapping methods in existence that aim to explore potential VT isthmuses, although their success rates vary. Most of the reported electrogram-based mapping studies have been performed with ablation catheters; meanwhile, the use of multipolar mapping catheters with smaller electrodes and closer interelectrode spacing has emerged, which allows for an assessment of detailed near-field abnormal electrograms at a higher resolution. Another recent advancement has occurred in the use of imaging techniques in VT ablation, particularly in refining the substrate. The goal of this paper is to review the key developments and limitations of current mapping strategies of substrate-based VT ablation and their outcomes. In addition, we briefly summarize the role of cardiac imaging in delineating VT substrate.
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Affiliation(s)
- Takeshi Kitamura
- IHU Liryc, Electrophysiology and Heart Modeling Institute, Fondation Bordeaux Université, Pessac-Bordeaux, France.,Electrophysiology and Ablation Unit, Bordeaux University Hospital (CHU), Pessac, France.,Centre de recherche Cardio-Thoracique de Bordeaux, University of Bordeaux, Bordeaux, France.,Tokyo Metropolitan Hiroo Hospital, Tokyo, Japan
| | - Claire A Martin
- IHU Liryc, Electrophysiology and Heart Modeling Institute, Fondation Bordeaux Université, Pessac-Bordeaux, France.,Electrophysiology and Ablation Unit, Bordeaux University Hospital (CHU), Pessac, France.,Centre de recherche Cardio-Thoracique de Bordeaux, University of Bordeaux, Bordeaux, France.,Royal Papworth Hospital NHS Foundation Trust, Cambridge, UK
| | - Konstantinos Vlachos
- IHU Liryc, Electrophysiology and Heart Modeling Institute, Fondation Bordeaux Université, Pessac-Bordeaux, France.,Electrophysiology and Ablation Unit, Bordeaux University Hospital (CHU), Pessac, France.,Centre de recherche Cardio-Thoracique de Bordeaux, University of Bordeaux, Bordeaux, France
| | - Ruairidh Martin
- IHU Liryc, Electrophysiology and Heart Modeling Institute, Fondation Bordeaux Université, Pessac-Bordeaux, France.,Electrophysiology and Ablation Unit, Bordeaux University Hospital (CHU), Pessac, France.,Centre de recherche Cardio-Thoracique de Bordeaux, University of Bordeaux, Bordeaux, France.,Newcastle University, Newcastle-upon-Tyne, UK
| | - Antonio Frontera
- IHU Liryc, Electrophysiology and Heart Modeling Institute, Fondation Bordeaux Université, Pessac-Bordeaux, France.,Electrophysiology and Ablation Unit, Bordeaux University Hospital (CHU), Pessac, France.,Centre de recherche Cardio-Thoracique de Bordeaux, University of Bordeaux, Bordeaux, France.,San Raffaele Hospital, Milan, Italy
| | - Masateru Takigawa
- IHU Liryc, Electrophysiology and Heart Modeling Institute, Fondation Bordeaux Université, Pessac-Bordeaux, France.,Electrophysiology and Ablation Unit, Bordeaux University Hospital (CHU), Pessac, France.,Centre de recherche Cardio-Thoracique de Bordeaux, University of Bordeaux, Bordeaux, France
| | - Nathaniel Thompson
- IHU Liryc, Electrophysiology and Heart Modeling Institute, Fondation Bordeaux Université, Pessac-Bordeaux, France.,Electrophysiology and Ablation Unit, Bordeaux University Hospital (CHU), Pessac, France.,Centre de recherche Cardio-Thoracique de Bordeaux, University of Bordeaux, Bordeaux, France
| | - Ghassen Cheniti
- IHU Liryc, Electrophysiology and Heart Modeling Institute, Fondation Bordeaux Université, Pessac-Bordeaux, France.,Electrophysiology and Ablation Unit, Bordeaux University Hospital (CHU), Pessac, France.,Centre de recherche Cardio-Thoracique de Bordeaux, University of Bordeaux, Bordeaux, France
| | - Gregoire Massouille
- IHU Liryc, Electrophysiology and Heart Modeling Institute, Fondation Bordeaux Université, Pessac-Bordeaux, France.,Electrophysiology and Ablation Unit, Bordeaux University Hospital (CHU), Pessac, France.,Centre de recherche Cardio-Thoracique de Bordeaux, University of Bordeaux, Bordeaux, France
| | - Anna Lam
- IHU Liryc, Electrophysiology and Heart Modeling Institute, Fondation Bordeaux Université, Pessac-Bordeaux, France.,Electrophysiology and Ablation Unit, Bordeaux University Hospital (CHU), Pessac, France.,Centre de recherche Cardio-Thoracique de Bordeaux, University of Bordeaux, Bordeaux, France
| | - Felix Bourier
- IHU Liryc, Electrophysiology and Heart Modeling Institute, Fondation Bordeaux Université, Pessac-Bordeaux, France.,Electrophysiology and Ablation Unit, Bordeaux University Hospital (CHU), Pessac, France.,Centre de recherche Cardio-Thoracique de Bordeaux, University of Bordeaux, Bordeaux, France
| | - Josselin Duchateau
- IHU Liryc, Electrophysiology and Heart Modeling Institute, Fondation Bordeaux Université, Pessac-Bordeaux, France.,Electrophysiology and Ablation Unit, Bordeaux University Hospital (CHU), Pessac, France.,Centre de recherche Cardio-Thoracique de Bordeaux, University of Bordeaux, Bordeaux, France
| | - Thomas Pambrun
- IHU Liryc, Electrophysiology and Heart Modeling Institute, Fondation Bordeaux Université, Pessac-Bordeaux, France.,Electrophysiology and Ablation Unit, Bordeaux University Hospital (CHU), Pessac, France.,Centre de recherche Cardio-Thoracique de Bordeaux, University of Bordeaux, Bordeaux, France
| | - Arnaud Denis
- IHU Liryc, Electrophysiology and Heart Modeling Institute, Fondation Bordeaux Université, Pessac-Bordeaux, France.,Electrophysiology and Ablation Unit, Bordeaux University Hospital (CHU), Pessac, France.,Centre de recherche Cardio-Thoracique de Bordeaux, University of Bordeaux, Bordeaux, France
| | - Nicolas Derval
- IHU Liryc, Electrophysiology and Heart Modeling Institute, Fondation Bordeaux Université, Pessac-Bordeaux, France.,Electrophysiology and Ablation Unit, Bordeaux University Hospital (CHU), Pessac, France.,Centre de recherche Cardio-Thoracique de Bordeaux, University of Bordeaux, Bordeaux, France
| | - Meleze Hocini
- IHU Liryc, Electrophysiology and Heart Modeling Institute, Fondation Bordeaux Université, Pessac-Bordeaux, France.,Electrophysiology and Ablation Unit, Bordeaux University Hospital (CHU), Pessac, France.,Centre de recherche Cardio-Thoracique de Bordeaux, University of Bordeaux, Bordeaux, France
| | - Michel HaÏssaguerre
- IHU Liryc, Electrophysiology and Heart Modeling Institute, Fondation Bordeaux Université, Pessac-Bordeaux, France.,Electrophysiology and Ablation Unit, Bordeaux University Hospital (CHU), Pessac, France.,Centre de recherche Cardio-Thoracique de Bordeaux, University of Bordeaux, Bordeaux, France
| | - Hubert Cochet
- IHU Liryc, Electrophysiology and Heart Modeling Institute, Fondation Bordeaux Université, Pessac-Bordeaux, France.,Electrophysiology and Ablation Unit, Bordeaux University Hospital (CHU), Pessac, France.,Centre de recherche Cardio-Thoracique de Bordeaux, University of Bordeaux, Bordeaux, France
| | - Pierre JaÏs
- IHU Liryc, Electrophysiology and Heart Modeling Institute, Fondation Bordeaux Université, Pessac-Bordeaux, France.,Electrophysiology and Ablation Unit, Bordeaux University Hospital (CHU), Pessac, France.,Centre de recherche Cardio-Thoracique de Bordeaux, University of Bordeaux, Bordeaux, France
| | - Frédéric Sacher
- IHU Liryc, Electrophysiology and Heart Modeling Institute, Fondation Bordeaux Université, Pessac-Bordeaux, France.,Electrophysiology and Ablation Unit, Bordeaux University Hospital (CHU), Pessac, France.,Centre de recherche Cardio-Thoracique de Bordeaux, University of Bordeaux, Bordeaux, France
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63
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Nayyar S, Downar E, Beheshti M, Liang T, Massé S, Magtibay K, Bhaskaran A, Saeed Y, Vigmond E, Nanthakumar K. Information theory to tachycardia therapy: electrogram entropy predicts diastolic microstructure of reentrant ventricular tachycardia. Am J Physiol Heart Circ Physiol 2019; 316:H134-H144. [DOI: 10.1152/ajpheart.00581.2018] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
There is no known strategy to differentiate which multicomponent electrograms in sinus rhythm maintain reentrant ventricular tachycardia (VT). Low entropy in the voltage breakdown of a multicomponent electrogram can localize conditions suitable for reentry but has not been validated against the classic VT activation mapping. We examined whether low entropy in a late and diversely activated ventricular scar region characterizes and differentiates the diastolic path of VT and represents protected tissue channels devoid of side branches. Intraoperative bipolar electrogram (BiEGM) activation and entropy maps were obtained during sinus rhythm in 17 patients with ischemic cardiomyopathy and compared with diastolic activation paths of VT (total of 39 VTs). Mathematical modeling of a zigzag main channel with side branches was also used to further validate structural representation of low entropy in the ventricular scar. A median of one region per patient (range: 1–2 regions) was identified in sinus rhythm, in which BiEGMwith the latest mean activation time and adjacent minimum entropy were assembled together in a high-activation dispersion region. These regions accurately recognized diastolic paths of 34 VTs, often to multiple inducible VTs within a single individual arrhythmogenic region. In mathematical modeling, side branching from the main channel had a strong influence on the BiEGMcomposition along the main channel. The BiEGMobtained from a long unbranched channel had the lowest entropy compared with those with multiple side branches. In conclusion, among a population of multicomponent sinus electrograms, those that demonstrate low entropy and are delayed colocalize to critical long-protected channels of VT. This information is pertinent for planning VT ablation in sinus rhythm.NEW & NOTEWORTHY Entropy is a measure to quantify breakdown in information. Electrograms from a protected tissue channel can only possess a few states in their voltage and thus less information. In contrast, current-load interactions from side branches in unprotected channels introduce a number of dissimilar voltage deflections and thus high information. We compare here a mapping approach based on entropy against a rigorous reference standard of activation mapping during VT and entropy was assessed in sinus rhythm.
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Affiliation(s)
- Sachin Nayyar
- The Hull Family Cardiac Fibrillation Management Laboratory, Toronto General Hospital, Toronto, Ontario, Canada
| | - Eugene Downar
- The Hull Family Cardiac Fibrillation Management Laboratory, Toronto General Hospital, Toronto, Ontario, Canada
| | - Mohammadali Beheshti
- The Hull Family Cardiac Fibrillation Management Laboratory, Toronto General Hospital, Toronto, Ontario, Canada
| | - Timothy Liang
- The Hull Family Cardiac Fibrillation Management Laboratory, Toronto General Hospital, Toronto, Ontario, Canada
| | - Stéphane Massé
- The Hull Family Cardiac Fibrillation Management Laboratory, Toronto General Hospital, Toronto, Ontario, Canada
| | - Karl Magtibay
- The Hull Family Cardiac Fibrillation Management Laboratory, Toronto General Hospital, Toronto, Ontario, Canada
| | - Abhishek Bhaskaran
- The Hull Family Cardiac Fibrillation Management Laboratory, Toronto General Hospital, Toronto, Ontario, Canada
| | - Yawer Saeed
- The Hull Family Cardiac Fibrillation Management Laboratory, Toronto General Hospital, Toronto, Ontario, Canada
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64
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Bourier F, Martin R, Martin CA, Takigawa M, Kitamura T, Frontera A, Cheniti G, Lam A, Vlachos K, Duchateau J, Pambrun T, Derval N, Denis A, Klotz N, Hocini M, Haïssaguerre M, Jaïs P, Cochet H, Sacher F. Is it feasible to offer 'targeted ablation' of ventricular tachycardia circuits with better understanding of isthmus anatomy and conduction characteristics? Europace 2019; 21:i27-i33. [PMID: 30801128 DOI: 10.1093/europace/euy173] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2018] [Accepted: 08/13/2018] [Indexed: 11/13/2022] Open
Abstract
Successful mapping and ablation of ventricular tachycardias remains a challenging clinical task. Whereas conventional entrainment and activation mapping was for many years the gold standard to identify reentrant circuits in ischaemic ventricular tachycardia ablation procedures, substrate mapping has become the cornerstone of ventricular tachycardia ablation. In the last decade, technology has dramatically improved. In parallel to high-density automated mapping, cardiac imaging and image integration tools are increasingly used to assess the structural ventricular tachycardia substrate. The aim of this review is to describe the technologies underlying these new mapping systems and to discuss their possible role in providing new insights into identification and visualization of reentrant tachycardia mechanisms.
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Affiliation(s)
- Felix Bourier
- IHU Liryc, Electrophysiology and Heart Modeling Institute, fondation Bordeaux Université, F Pessac- Bordeaux, France.,Bordeaux University Hospital (CHU), Electrophysiology and Ablation Unit, F Pessac, France
| | - Ruairidh Martin
- IHU Liryc, Electrophysiology and Heart Modeling Institute, fondation Bordeaux Université, F Pessac- Bordeaux, France.,Bordeaux University Hospital (CHU), Electrophysiology and Ablation Unit, F Pessac, France
| | - Claire A Martin
- IHU Liryc, Electrophysiology and Heart Modeling Institute, fondation Bordeaux Université, F Pessac- Bordeaux, France.,Bordeaux University Hospital (CHU), Electrophysiology and Ablation Unit, F Pessac, France
| | - Masateru Takigawa
- IHU Liryc, Electrophysiology and Heart Modeling Institute, fondation Bordeaux Université, F Pessac- Bordeaux, France.,Bordeaux University Hospital (CHU), Electrophysiology and Ablation Unit, F Pessac, France
| | - Takeshi Kitamura
- IHU Liryc, Electrophysiology and Heart Modeling Institute, fondation Bordeaux Université, F Pessac- Bordeaux, France.,Bordeaux University Hospital (CHU), Electrophysiology and Ablation Unit, F Pessac, France
| | - Antonio Frontera
- IHU Liryc, Electrophysiology and Heart Modeling Institute, fondation Bordeaux Université, F Pessac- Bordeaux, France.,Bordeaux University Hospital (CHU), Electrophysiology and Ablation Unit, F Pessac, France
| | - Ghassen Cheniti
- IHU Liryc, Electrophysiology and Heart Modeling Institute, fondation Bordeaux Université, F Pessac- Bordeaux, France.,Bordeaux University Hospital (CHU), Electrophysiology and Ablation Unit, F Pessac, France
| | - Anna Lam
- IHU Liryc, Electrophysiology and Heart Modeling Institute, fondation Bordeaux Université, F Pessac- Bordeaux, France.,Bordeaux University Hospital (CHU), Electrophysiology and Ablation Unit, F Pessac, France
| | - Konstantinos Vlachos
- IHU Liryc, Electrophysiology and Heart Modeling Institute, fondation Bordeaux Université, F Pessac- Bordeaux, France.,Bordeaux University Hospital (CHU), Electrophysiology and Ablation Unit, F Pessac, France
| | - Josselin Duchateau
- IHU Liryc, Electrophysiology and Heart Modeling Institute, fondation Bordeaux Université, F Pessac- Bordeaux, France.,Bordeaux University Hospital (CHU), Electrophysiology and Ablation Unit, F Pessac, France.,University Bordeaux, Centre de recherche Cardio-Thoracique de Bordeaux, U1045, F Bordeaux, France.,INSERM, Centre de recherche Cardio-Thoracique de Bordeaux, U1045, F Bordeaux, France
| | - Thomas Pambrun
- IHU Liryc, Electrophysiology and Heart Modeling Institute, fondation Bordeaux Université, F Pessac- Bordeaux, France.,Bordeaux University Hospital (CHU), Electrophysiology and Ablation Unit, F Pessac, France.,University Bordeaux, Centre de recherche Cardio-Thoracique de Bordeaux, U1045, F Bordeaux, France.,INSERM, Centre de recherche Cardio-Thoracique de Bordeaux, U1045, F Bordeaux, France
| | - Nicolas Derval
- IHU Liryc, Electrophysiology and Heart Modeling Institute, fondation Bordeaux Université, F Pessac- Bordeaux, France.,Bordeaux University Hospital (CHU), Electrophysiology and Ablation Unit, F Pessac, France.,University Bordeaux, Centre de recherche Cardio-Thoracique de Bordeaux, U1045, F Bordeaux, France.,INSERM, Centre de recherche Cardio-Thoracique de Bordeaux, U1045, F Bordeaux, France
| | - Arnaud Denis
- IHU Liryc, Electrophysiology and Heart Modeling Institute, fondation Bordeaux Université, F Pessac- Bordeaux, France.,Bordeaux University Hospital (CHU), Electrophysiology and Ablation Unit, F Pessac, France.,University Bordeaux, Centre de recherche Cardio-Thoracique de Bordeaux, U1045, F Bordeaux, France.,INSERM, Centre de recherche Cardio-Thoracique de Bordeaux, U1045, F Bordeaux, France
| | - Nicolas Klotz
- IHU Liryc, Electrophysiology and Heart Modeling Institute, fondation Bordeaux Université, F Pessac- Bordeaux, France.,Bordeaux University Hospital (CHU), Electrophysiology and Ablation Unit, F Pessac, France.,University Bordeaux, Centre de recherche Cardio-Thoracique de Bordeaux, U1045, F Bordeaux, France.,INSERM, Centre de recherche Cardio-Thoracique de Bordeaux, U1045, F Bordeaux, France
| | - Mélèze Hocini
- IHU Liryc, Electrophysiology and Heart Modeling Institute, fondation Bordeaux Université, F Pessac- Bordeaux, France.,Bordeaux University Hospital (CHU), Electrophysiology and Ablation Unit, F Pessac, France.,University Bordeaux, Centre de recherche Cardio-Thoracique de Bordeaux, U1045, F Bordeaux, France.,INSERM, Centre de recherche Cardio-Thoracique de Bordeaux, U1045, F Bordeaux, France
| | - Michel Haïssaguerre
- IHU Liryc, Electrophysiology and Heart Modeling Institute, fondation Bordeaux Université, F Pessac- Bordeaux, France.,Bordeaux University Hospital (CHU), Electrophysiology and Ablation Unit, F Pessac, France.,University Bordeaux, Centre de recherche Cardio-Thoracique de Bordeaux, U1045, F Bordeaux, France.,INSERM, Centre de recherche Cardio-Thoracique de Bordeaux, U1045, F Bordeaux, France
| | - Pierre Jaïs
- IHU Liryc, Electrophysiology and Heart Modeling Institute, fondation Bordeaux Université, F Pessac- Bordeaux, France.,Bordeaux University Hospital (CHU), Electrophysiology and Ablation Unit, F Pessac, France.,University Bordeaux, Centre de recherche Cardio-Thoracique de Bordeaux, U1045, F Bordeaux, France.,INSERM, Centre de recherche Cardio-Thoracique de Bordeaux, U1045, F Bordeaux, France
| | - Hubert Cochet
- IHU Liryc, Electrophysiology and Heart Modeling Institute, fondation Bordeaux Université, F Pessac- Bordeaux, France.,Bordeaux University Hospital (CHU), Electrophysiology and Ablation Unit, F Pessac, France.,University Bordeaux, Centre de recherche Cardio-Thoracique de Bordeaux, U1045, F Bordeaux, France.,INSERM, Centre de recherche Cardio-Thoracique de Bordeaux, U1045, F Bordeaux, France
| | - Frédéric Sacher
- IHU Liryc, Electrophysiology and Heart Modeling Institute, fondation Bordeaux Université, F Pessac- Bordeaux, France.,Bordeaux University Hospital (CHU), Electrophysiology and Ablation Unit, F Pessac, France.,University Bordeaux, Centre de recherche Cardio-Thoracique de Bordeaux, U1045, F Bordeaux, France.,INSERM, Centre de recherche Cardio-Thoracique de Bordeaux, U1045, F Bordeaux, France
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