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Maury P, Duchateau J, Rollin A, Hocini M, Voglimacci-Stephanopoli Q, Monteil B, Sacher F, Jaïs P, Bernus O, Mondoly P, Delmas C, Haïssaguerre M, Dubois R. Long-Lasting Ventricular Fibrillation in Humans ECG Characteristics and Effect of Radiofrequency Ablation. Circ Arrhythm Electrophysiol 2020; 13:e008639. [PMID: 32911973 DOI: 10.1161/circep.120.008639] [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] [Indexed: 11/16/2022]
Abstract
BACKGROUND Studies of ventricular fibrillation (VF) in humans are limited because of the short available duration. We sought to study surface ECG waveforms and effect of ablation in long-lasting VF in patients with left assist devices. METHODS Continuous 12-lead ECG of 5 episodes of long-lasting VF occurring in 3 patients with left ventricular assist device were analyzed. Spectral analysis (dominant frequency) and quantification of waveform amplitude, regularity (Unbiased Regularity Index), and complexity (Nondipolar Index) were performed over a median of 24 minutes of VF. Radiofrequency ablation was performed during VF in 2 patients. RESULTS There was a significant increase in dominant frequency between VF onset and termination but none of the other parameters significantly changed. Some VF parameters varied from patient to patient and from lead to lead. Dominant frequency decreased after radiofrequency ablation in both cases and VF terminated spontaneously shortly after ablation in one case. The previously incessant VFs in these 2 patients did not recur afterward. CONCLUSIONS VF rate increases over time in patients with left ventricular assist devices and is lowered by ablation. Long-lasting VF may be modified or even terminated by ablation.
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Affiliation(s)
- Philippe Maury
- Department of Cardiology, University Hospital Rangueil, Toulouse, France (P.M., A.R., Q.V.-S., B.M., P.M., C.D.).,Unité Inserm U 1048, Toulouse, France (P.M.)
| | - Josselin Duchateau
- Bordeaux University Hospital, France (J.D., M. Hocini, F.S., P.J., M. Haïssaguerre).,LIRYC Institute/INSERM 1045, Bordeaux University, France (J.D., M. Hocini, F.S., P.J., O.B., M. Haïssaguerre, R.D.)
| | - Anne Rollin
- Department of Cardiology, University Hospital Rangueil, Toulouse, France (P.M., A.R., Q.V.-S., B.M., P.M., C.D.)
| | - Meleze Hocini
- Bordeaux University Hospital, France (J.D., M. Hocini, F.S., P.J., M. Haïssaguerre).,LIRYC Institute/INSERM 1045, Bordeaux University, France (J.D., M. Hocini, F.S., P.J., O.B., M. Haïssaguerre, R.D.)
| | | | - Benjamin Monteil
- Department of Cardiology, University Hospital Rangueil, Toulouse, France (P.M., A.R., Q.V.-S., B.M., P.M., C.D.)
| | - Frederic Sacher
- Bordeaux University Hospital, France (J.D., M. Hocini, F.S., P.J., M. Haïssaguerre).,LIRYC Institute/INSERM 1045, Bordeaux University, France (J.D., M. Hocini, F.S., P.J., O.B., M. Haïssaguerre, R.D.)
| | - Pierre Jaïs
- Bordeaux University Hospital, France (J.D., M. Hocini, F.S., P.J., M. Haïssaguerre).,LIRYC Institute/INSERM 1045, Bordeaux University, France (J.D., M. Hocini, F.S., P.J., O.B., M. Haïssaguerre, R.D.)
| | - Olivier Bernus
- LIRYC Institute/INSERM 1045, Bordeaux University, France (J.D., M. Hocini, F.S., P.J., O.B., M. Haïssaguerre, R.D.)
| | - Pierre Mondoly
- Department of Cardiology, University Hospital Rangueil, Toulouse, France (P.M., A.R., Q.V.-S., B.M., P.M., C.D.)
| | - Clément Delmas
- Department of Cardiology, University Hospital Rangueil, Toulouse, France (P.M., A.R., Q.V.-S., B.M., P.M., C.D.)
| | - Michel Haïssaguerre
- Bordeaux University Hospital, France (J.D., M. Hocini, F.S., P.J., M. Haïssaguerre).,LIRYC Institute/INSERM 1045, Bordeaux University, France (J.D., M. Hocini, F.S., P.J., O.B., M. Haïssaguerre, R.D.)
| | - Rémi Dubois
- LIRYC Institute/INSERM 1045, Bordeaux University, France (J.D., M. Hocini, F.S., P.J., O.B., M. Haïssaguerre, R.D.)
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Tri J, Asirvatham R, DeSimone CV, Killu AM, Sugrue AM, Suddendorf SH, Ladewig DJ, Kapa S, Friedman PA, McLeod CJ, Asirvatham SJ. Intramural conduction system gradients and electrogram regularity during ventricular fibrillation. Indian Pacing Electrophysiol J 2018; 18:195-200. [PMID: 30036650 PMCID: PMC6303163 DOI: 10.1016/j.ipej.2018.07.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2018] [Revised: 06/06/2018] [Accepted: 07/19/2018] [Indexed: 11/25/2022] Open
Abstract
INTRODUCTION The His-Purkinje system has been shown to harbor triggers for ventricular fibrillation (VF) initiation. However, the substrate responsible for VF maintenance remains elusive. We hypothesized that standard, electrode-based, point-to-point mapping would yield meaningful insight into site-specific patterns and organization which may shed light on the critical substrate for maintenance of VF. METHODS VF was induced under general anesthesia by direct current (DC) application to the right ventricle in 7 acute canines. A standard EPT Blazer mapping catheter (Boston Scientific, Natuck, MA) was used for mapping in conjunction with a Prucka recording system. We collected 30 consecutive electrograms at 24 distinct sites, confirmed by fluoroscopy and intracardiac echo. These sites included both endocardial and epicardial locations throughout the ventricles and conduction system. RESULTS A total of 5040 individual data points were collected in 7 separate canine studies. During VF mapping, a transmural disparity was found between the epicardium (average cycle length [CL] of 1136 m s) and the endocardium (average CL of 123 m s) with a p value of <0.01. An additional, intramural gradient was found when comparing the proximal, insulated conduction system to the distal, non-insulated conduction system (average CL 218 versus 111 m s [p = 0.03]). CONCLUSION Our data are supportive of a novel observation of intramural difference between insulated and non-insulated regions of the His-Purkinje network in canines. In addition, certain areas exhibited periods of regular electrogram characteristics; this was despite the heart remaining in terminal VF. These early canine data merit further study to investigate if specific ablation of the distal conduction system can perturb or extinguish VF.
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Affiliation(s)
- Jason Tri
- Mayo Clinic Research Internship, Mayo Clinic, Rochester, MN, USA
| | | | | | - Ammar M Killu
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN, USA
| | - Alan M Sugrue
- Division of Internal Medicine, Mayo Clinic, Rochester, MN, USA
| | | | | | - Suraj Kapa
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN, USA
| | - Paul A Friedman
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN, USA
| | | | - Samuel J Asirvatham
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN, USA; Department of Pediatrics and Adolescent Medicine, Mayo Clinic, Rochester, MN, USA.
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