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Ramirez FD, Winterfield JR, Shi X, Chou D, Robinson D, Angel N, Shah P, Sorrell T, Ghafoori E, Vanderper A, Mariappan L, Soré B, Peyrat JM, Loyer V, Nakatani Y, Cochet H, Jaïs P. Non-contact whole-chamber charge density mapping of the left ventricle: preclinical evaluation in a sheep model. Heart Rhythm 2022; 19:828-836. [PMID: 35032670 DOI: 10.1016/j.hrthm.2022.01.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Revised: 01/06/2022] [Accepted: 01/07/2022] [Indexed: 11/19/2022]
Abstract
BACKGROUND Conventional contact-based electroanatomic mapping is poorly suited for rapid or dynamic ventricular arrhythmias. Whole-chamber charge density (CD) mapping could efficiently characterize complex ventricular tachyarrhythmias and yield insights into their underlying mechanisms. OBJECTIVE This study sought to evaluate the feasibility and accuracy of non-contact whole-chamber left ventricular (LV) CD mapping, and to characterize CD activation patterns during sinus rhythm, ventricular pacing, and ventricular fibrillation (VF). METHODS Ischemic scar as defined by CD amplitude thresholds was compared to late gadolinium enhancement criteria on magnetic resonance imaging using an iterative closest point algorithm. Electrograms recorded at sites of tissue contact were compared to the nearest non-contact CD-derived electrograms to calculate signal morphology cross-correlations and time differences. Regions of consistently slow conduction were examined relative to areas of scar and to localized irregular activation (LIA) during VF. RESULTS Areas under receiver operating characteristic curves (AUCs) of CD-defined dense and total LV scar were 0.92 ± 0.03 and 0.87 ± 0.06, with accuracies of 0.86±0.03 and 0.80±0.05, respectively. Morphology cross-correlation between 8,677 contact and corresponding non-contact electrograms was 0.93±0.10, with a mean time difference of 2.5±5.6 msec. Areas of consistently slow conduction tended to occur at scar borders and exhibited spatial agreement with LIA during VF (AUC 0.90±0.02). CONCLUSION Non-contact LV CD mapping can accurately delineate ischemic scar. CD-derived ventricular electrograms correlate strongly with conventional contact-based electrograms. Regions with consistently slow conduction are often at scar borders and tend to harbor LIA during VF.
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Affiliation(s)
- F Daniel Ramirez
- Electrophysiology and Heart Modelling Institute (LIRYC), Bordeaux-Pessac, France; Department of Electrophysiology and Cardiac Stimulation, Centre Hospitalier Universitaire de Bordeaux, Bordeaux-Pessac, France; Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario Canada
| | - Jeffrey R Winterfield
- Division of Cardiology, Medical University of South Carolina, Charleston, South Carolina
| | | | | | - Dave Robinson
- Acutus Medical, Carlsbad, California; inHEART, Bordeaux-Pessac, France
| | | | | | | | | | | | | | | | | | - Virginie Loyer
- Electrophysiology and Heart Modelling Institute (LIRYC), Bordeaux-Pessac, France
| | - Yosuke Nakatani
- Electrophysiology and Heart Modelling Institute (LIRYC), Bordeaux-Pessac, France; Department of Electrophysiology and Cardiac Stimulation, Centre Hospitalier Universitaire de Bordeaux, Bordeaux-Pessac, France
| | - Hubert Cochet
- Electrophysiology and Heart Modelling Institute (LIRYC), Bordeaux-Pessac, France; Department of Electrophysiology and Cardiac Stimulation, Centre Hospitalier Universitaire de Bordeaux, Bordeaux-Pessac, France; inHEART, Bordeaux-Pessac, France
| | - Pierre Jaïs
- Electrophysiology and Heart Modelling Institute (LIRYC), Bordeaux-Pessac, France; Department of Electrophysiology and Cardiac Stimulation, Centre Hospitalier Universitaire de Bordeaux, Bordeaux-Pessac, France; inHEART, Bordeaux-Pessac, France.
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2
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Aiba T. Ischemia-induced premature ventricular complexes: Is it still complex? Heart Rhythm 2021; 18:1988-1989. [PMID: 34428560 DOI: 10.1016/j.hrthm.2021.08.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Accepted: 08/18/2021] [Indexed: 10/20/2022]
Affiliation(s)
- Takeshi Aiba
- Department of Clinical Laboratory Medicine and Genetics, National Cerebral and Cardiovascular Center, Osaka, Japan; Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Osaka, Japan.
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3
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Shenasa M, Razavi SM, Shenasa H, Al-Ahmad A. The Ideal Cardiac Mapping System. Card Electrophysiol Clin 2019; 11:739-748. [PMID: 31706480 DOI: 10.1016/j.ccep.2019.08.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Cardiac mapping has witnessed significant and unprecedented progress over more than a century. At present, several mapping/imaging technologies are commercially available, alone or in combination. This article briefly discusses the advantages and limitations (disadvantages) of each technique.
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Affiliation(s)
- Mohammad Shenasa
- Department of Cardiovascular Services, Heart and Rhythm Medical Group, O'Connor Hospital, San Jose, CA 95030, USA.
| | - Seyed-Mostafa Razavi
- Department of Cardiovascular Services, Heart and Rhythm Medical Group, O'Connor Hospital, San Jose, CA 95030, USA
| | - Hossein Shenasa
- Department of Cardiovascular Services, Heart and Rhythm Medical Group, O'Connor Hospital, San Jose, CA 95030, USA
| | - Amin Al-Ahmad
- Texas Cardiac Arrhythmia Institute, 3000 North IH35, Suite 700, Austin, TX 78705, USA
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4
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HUTCHINSON MATHEWD. Multielectrode Left Ventricular Mapping: Too Much or Not Enough? Pacing Clin Electrophysiol 2015; 38:660-2. [DOI: 10.1111/pace.12616] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2015] [Accepted: 02/16/2015] [Indexed: 11/28/2022]
Affiliation(s)
- MATHEW D. HUTCHINSON
- Division of Cardiology, Department of Medicine; University of Pennsylvania, Perelman School of Medicine; Philadelphia Pennsylvania
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5
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Spatial characterization of electrogram morphology from transmural recordings in the intact normal heart. PLoS One 2014; 9:e110399. [PMID: 25361049 PMCID: PMC4215922 DOI: 10.1371/journal.pone.0110399] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2014] [Accepted: 09/05/2014] [Indexed: 11/19/2022] Open
Abstract
PURPOSE Unipolar (UE) and bipolar electrograms (BE) are utilized to identify arrhythmogenic substrate. We quantified the effect of increasing distance from the source of propagation on local electrogram amplitude; and determined if transmural electrophysiological gradients exist with respect to propagation and stimulation depth. METHODS Mapping was performed on 5 sheep. Deployment of >50 quadripolar transmural needles in the LV were located in Cartesian space using Ensite. Contact electrograms from all needles were recorded during multisite bipolar pacing from epicardial then endocardial electrodes. Analysis was performed to determine stimulus distance to local activation time, peak negative amplitude (V-P), and peak-peak amplitude (VP-P) for (1) unfiltered UE, and (2) unfiltered and 30 Hz high-pass filtered BEs. Each sheep was analysed using repeated ANOVA. RESULTS Increasing distance from the pacing sites led to significant (p<0.01) attenuation of UEs (V-P = 7.0±0.5%; VP-P = 5.4±0.3% per cm). Attenuation of BE with distance was insignificant (Vp-p unfiltered = 2.2±0.5%; filtered = 1.7±1.4% per cm). Independent of pacing depth, significant (p<0.01) transmural electrophysiological gradients were observed, with highest amplitude occurring at epicardial layers for UE and endocardial layers for BE. Furthermore, during pacing, propagation was earlier at the epicardium than endocardial layer by 1.6±2.0 ms (UE) and 1.4±2.8 ms (BE) (all p>0.01) during endocardial stimulation, and 2.3±2.4 ms (UE) and 1.8±3.7 ms (BE) during epicardal stimulation (all p<0.01). CONCLUSIONS Electrogram amplitude is inversely proportional to propagation distance for unipolar modalities only, which affected V-P>VP-P. Conduction propagates preferentially via the epicardium during stimulation and is believed to contribute to a transmural amplitude gradient.
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6
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Hsieh CH, Chia EM, Huang K, Lu J, Barry M, Pouliopoulos J, Ross DL, Thomas SP, Kovoor P. Primary Radiofrequency Ablation of Ventricular Tachycardia Early After Myocardial Infarction. Circ Arrhythm Electrophysiol 2013; 6:1215-21. [DOI: 10.1161/circep.113.000447] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background—
Ventricular tachycardia (VT) is a significant complication of myocardial infarction. Radiofrequency ablation for postinfarct VT is reserved for drug refractory VT or VT storms. Our hypothesis is that radiofrequency ablation in the early postinfarct period could abolish or diminish late recurrences of VT.
Methods and Results—
Myocardial infarct was induced by balloon occlusion of the left anterior descending artery in 35 sheep. The 25 survivors underwent programmed ventricular stimulation and electroanatomical mapping 8 days postinfarct. Animals with inducible VT (12 out of 25 animals) underwent immediate radiofrequency ablation. Further VT inductions were performed 100 and 200 days postinfarct. At day 8, 3.0±0.9 VT morphologies per animal were inducible. All were successfully ablated with 24±6 applications of radiofrequency energy. All had ablations on the left ventricular endocardium, and 67% had ablations on the right ventricular aspect of the interventricular septum. All targeted arrhythmias were successfully ablated acutely. One animal was euthanized because of hypotension from a serious pericardial effusion. The other 11 survived and remained arrhythmia free on subsequent inductions on the 100th and 200th days (
P
<0.001). The 13 animals without inducible VT remained noninducible at the subsequent studies. A historical control arm of 9 animals with inducible VT at day 8 remained inducible at day 100.
Conclusions—
Radiofrequency ablation on the eighth day after infarction abolished inducibility of VT at late induction studies ≤200 days in an ovine model. Early identification and ablation of VT after infarction may prevent or reduce late ventricular arrhythmias but needs to be validated in clinical studies.
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Affiliation(s)
- Calvin H.C. Hsieh
- From the Westmead Hospital and the University of Sydney, Sydney, Australia
| | - Ee-May Chia
- From the Westmead Hospital and the University of Sydney, Sydney, Australia
| | - Kaimin Huang
- From the Westmead Hospital and the University of Sydney, Sydney, Australia
| | - Juntang Lu
- From the Westmead Hospital and the University of Sydney, Sydney, Australia
| | - Michael Barry
- From the Westmead Hospital and the University of Sydney, Sydney, Australia
| | - Jim Pouliopoulos
- From the Westmead Hospital and the University of Sydney, Sydney, Australia
| | - David L. Ross
- From the Westmead Hospital and the University of Sydney, Sydney, Australia
| | - Stuart P. Thomas
- From the Westmead Hospital and the University of Sydney, Sydney, Australia
| | - Pramesh Kovoor
- From the Westmead Hospital and the University of Sydney, Sydney, Australia
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7
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Hsieh CH, Chia EM, Huang K, Lu J, Barry M, Pouliopoulos J, Ross DL, Thomas SP, Kovoor P. Evolution of Ventricular Tachycardia and Its Electrophysiological Substrate Early After Myocardial Infarction. Circ Arrhythm Electrophysiol 2013; 6:1010-7. [DOI: 10.1161/circep.113.000348] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
| | - Ee-May Chia
- From the Westmead Hospital, Sydney, Australia
| | | | - Juntang Lu
- From the Westmead Hospital, Sydney, Australia
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8
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Treo EF, Cervantes DO, Ciaccio EJ. Automated detection and mapping of electrical activation when electrogram morphology is complex. Biomed Signal Process Control 2013. [DOI: 10.1016/j.bspc.2012.04.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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9
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Ginks MR, Lambiase PD, Duckett SG, Bostock J, Chinchapatnam P, Rhode K, McPhail MJ, Simon M, Bucknall C, Carr-White G, Razavi R, Rinaldi CA. A Simultaneous X-Ray/MRI and Noncontact Mapping Study of the Acute Hemodynamic Effect of Left Ventricular Endocardial and Epicardial Cardiac Resynchronization Therapy in Humans. Circ Heart Fail 2011; 4:170-9. [PMID: 21216832 DOI: 10.1161/circheartfailure.110.958124] [Citation(s) in RCA: 61] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Matthew R. Ginks
- From Guy's and St Thomas' Hospitals (M.R.G., J.B., C.B., G.C.-W., R.R., A.R.), London, United Kingdom; King's College (M.R.G., S.G.D., P.C., K.R., R.R., A.R.), London, United Kingdom; The Heart Hospital (P.D.L.), London, United Kingdom; Imperial College (M.J.W.M.), London, United Kingdom; and St Jude Medical (M.S.), United Kingdom
| | - Pier D. Lambiase
- From Guy's and St Thomas' Hospitals (M.R.G., J.B., C.B., G.C.-W., R.R., A.R.), London, United Kingdom; King's College (M.R.G., S.G.D., P.C., K.R., R.R., A.R.), London, United Kingdom; The Heart Hospital (P.D.L.), London, United Kingdom; Imperial College (M.J.W.M.), London, United Kingdom; and St Jude Medical (M.S.), United Kingdom
| | - Simon G. Duckett
- From Guy's and St Thomas' Hospitals (M.R.G., J.B., C.B., G.C.-W., R.R., A.R.), London, United Kingdom; King's College (M.R.G., S.G.D., P.C., K.R., R.R., A.R.), London, United Kingdom; The Heart Hospital (P.D.L.), London, United Kingdom; Imperial College (M.J.W.M.), London, United Kingdom; and St Jude Medical (M.S.), United Kingdom
| | - Julian Bostock
- From Guy's and St Thomas' Hospitals (M.R.G., J.B., C.B., G.C.-W., R.R., A.R.), London, United Kingdom; King's College (M.R.G., S.G.D., P.C., K.R., R.R., A.R.), London, United Kingdom; The Heart Hospital (P.D.L.), London, United Kingdom; Imperial College (M.J.W.M.), London, United Kingdom; and St Jude Medical (M.S.), United Kingdom
| | - Phani Chinchapatnam
- From Guy's and St Thomas' Hospitals (M.R.G., J.B., C.B., G.C.-W., R.R., A.R.), London, United Kingdom; King's College (M.R.G., S.G.D., P.C., K.R., R.R., A.R.), London, United Kingdom; The Heart Hospital (P.D.L.), London, United Kingdom; Imperial College (M.J.W.M.), London, United Kingdom; and St Jude Medical (M.S.), United Kingdom
| | - Kawal Rhode
- From Guy's and St Thomas' Hospitals (M.R.G., J.B., C.B., G.C.-W., R.R., A.R.), London, United Kingdom; King's College (M.R.G., S.G.D., P.C., K.R., R.R., A.R.), London, United Kingdom; The Heart Hospital (P.D.L.), London, United Kingdom; Imperial College (M.J.W.M.), London, United Kingdom; and St Jude Medical (M.S.), United Kingdom
| | - Mark J.W. McPhail
- From Guy's and St Thomas' Hospitals (M.R.G., J.B., C.B., G.C.-W., R.R., A.R.), London, United Kingdom; King's College (M.R.G., S.G.D., P.C., K.R., R.R., A.R.), London, United Kingdom; The Heart Hospital (P.D.L.), London, United Kingdom; Imperial College (M.J.W.M.), London, United Kingdom; and St Jude Medical (M.S.), United Kingdom
| | - Marcus Simon
- From Guy's and St Thomas' Hospitals (M.R.G., J.B., C.B., G.C.-W., R.R., A.R.), London, United Kingdom; King's College (M.R.G., S.G.D., P.C., K.R., R.R., A.R.), London, United Kingdom; The Heart Hospital (P.D.L.), London, United Kingdom; Imperial College (M.J.W.M.), London, United Kingdom; and St Jude Medical (M.S.), United Kingdom
| | - Cliff Bucknall
- From Guy's and St Thomas' Hospitals (M.R.G., J.B., C.B., G.C.-W., R.R., A.R.), London, United Kingdom; King's College (M.R.G., S.G.D., P.C., K.R., R.R., A.R.), London, United Kingdom; The Heart Hospital (P.D.L.), London, United Kingdom; Imperial College (M.J.W.M.), London, United Kingdom; and St Jude Medical (M.S.), United Kingdom
| | - Gerald Carr-White
- From Guy's and St Thomas' Hospitals (M.R.G., J.B., C.B., G.C.-W., R.R., A.R.), London, United Kingdom; King's College (M.R.G., S.G.D., P.C., K.R., R.R., A.R.), London, United Kingdom; The Heart Hospital (P.D.L.), London, United Kingdom; Imperial College (M.J.W.M.), London, United Kingdom; and St Jude Medical (M.S.), United Kingdom
| | - Reza Razavi
- From Guy's and St Thomas' Hospitals (M.R.G., J.B., C.B., G.C.-W., R.R., A.R.), London, United Kingdom; King's College (M.R.G., S.G.D., P.C., K.R., R.R., A.R.), London, United Kingdom; The Heart Hospital (P.D.L.), London, United Kingdom; Imperial College (M.J.W.M.), London, United Kingdom; and St Jude Medical (M.S.), United Kingdom
| | - C. Aldo Rinaldi
- From Guy's and St Thomas' Hospitals (M.R.G., J.B., C.B., G.C.-W., R.R., A.R.), London, United Kingdom; King's College (M.R.G., S.G.D., P.C., K.R., R.R., A.R.), London, United Kingdom; The Heart Hospital (P.D.L.), London, United Kingdom; Imperial College (M.J.W.M.), London, United Kingdom; and St Jude Medical (M.S.), United Kingdom
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10
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Pouliopoulos J, Sivagangabalan G, Barry MA, Thiagalingam A, Huang K, Lu J, Byth K, Kovoor P. Revised non-contact mapping of ventricular scar in a post-infarct ovine model with validation using contact mapping and histology. Europace 2010; 12:881-9. [PMID: 20363762 DOI: 10.1093/europace/euq098] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
AIMS Identification of arrhythmogenic scar using non-contact (NC) sinus rhythm (SR) mapping is limited. Dynamic substrate mapping (DSM) overcomes these limitations but is less accurate than plunge needle electrode mapping. We developed a revised method for calculating DSM which was validated using detailed histological analysis and compared with conventional mapping modalities. METHODS AND RESULTS Mapping was performed in eight sheep, >9 weeks post-myocardial infarction. Twenty multielectrode needles were deployed at thoracotomy in the left ventricle within and surrounding scar, and located using Ensite. Simultaneous catheter, needle, and NC electrograms were recorded during SR and multisite pacing. Dynamic substrate mapping maps were calculated as the maximum local peak negative voltage (PNV). Absolute mean DSM (AMDSM) maps, based on peak-peak voltage (P-PV), were calculated to minimize local pacing effects and take into account anisotropic influence. Dynamic substrate mapping and AMDSM maps were normalized based on global maximum voltages attained. Histologically quantified scar and mapping criteria were compared using Spearman's correlation and receiver operator curves (area under the curve, AUC) using 50% scar cut-off. For unipolar mapping, needles had greatest sensitivity at identifying scar which was better for P-PV (AUC; needle = 0.90, catheter = 0.70, NC = 0.66) than for PNV (AUC; needle = 0.79, NC = 0.38). AMDSM (AUC = 0.75) had superior scar discrimination than either catheter (AUC; unipolar = 0.70, bipolar = 0.71) or DSM (AUC = 0.67). Absolute mean DSM accuracy was improved when valvular geometries were excluded (AUC = 0.77). CONCLUSION Absolute mean DSM was comparably accurate in identifying scarred myocardium as PNV needle mapping but was superior to conventional catheter and NC mapping.
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Affiliation(s)
- Jim Pouliopoulos
- Department of Cardiology, Westmead Hospital, PO Box 533, Wentworthville, Sydney, NSW 2145, Australia
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11
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Natale A, Raviele A, Al-Ahmad A, Alfieri O, Aliot E, Almendral J, Breithardt G, Brugada J, Calkins H, Callans D, Cappato R, Camm JA, Della Bella P, Guiraudon GM, Haïssaguerre M, Hindricks G, Ho SY, Kuck KH, Marchlinski F, Packer DL, Prystowsky EN, Reddy VY, Ruskin JN, Scanavacca M, Shivkumar K, Soejima K, Stevenson WJ, Themistoclakis S, Verma A, Wilber D. Venice Chart International Consensus document on ventricular tachycardia/ventricular fibrillation ablation. J Cardiovasc Electrophysiol 2010; 21:339-79. [PMID: 20082650 DOI: 10.1111/j.1540-8167.2009.01686.x] [Citation(s) in RCA: 64] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Affiliation(s)
- Andrea Natale
- Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin, TX, USA
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12
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Bella PD, Maccabelli G, Trevisi N. Catheter ablation of ventricular tachycardia guided by noncontact mapping. Future Cardiol 2009; 4:527-40. [PMID: 19804346 DOI: 10.2217/14796678.4.5.527] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Catheter ablation of untolerated and unstable ventricular tachycardia may not be performed using a conventional activation mapping tecnique. The noncontact mapping system enables reconstruction of the spreading of activation wave through a virtually generated ventricular chamber, even from a single tachycardia beat, and was introduced as a tool to guide mapping and ablation of untolerated or unsustained ventricular arrhythmias. The reduced accuracy in the setting of enlarged ventricles is recognized as the main limitation of this tecnique. While noncontract mapping appears to be especially suitable in guiding the ablation of unsustained idiopathic ventricular arrhythmias, it can also be successfully used as a guide to perform ablation of untolerated re-entry-related ventricular tachycardias during sinus rhythm.
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Affiliation(s)
- Paolo Della Bella
- University of Milan, Centro Cardiologico Monzino, Institute of Cardiology, Via Parea 4, 20138 Milano, Italy.
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PRATOLA CLAUDIO, BALDO ELISA, TOSELLI TIZIANO, NOTARSTEFANO PASQUALE, PAOLO ARTALE, FERRARI ROBERTO. Contact versus Noncontact Mapping for Ablation of Ventricular Tachycardia in Patients with Previous Myocardial Infarction. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2009; 32:842-50. [DOI: 10.1111/j.1540-8159.2009.02398.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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15
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Aliot EM, Stevenson WG, Almendral-Garrote JM, Bogun F, Calkins CH, Delacretaz E, Bella PD, Hindricks G, Jais P, Josephson ME, Kautzner J, Kay GN, Kuck KH, Lerman BB, Marchlinski F, Reddy V, Schalij MJ, Schilling R, Soejima K, Wilber D. EHRA/HRS Expert Consensus on Catheter Ablation of Ventricular Arrhythmias: Developed in a partnership with the European Heart Rhythm Association (EHRA), a Registered Branch of the European Society of Cardiology (ESC), and the Heart Rhythm Society (HRS); in collaboration with the American College of Cardiology (ACC) and the American Heart Association (AHA). Europace 2009; 11:771-817. [DOI: 10.1093/europace/eup098] [Citation(s) in RCA: 283] [Impact Index Per Article: 18.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Sivagangabalan G, Pouliopoulos J, Huang K, Lu J, Barry MA, Thiagalingam A, Ross DL, Thomas SP, Kovoor P. Comparison of Electroanatomic Contact and Noncontact Mapping of Ventricular Scar in a Postinfarct Ovine Model With Intramural Needle Electrode Recording and Histological Validation. Circ Arrhythm Electrophysiol 2008; 1:363-9. [DOI: 10.1161/circep.108.799619] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background—
Substrate-based ablation is useful for nonhemodynamically tolerated postinfarct ventricular tachycardia. We assessed the accuracy of the CARTO contact and EnSite noncontact systems at identifying scar in a chronic ovine model with intramural plunge needle electrode recording and histological validation.
Methods and Results—
Scar mapping was performed on 8 male sheep with previous percutaneous-induced myocardial infarction. Up to 20 plunge needles were inserted into the left ventricle of each animal in areas of dense scar, scar border, and normal myocardium. A simultaneous CARTO map and EnSite geometry were acquired using a single catheter, and needle electrode locations were registered. A dynamic substrate map was constructed using ratiometric 50% peak negative voltage. The scar percentage around each needle location was quantified histologically. Analysis was performed on 152 plunge needles and corresponding histological blocks. Spearman correlation with histology was 0.690 (
P
<0.001) for needle electrode peak-to-peak voltage (PPV), 0.362 (
P
<0.001) and 0.492 (
P
<0.001) for CARTO bipolar and unipolar PPV, and 0.381 (
P
<0.001) for EnSite dynamic substrate map (≤40 mm from array). The area under the receiver operator characteristics curve (<50% and ≥50% scar) was 0.896 for needle electrode PPV, 0.726 and 0.697 for CARTO bipolar and unipolar PPV, and 0.703 for EnSite dynamic substrate map (≤40 mm from array).
Conclusions—
Both the CARTO contact and EnSite noncontact systems were moderately accurate in identifying postinfarct scar when compared with intramural electrodes and confirmed with histology. The EnSite dynamic substrate map was comparable to the CARTO contact bipolar PPV when points >40 mm from the array were excluded.
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Affiliation(s)
| | - Jim Pouliopoulos
- From the Cardiology Department, Westmead Hospital, Sydney, Australia
| | - Kaimin Huang
- From the Cardiology Department, Westmead Hospital, Sydney, Australia
| | - Juntang Lu
- From the Cardiology Department, Westmead Hospital, Sydney, Australia
| | - Michael A. Barry
- From the Cardiology Department, Westmead Hospital, Sydney, Australia
| | | | - David L. Ross
- From the Cardiology Department, Westmead Hospital, Sydney, Australia
| | - Stuart P. Thomas
- From the Cardiology Department, Westmead Hospital, Sydney, Australia
| | - Pramesh Kovoor
- From the Cardiology Department, Westmead Hospital, Sydney, Australia
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Voss F, Steen H, Bauer A, Giannitsis E, Katus HA, Becker R. Determination of myocardial infarct size by noncontact mapping. Heart Rhythm 2008; 5:308-14. [DOI: 10.1016/j.hrthm.2007.10.026] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2007] [Accepted: 10/10/2007] [Indexed: 11/27/2022]
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18
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Rao L, Ling Y, He R, Gilbert AL, Frangogiannis NG, Wang J, Nagueh SF, Khoury DS. Integrated multimodal-catheter imaging unveils principal relationships among ventricular electrical activity, anatomy, and function. Am J Physiol Heart Circ Physiol 2007; 294:H1002-9. [PMID: 18083892 DOI: 10.1152/ajpheart.01297.2006] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Multiple imaging modalities are employed independent of one another while managing complex cardiac arrhythmias. To combine electrical, anatomical, and functional imaging in a single catheter system, we developed a balloon catheter that carried 64 electrodes on its surface and an intracardiac echocardiography (ICE) catheter through a central lumen. The catheter system was inserted, and the balloon was inflated inside the left ventricle (LV) of eight dogs with 6-wk-old infarction, created by occlusion in the left anterior descending coronary artery. Anatomy was constructed by ICE imaging (9 MHz) through the balloon. Single-beat noncontact mapping (NCM) was performed via the multielectrode array to reconstruct unipolar endocardial electrograms during sinus rhythm. Standard contact mapping (CM) of the endocardium was also carried out for reference. Myocardial infarction in anterior LV extending from the middle to apical regions was localized both by ICE and NCM and validated by CM and pathology. The overall difference in the activation times between NCM and CM was 3 +/- 1 ms. Unipolar voltage in infarcted middle anterior LV was smaller than the voltage in normal middle inferior LV both by NCM (11 +/- 4 vs. 16 +/- 3 mV; P = 0.002) and CM (11 +/- 3 vs. 20 +/- 4 mV; P < 0.001). Unipolar voltage was also inversely related to infarct transmurality, both by NCM (r = -0.87; P = 0.005) and CM (r = -0.94; P < 0.001). The infarct area by ICE (7.7 +/- 2.9 cm(2)) was in agreement with CM (bipolar voltage, <1 mV; and area, 7.6 +/- 3.3 cm(2); r = 0.80; P = 0.016). Meanwhile, the voltage threshold that depicted the infarct area by NCM was directly related to the smallest unipolar voltage reconstructed within the infarct (r = 0.96; P < 0.001). In conclusion, combining NCM and ICE imaging in a single catheter system is feasible. The preclinical development of such an integrated system and its evaluation in experimental myocardial infarction demonstrate capabilities for single-beat mapping at multiple sites as well as the online assessment of anatomy and myocardial function.
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Affiliation(s)
- Liyun Rao
- Department of Cardiology, Methodist DeBakey Heart Center, The Methodist Hospital Research Institute, Houston, TX 77030, USA
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Kriebel T, Saul JP, Schneider H, Sigler M, Paul T. Noncontact mapping and radiofrequency catheter ablation of fast and hemodynamically unstable ventricular tachycardia after surgical repair of tetralogy of Fallot. J Am Coll Cardiol 2007; 50:2162-8. [PMID: 18036455 DOI: 10.1016/j.jacc.2007.07.074] [Citation(s) in RCA: 56] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2007] [Revised: 07/30/2007] [Accepted: 07/30/2007] [Indexed: 11/19/2022]
Abstract
OBJECTIVES The goal of this work was to assess efficacy of radiofrequency (RF) ablation of fast ventricular tachycardia (VT) in patients after surgical repair of tetralogy of Fallot (TOF) guided by noncontact mapping. BACKGROUND Ventricular tachycardias after repair of TOF are associated with significant morbidity and mortality. METHODS Ten patients after surgical repair of TOF underwent electrophysiological study for hemodynamically unstable VT using the noncontact mapping system. Dynamic substrate mapping was performed and activation was recorded during basic rhythm and induced VT (mean cycle length 269 ms) using color-coded isopotential maps and reconstructed unipolar electrograms. RESULTS A total of 13 VTs were induced in the 10 patients. In 11 of 13 VTs, a macro-re-entrant mechanism was identified; 2 had a focal origin. For macro-re-entrant VT, RF current lesion lines were created between areas of residual conduction; in 2 patients, no RF current was delivered due to high risk of atrioventricular block. Focal applications were performed for the focal VTs. Ventricular tachycardia was not inducible after RF application in the 8 patients in whom ablation was attempted (100%, 80% of all patients). An internal cardioverter-defibrillator had already been implanted in 2 patients and was recommended to the rest of the group. During follow-up (mean 35.4 months), 6 of 8 patients with a successful procedure were still free of VT, and 2 patients had recurrence of VT with a different cycle length. CONCLUSIONS In patients with fast and unstable VT after surgical repair of TOF, noncontact mapping helped to identify the tachycardia substrate and allowed for effective and safe treatment by RF ablation.
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Affiliation(s)
- Thomas Kriebel
- Department of Pediatric Cardiology and Intensive Care Medicine, Georg-August-University Göttingen, Göttingen, Germany.
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KALTMAN JONATHANR, GILLESPIE MATTHEWJ, SEYMOUR TRAVIS, KHAN AZEEM, ZELTSER ILANAJ, RHODES LARRYA, TANEL RONNE, VETTER VICTORIAL, WILLIAM GAYNOR J, SHAH MAULLYJ. Substrate Characterization of Ventricular Tachycardia in a Porcine Model of Tetralogy of Fallot Using Noncontact Mapping. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2007; 30:1316-22. [DOI: 10.1111/j.1540-8159.2007.00864.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Almendral J, Josephson ME. All Patients With Hemodynamically Tolerated Postinfarction Ventricular Tachycardia Do Not Require an Implantable Cardioverter-Defibrillator. Circulation 2007; 116:1204-12. [PMID: 17768304 DOI: 10.1161/circulationaha.106.670067] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Jesús Almendral
- Servicio de Cardiologia (Planta 5), Hospital Gregorio Marañon, Doctor Esquerdo, 46, 28007-Madrid, Spain.
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Abrams DJ, Earley MJ, Sporton SC, Kistler PM, Gatzoulis MA, Mullen MJ, Till JA, Cullen S, Walker F, Lowe MD, Deanfield JE, Schilling RJ. Comparison of Noncontact and Electroanatomic Mapping to Identify Scar and Arrhythmia Late After the Fontan Procedure. Circulation 2007; 115:1738-46. [PMID: 17372177 DOI: 10.1161/circulationaha.106.633982] [Citation(s) in RCA: 60] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background—
The right atrium late after the Fontan procedure is characterized by multiple complex arrhythmia circuits. We performed simultaneous electroanatomic and noncontact mapping to assess the accuracy of both systems to identify scar and arrhythmia.
Methods and Results—
Mapping was performed in 26 patients aged 26.8±8.9 years, 18.7±4.4 years after Fontan surgery. The area and site of abnormal endocardium defined by electroanatomic mapping (bipolar contact electrogram <0.5 mV) were compared with those defined by noncontact mapping during sinus rhythm and by dynamic substrate mapping. Contact and reconstructed unipolar electrograms at a known distance from the multielectrode array, recorded by the noncontact system simultaneously at 452 endocardial sites, were compared for morphological cross correlation, timing difference, and amplitude. Mapping of arrhythmias was performed with both systems when possible. The median patient abnormal endocardium as defined by electroanatomic mapping covered 38.0% (range 16.7% to 97.8%) of the right atrial surface area, as opposed to 60.9% (range 21.3% to 98.5%) defined by noncontact mapping during sinus rhythm and 11.9% (range 0.4% to 67.3%) by dynamic substrate mapping. A significant decrease in electrogram cross correlation (
P
=0.003), timing (
P
=0.012), and amplitude (
P
=0.003) of reconstructed electrograms, but not of contact electrograms (
P
=0.742), was seen at endocardial sites >40 mm from the multielectrode array. Successful arrhythmia mapping by electroanatomic versus noncontact mapping was superior in 15 patients (58%), the same in 6 (23%), and inferior in 5 (19%;
P
=0.044).
Conclusions—
Electroanatomic mapping is the superior modality for arrhythmia mapping late after the Fontan procedure. Noncontact mapping is limited by a significant reduction in reconstructed electrogram correlation, timing, and amplitude >40 mm from the multielectrode array and cannot accurately define areas of scar and low-voltage endocardium.
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MESH Headings
- Adolescent
- Adult
- Aging
- Amiodarone/therapeutic use
- Arrhythmias, Cardiac/drug therapy
- Arrhythmias, Cardiac/etiology
- Arrhythmias, Cardiac/physiopathology
- Arrhythmias, Cardiac/therapy
- Atrial Function, Right
- Cardiac Catheterization/instrumentation
- Cardiac Catheterization/methods
- Catheter Ablation
- Cicatrix/pathology
- Cicatrix/physiopathology
- Combined Modality Therapy
- Diagnosis, Computer-Assisted/instrumentation
- Diagnosis, Computer-Assisted/methods
- Drug Resistance
- Electrocardiography
- Electrodes
- Endocardium/pathology
- Endocardium/physiopathology
- Female
- Fontan Procedure/adverse effects
- Fontan Procedure/methods
- Heart Atria/pathology
- Heart Atria/physiopathology
- Heart Atria/surgery
- Humans
- Imaging, Three-Dimensional/instrumentation
- Imaging, Three-Dimensional/methods
- Male
- Models, Cardiovascular
- Organ Size
- Postoperative Period
- Pressure
- Pulmonary Circulation
- Pulmonary Veins/physiopathology
- Pulmonary Veins/surgery
- Tachycardia/drug therapy
- Tachycardia/etiology
- Tachycardia/physiopathology
- Tachycardia/therapy
- Vena Cava, Superior/physiopathology
- Vena Cava, Superior/surgery
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Affiliation(s)
- Dominic J Abrams
- Department of Cardiac Electrophysiology, St Bartholomew's Hospital, London, EC1A 7BE, United Kingdom
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