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Song X, Que D, Zhu Y, Yu W, Xu H, Zhang X, Yan J, Wang Y, Rui B, Yang Y, Zhuang Z, Huang G, Zhao X, Yang C, Cai Y, Yang P. Guiding ablation strategies for ventricular tachycardia in patients with structural heart disease by analyzing links and conversion patterns of traceable abnormal late potential zone. J Cardiovasc Electrophysiol 2023; 34:2273-2282. [PMID: 37694672 DOI: 10.1111/jce.16051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Revised: 08/19/2023] [Accepted: 08/26/2023] [Indexed: 09/12/2023]
Abstract
BACKGROUND Substrate-based ablation can treat uninducible or hemodynamically instability scar-related ventricular tachycardia (VT). However, whether a correlation exists between the critical VT isthmus and late activation zone (LAZ) during sinus rhythm (SR) is unknown. OBJECTIVE To demonstrate the structural and functional properties of abnormal substrates and analyze the link between the VT circuit and abnormal activity during SR. METHODS Thirty-six patients with scar-related VT (age, 50.0 ± 13.7 years and 86.1% men) who underwent VT ablation were reviewed. The automatic rhythmia ultrahigh resolution mapping system was used for electroanatomic substrate mapping. The clinical characteristics and mapping findings, particularly the LAZ characteristics during SR and VT, were analyzed. To determine the association between the LAZ during the SR and VT circuits, the LAZ was defined as five activation patterns: entrance, exit, core, blind alley, and conduction barrier. RESULTS Forty-five VTs were induced in 36 patients, 91.1% of which were monomorphic. The LAZ of all patients was mapped during the SR and VT circuits, and the consistency of the anatomical locations of the LAZ and VT circuits was analyzed. Using the ultrahigh resolution mapping system, interconversion patterns, including the bridge, T, puzzle, maze, and multilayer types, were identified. VT ablation enabled precise ablation of abnormal late potential conduction channels. CONCLUSION Five interconversion patterns of the LAZ during the SR and VT circuits were summarized. These findings may help formulate more precise substrate-based ablation strategies for scar-related VT and shorter procedure times.
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Affiliation(s)
- Xudong Song
- Department of Cardiology, Laboratory of Heart Center, Zhujiang Hospital, Southern Medical University, Guangzhou, China
- Heart Center of Zhujiang Hospital, Guangdong Provincial Biomedical Engineering Technology Research Center for Cardiovascular Disease, Guangzhou, China
- Heart Center of Zhujiang Hospital, Sino-Japanese Cooperation Platform for Translational Research in Heart Failure, Guangzhou, China
| | - Dongdong Que
- Department of Cardiology, Laboratory of Heart Center, Zhujiang Hospital, Southern Medical University, Guangzhou, China
- Heart Center of Zhujiang Hospital, Guangdong Provincial Biomedical Engineering Technology Research Center for Cardiovascular Disease, Guangzhou, China
- Heart Center of Zhujiang Hospital, Sino-Japanese Cooperation Platform for Translational Research in Heart Failure, Guangzhou, China
| | - Yingqi Zhu
- Department of Cardiology, Laboratory of Heart Center, Zhujiang Hospital, Southern Medical University, Guangzhou, China
- Heart Center of Zhujiang Hospital, Guangdong Provincial Biomedical Engineering Technology Research Center for Cardiovascular Disease, Guangzhou, China
- Heart Center of Zhujiang Hospital, Sino-Japanese Cooperation Platform for Translational Research in Heart Failure, Guangzhou, China
| | - Wenjie Yu
- Department of Cardiology, Laboratory of Heart Center, Zhujiang Hospital, Southern Medical University, Guangzhou, China
- Heart Center of Zhujiang Hospital, Guangdong Provincial Biomedical Engineering Technology Research Center for Cardiovascular Disease, Guangzhou, China
- Heart Center of Zhujiang Hospital, Sino-Japanese Cooperation Platform for Translational Research in Heart Failure, Guangzhou, China
| | - Haoran Xu
- Boston Scientific China, Shanghai, China
| | - Xiuli Zhang
- Department of Cardiology, Laboratory of Heart Center, Zhujiang Hospital, Southern Medical University, Guangzhou, China
- Heart Center of Zhujiang Hospital, Guangdong Provincial Biomedical Engineering Technology Research Center for Cardiovascular Disease, Guangzhou, China
- Heart Center of Zhujiang Hospital, Sino-Japanese Cooperation Platform for Translational Research in Heart Failure, Guangzhou, China
| | - Jing Yan
- Department of Cardiology, Laboratory of Heart Center, Zhujiang Hospital, Southern Medical University, Guangzhou, China
- Heart Center of Zhujiang Hospital, Guangdong Provincial Biomedical Engineering Technology Research Center for Cardiovascular Disease, Guangzhou, China
- Heart Center of Zhujiang Hospital, Sino-Japanese Cooperation Platform for Translational Research in Heart Failure, Guangzhou, China
| | - Yuxi Wang
- Department of Cardiology, Laboratory of Heart Center, Zhujiang Hospital, Southern Medical University, Guangzhou, China
- Heart Center of Zhujiang Hospital, Guangdong Provincial Biomedical Engineering Technology Research Center for Cardiovascular Disease, Guangzhou, China
- Heart Center of Zhujiang Hospital, Sino-Japanese Cooperation Platform for Translational Research in Heart Failure, Guangzhou, China
| | - Bowen Rui
- Department of Cardiology, Laboratory of Heart Center, Zhujiang Hospital, Southern Medical University, Guangzhou, China
- Heart Center of Zhujiang Hospital, Guangdong Provincial Biomedical Engineering Technology Research Center for Cardiovascular Disease, Guangzhou, China
- Heart Center of Zhujiang Hospital, Sino-Japanese Cooperation Platform for Translational Research in Heart Failure, Guangzhou, China
| | - Yashu Yang
- Department of Cardiology, Laboratory of Heart Center, Zhujiang Hospital, Southern Medical University, Guangzhou, China
- Heart Center of Zhujiang Hospital, Guangdong Provincial Biomedical Engineering Technology Research Center for Cardiovascular Disease, Guangzhou, China
- Heart Center of Zhujiang Hospital, Sino-Japanese Cooperation Platform for Translational Research in Heart Failure, Guangzhou, China
| | - Zhenyu Zhuang
- Department of Cardiology, Laboratory of Heart Center, Zhujiang Hospital, Southern Medical University, Guangzhou, China
- Heart Center of Zhujiang Hospital, Guangdong Provincial Biomedical Engineering Technology Research Center for Cardiovascular Disease, Guangzhou, China
- Heart Center of Zhujiang Hospital, Sino-Japanese Cooperation Platform for Translational Research in Heart Failure, Guangzhou, China
| | - Guanlin Huang
- Department of Cardiology, Laboratory of Heart Center, Zhujiang Hospital, Southern Medical University, Guangzhou, China
- Heart Center of Zhujiang Hospital, Guangdong Provincial Biomedical Engineering Technology Research Center for Cardiovascular Disease, Guangzhou, China
- Heart Center of Zhujiang Hospital, Sino-Japanese Cooperation Platform for Translational Research in Heart Failure, Guangzhou, China
| | - Xiaoqing Zhao
- Department of Cardiology, Laboratory of Heart Center, Zhujiang Hospital, Southern Medical University, Guangzhou, China
- Heart Center of Zhujiang Hospital, Guangdong Provincial Biomedical Engineering Technology Research Center for Cardiovascular Disease, Guangzhou, China
- Heart Center of Zhujiang Hospital, Sino-Japanese Cooperation Platform for Translational Research in Heart Failure, Guangzhou, China
| | - Chaobo Yang
- Department of Cardiology, Laboratory of Heart Center, Zhujiang Hospital, Southern Medical University, Guangzhou, China
- Heart Center of Zhujiang Hospital, Guangdong Provincial Biomedical Engineering Technology Research Center for Cardiovascular Disease, Guangzhou, China
- Heart Center of Zhujiang Hospital, Sino-Japanese Cooperation Platform for Translational Research in Heart Failure, Guangzhou, China
| | - Yanbin Cai
- Department of Cardiology, Laboratory of Heart Center, Zhujiang Hospital, Southern Medical University, Guangzhou, China
- Heart Center of Zhujiang Hospital, Guangdong Provincial Biomedical Engineering Technology Research Center for Cardiovascular Disease, Guangzhou, China
- Heart Center of Zhujiang Hospital, Sino-Japanese Cooperation Platform for Translational Research in Heart Failure, Guangzhou, China
| | - Pingzhen Yang
- Department of Cardiology, Laboratory of Heart Center, Zhujiang Hospital, Southern Medical University, Guangzhou, China
- Heart Center of Zhujiang Hospital, Guangdong Provincial Biomedical Engineering Technology Research Center for Cardiovascular Disease, Guangzhou, China
- Heart Center of Zhujiang Hospital, Sino-Japanese Cooperation Platform for Translational Research in Heart Failure, Guangzhou, China
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Tanaka Y, Takahashi A, Kawaguchi N, Nakashima E, Takagi K, Okubo K, Hikita H, Sasano T. Intuitive diagnosis of complex atrial tachycardia mechanisms using a novel histogram module of an ultra-high-resolution mapping system. J Interv Card Electrophysiol 2022; 64:203-215. [PMID: 35262857 DOI: 10.1007/s10840-022-01165-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Accepted: 02/16/2022] [Indexed: 12/01/2022]
Abstract
PURPOSE The LUMIPOINT™ software module was developed to aid the physician in determining the mechanism of individual atrial tachycardias (ATs). The purpose of this study was to assess the clinical utility of the SKYLINE™ histogram that is a part of LUMIPOINT™. METHODS This study included consecutive patients with iatrogenic sustained AT who underwent catheter ablation using conventional mapping (RHYTHMIA™). SKYLINE™ patterns were analyzed offline and classified into two types: (1) focal type (type-F) exhibiting a low-amplitude (relative activating surface area < 10%) plateau period and (2) reentrant type (type-R) showing no plateau period. How well the two patterns distinguished between focal and macroreentrant ATs as determined by conventional mapping was evaluated. RESULTS We studied 101 iatrogenic ATs in 91 patients (female: 24, mean age: 67.3 ± 9.1 years). Activation mapping revealed 79 (78.2%) macroreentrant, 6 (5.9%) localized reentrant, and 16 (15.8%) focal ATs. Among the 72 type-R ATs, the mechanism was truly a macroreentry in 70 ATs. However, one focal AT and one localized reentrant AT displayed a type-R pattern (pseudo-reentry pattern). In the 29 type-F ATs, nine macroreentrant ATs were recognized (pseudo-focal pattern). Using SKYLINE™ type-R to differentiate macroreentrant AT from AT with centrifugal activation (focal or localized reentry), the sensitivity and specificity were 88.6% and 90.9%, respectively. Even when the SKYLINE™ type did not match the mapping-based AT mechanism, all discrepancies were electrophysiologically explicable using the SKYLINE™ histograms. CONCLUSIONS SKYLINE™ histograms are a useful tool for the intuitive diagnosis of AT mechanisms.
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Affiliation(s)
- Yasuaki Tanaka
- Cardiovascular Center, Yokosuka Kyosai Hospital, 1-16 Yonegahamadori, Yokosuka, Kanagawa, 238-8558, Japan.
| | - Atsushi Takahashi
- Cardiovascular Center, Yokosuka Kyosai Hospital, 1-16 Yonegahamadori, Yokosuka, Kanagawa, 238-8558, Japan
| | - Naohiko Kawaguchi
- Cardiovascular Center, Yokosuka Kyosai Hospital, 1-16 Yonegahamadori, Yokosuka, Kanagawa, 238-8558, Japan
| | - Emiko Nakashima
- Cardiovascular Center, Yokosuka Kyosai Hospital, 1-16 Yonegahamadori, Yokosuka, Kanagawa, 238-8558, Japan
| | - Katsumasa Takagi
- Cardiovascular Center, Yokosuka Kyosai Hospital, 1-16 Yonegahamadori, Yokosuka, Kanagawa, 238-8558, Japan
| | - Kenji Okubo
- Cardiovascular Center, Yokosuka Kyosai Hospital, 1-16 Yonegahamadori, Yokosuka, Kanagawa, 238-8558, Japan
| | - Hiroyuki Hikita
- Cardiovascular Center, Yokosuka Kyosai Hospital, 1-16 Yonegahamadori, Yokosuka, Kanagawa, 238-8558, Japan
| | - Tetsuo Sasano
- Department of Cardiology, Tokyo Medical and Dental University, Tokyo, Japan
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Ciaccio EJ, Anter E, Coromilas J, Wan EY, Yarmohammadi H, Wit AL, Peters NS, Garan H. Structure and function of the ventricular tachycardia isthmus. Heart Rhythm 2022; 19:137-153. [PMID: 34371192 DOI: 10.1016/j.hrthm.2021.08.001] [Citation(s) in RCA: 31] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2021] [Revised: 07/22/2021] [Accepted: 08/01/2021] [Indexed: 12/24/2022]
Abstract
Catheter ablation of postinfarction reentrant ventricular tachycardia (VT) has received renewed interest owing to the increased availability of high-resolution electroanatomic mapping systems that can describe the VT circuits in greater detail, and the emergence and need to target noninvasive external beam radioablation. These recent advancements provide optimism for improving the clinical outcome of VT ablation in patients with postinfarction and potentially other scar-related VTs. The combination of analyses gleaned from studies in swine and canine models of postinfarction reentrant VT, and in human studies, suggests the existence of common electroanatomic properties for reentrant VT circuits. Characterizing these properties may be useful for increasing the specificity of substrate mapping techniques and for noninvasive identification to guide ablation. Herein, we describe properties of reentrant VT circuits that may assist in elucidating the mechanisms of onset and maintenance, as well as a means to localize and delineate optimal catheter ablation targets.
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Affiliation(s)
- Edward J Ciaccio
- Department of Medicine, Division of Cardiology, Columbia University College of Physicians and Surgeons, New York, New York; ElectroCardioMaths Programme, Imperial Centre for Cardiac Engineering, Imperial College London, London, United Kingdom.
| | - Elad Anter
- Department of Cardiovascular Medicine, Cardiac Electrophysiology, Cleveland Clinic, Cleveland, Ohio
| | - James Coromilas
- Department of Medicine, Division of Cardiovascular Disease and Hypertension, Rutgers University, New Brunswick, New Jersey
| | - Elaine Y Wan
- Department of Medicine, Division of Cardiology, Columbia University College of Physicians and Surgeons, New York, New York
| | - Hirad Yarmohammadi
- Department of Medicine, Division of Cardiology, Columbia University College of Physicians and Surgeons, New York, New York
| | - Andrew L Wit
- Department of Pharmacology, Columbia University College of Physicians and Surgeons, New York, New York
| | - Nicholas S Peters
- ElectroCardioMaths Programme, Imperial Centre for Cardiac Engineering, Imperial College London, London, United Kingdom
| | - Hasan Garan
- Department of Medicine, Division of Cardiology, Columbia University College of Physicians and Surgeons, New York, New York
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4
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Nakashima T, Cheniti G, Takagi T, Vlachos K, Goujeau C, André C, Krisai P, Ramirez FD, Pintican G, Kamakura T, Nakatani Y, Surget E, Roux JR, Meillet V, Carapezzi A, Tixier R, Chauvel R, Pambrun T, Duchateau J, Derval N, Pillois X, Cochet H, Hocini M, Haïssaguerre M, Jaïs P, Sacher F. Local abnormal ventricular activity detection in scar-related VT: Microelectrode versus conventional bipolar electrode. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2021; 44:1075-1084. [PMID: 33932234 DOI: 10.1111/pace.14253] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Revised: 04/11/2021] [Accepted: 04/25/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND Conventional bipolar electrodes (CBE) may be suboptimal to detect local abnormal ventricular activities (LAVAs). Microelectrodes (ME) may improve the detection of LAVAs. This study sought to elucidate the detectability of LAVAs using ME compared with CBE in patients with scar-related ventricular tachycardia (VT). METHODS We included consecutive patients with structural heart disease who underwent radiofrequency catheter ablation for scar-related VT using either of the following catheters equipped with ME: QDOTTM or IntellaTip MIFITM. Detection field of LAVA potentials were classified as three types: Type 1 (both CBE and ME detected LAVA), Type 2 (CBE did not detect LAVA while ME did), and Type 3 (CBE detected LAVA while ME did not). RESULTS In 16 patients (68 ± 16 years; 14 males), 260 LAVAs electrograms (QDOT = 72; MIFI = 188) were analyzed. Type 1, type 2, and type 3 detections were 70.8% (QDOT, 69.4%; MIFI, 71.3%), 20.0% (QDOT, 23.6%; MIFI, 18.6%) and 9.2% (QDOT, 6.9%; MIFI, 10.1%), respectively. The LAVAs amplitudes detected by ME were higher than those detected by CBE in both catheters (QDOT: ME 0.79 ± 0.50 mV vs. CBE 0.41 ± 0.42 mV, p = .001; MIFI: ME 0.73 ± 0.64 mV vs. CBE 0.38 ± 0.36 mV, p < .001). CONCLUSIONS ME allow to identify 20% of LAVAs missed by CBE. ME showed higher amplitude LAVAs than CBE. However, 9.2% of LAVAs can still be missed by ME.
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Affiliation(s)
- Takashi Nakashima
- Department of Cardiac Pacing and Electrophysiology, Univ. Bordeaux, Bordeaux University Hospital (CHU), Pessac-Bordeaux, France
| | - Ghassen Cheniti
- Department of Cardiac Pacing and Electrophysiology, Univ. Bordeaux, Bordeaux University Hospital (CHU), Pessac-Bordeaux, France
| | - Takamitsu Takagi
- Department of Cardiac Pacing and Electrophysiology, Univ. Bordeaux, Bordeaux University Hospital (CHU), Pessac-Bordeaux, France
| | - Konstantinos Vlachos
- Department of Cardiac Pacing and Electrophysiology, Univ. Bordeaux, Bordeaux University Hospital (CHU), Pessac-Bordeaux, France.,Department of Cardiac Pacing and Electrophysiology, Evangelismos General Hospital of Athens, Athens, Greece
| | - Cyril Goujeau
- Department of Cardiac Pacing and Electrophysiology, Univ. Bordeaux, Bordeaux University Hospital (CHU), Pessac-Bordeaux, France
| | - Clémentine André
- Department of Cardiac Pacing and Electrophysiology, Univ. Bordeaux, Bordeaux University Hospital (CHU), Pessac-Bordeaux, France
| | - Philipp Krisai
- Department of Cardiac Pacing and Electrophysiology, Univ. Bordeaux, Bordeaux University Hospital (CHU), Pessac-Bordeaux, France
| | - F Daniel Ramirez
- Department of Cardiac Pacing and Electrophysiology, Univ. Bordeaux, Bordeaux University Hospital (CHU), Pessac-Bordeaux, France.,Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Gabriela Pintican
- Department of Cardiac Pacing and Electrophysiology, Univ. Bordeaux, Bordeaux University Hospital (CHU), Pessac-Bordeaux, France
| | - Tsukasa Kamakura
- Department of Cardiac Pacing and Electrophysiology, Univ. Bordeaux, Bordeaux University Hospital (CHU), Pessac-Bordeaux, France
| | - Yosuke Nakatani
- Department of Cardiac Pacing and Electrophysiology, Univ. Bordeaux, Bordeaux University Hospital (CHU), Pessac-Bordeaux, France
| | - Elodie Surget
- Department of Cardiac Pacing and Electrophysiology, Univ. Bordeaux, Bordeaux University Hospital (CHU), Pessac-Bordeaux, France
| | | | | | | | - Romain Tixier
- Department of Cardiac Pacing and Electrophysiology, Univ. Bordeaux, Bordeaux University Hospital (CHU), Pessac-Bordeaux, France
| | - Remi Chauvel
- Department of Cardiac Pacing and Electrophysiology, Univ. Bordeaux, Bordeaux University Hospital (CHU), Pessac-Bordeaux, France
| | - Thomas Pambrun
- Department of Cardiac Pacing and Electrophysiology, Univ. Bordeaux, Bordeaux University Hospital (CHU), Pessac-Bordeaux, France
| | - Josselin Duchateau
- Department of Cardiac Pacing and Electrophysiology, Univ. Bordeaux, Bordeaux University Hospital (CHU), Pessac-Bordeaux, France
| | - Nicolas Derval
- Department of Cardiac Pacing and Electrophysiology, Univ. Bordeaux, Bordeaux University Hospital (CHU), Pessac-Bordeaux, France
| | - Xavier Pillois
- Department of Cardiac Pacing and Electrophysiology, Univ. Bordeaux, Bordeaux University Hospital (CHU), Pessac-Bordeaux, France
| | - Hubert Cochet
- Department of Cardiac Pacing and Electrophysiology, Univ. Bordeaux, Bordeaux University Hospital (CHU), Pessac-Bordeaux, France
| | - Mélèze Hocini
- Department of Cardiac Pacing and Electrophysiology, Univ. Bordeaux, Bordeaux University Hospital (CHU), Pessac-Bordeaux, France
| | - Michel Haïssaguerre
- Department of Cardiac Pacing and Electrophysiology, Univ. Bordeaux, Bordeaux University Hospital (CHU), Pessac-Bordeaux, France
| | - Pierre Jaïs
- Department of Cardiac Pacing and Electrophysiology, Univ. Bordeaux, Bordeaux University Hospital (CHU), Pessac-Bordeaux, France
| | - Frédéric Sacher
- Department of Cardiac Pacing and Electrophysiology, Univ. Bordeaux, Bordeaux University Hospital (CHU), Pessac-Bordeaux, France
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De Simone A, Anselmino M, Scaglione M, Stabile G, Solimene F, De Bellis A, Pepe M, Panella A, Ferraris F, Malacrida M, Maddaluno F, Gaita F, García-Bolao I. Is the mid-diastolic isthmus always the best ablation target for re-entrant atrial tachycardias? J Cardiovasc Med (Hagerstown) 2020; 21:113-122. [PMID: 31895131 DOI: 10.2459/jcm.0000000000000923] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
AIMS We evaluated the ability of an ultrahigh mapping system to identify the most convenient Rhythmia ablation target (RAT) in intra-atrial re-entrant tachycardias (IART) in terms of the narrowest area to transect to interrupt the re-entry. METHODS A total of 24 consecutive patients were enrolled with a total of 26 IARTs. The Rhythmia mapping system was used to identify the RAT in all IARTs. RESULTS In 18 cases the RAT matched the mid-diastolic phase of the re-entry whereas in 8 cases the RAT differed. In these patients, the mid-diastolic tissue in the active circuit never represented the area with the slowest conduction velocity of the re-entry. The mean conduction velocity at the mid-diastolic site was significantly slower in the group of patients in which the RAT matched the mid-diastolic site (P = 0.0173) and that of the remaining circuit was significantly slower in the group in which the RAT did not match (P = 0.0068). The mean conduction velocity at the RAT was comparable between the two groups (P = 0.66). CONCLUSION Identifying the RAT in challenging IARTs by means of high-density representation of the wavefront propagation of the tachycardia seems feasible and effective. In one-third of cases this approach identifies an area that differs from the mid-diastolic corridor.
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Affiliation(s)
| | - Matteo Anselmino
- Department of Medical Sciences, 'Città della Salute e della Scienza di Torino' Hospital, University of Turin, Turin
| | | | | | | | | | | | | | - Federico Ferraris
- Department of Medical Sciences, 'Città della Salute e della Scienza di Torino' Hospital, University of Turin, Turin
| | | | | | - Fiorenzo Gaita
- Department of Medical Sciences, 'Città della Salute e della Scienza di Torino' Hospital, University of Turin, Turin
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Targeting Abnormal Electrograms for Substrate-Based Ablation of Ventricular Tachycardia. JACC Clin Electrophysiol 2020; 6:812-814. [DOI: 10.1016/j.jacep.2020.04.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Revised: 04/06/2020] [Accepted: 04/08/2020] [Indexed: 11/19/2022]
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7
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Kim Y, Chen S, Ernst S, Guzman CE, Han S, Kalarus Z, Labadet C, Lin Y, Lo L, Nogami A, Saad EB, Sapp J, Sticherling C, Tilz R, Tung R, Kim YG, Stiles MK. 2019 APHRS expert consensus statement on three-dimensional mapping systems for tachycardia developed in collaboration with HRS, EHRA, and LAHRS. J Arrhythm 2020; 36:215-270. [PMID: 32256872 PMCID: PMC7132207 DOI: 10.1002/joa3.12308] [Citation(s) in RCA: 56] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2020] [Accepted: 01/20/2020] [Indexed: 12/24/2022] Open
Affiliation(s)
- Young‐Hoon Kim
- Department of Internal MedicineArrhythmia CenterKorea University Medicine Anam HospitalSeoulRepublic of Korea
| | - Shih‐Ann Chen
- Division of CardiologyDepartment of MedicineTaipei Veterans General HospitalTaipeiROC
| | - Sabine Ernst
- Department of CardiologyRoyal Brompton and Harefield HospitalImperial College LondonLondonUK
| | | | - Seongwook Han
- Division of CardiologyDepartment of Internal MedicineKeimyung University School of MedicineDaeguRepublic of Korea
| | - Zbigniew Kalarus
- Department of CardiologyMedical University of SilesiaKatowicePoland
| | - Carlos Labadet
- Cardiology DepartmentArrhythmias and Electrophysiology ServiceClinica y Maternidad Suizo ArgentinaBuenos AiresArgentina
| | - Yenn‐Jian Lin
- Division of CardiologyDepartment of MedicineTaipei Veterans General HospitalTaipeiROC
| | - Li‐Wei Lo
- Division of CardiologyDepartment of MedicineTaipei Veterans General HospitalTaipeiROC
| | - Akihiko Nogami
- Department of CardiologyFaculty of MedicineUniversity of TsukubaTsukubaJapan
| | - Eduardo B. Saad
- Center for Atrial FibrillationHospital Pro‐CardiacoRio de JaneiroBrazil
| | - John Sapp
- Division of CardiologyDepartment of MedicineQEII Health Sciences CentreDalhousie UniversityHalifaxNSCanada
| | | | - Roland Tilz
- Medical Clinic II (Department of Cardiology, Angiology and Intensive Care Medicine)University Hospital Schleswig‐Holstein (UKSH) – Campus LuebeckLuebeckGermany
| | - Roderick Tung
- Center for Arrhythmia CarePritzker School of MedicineUniversity of Chicago MedicineChicagoILUSA
| | - Yun Gi Kim
- Department of Internal MedicineArrhythmia CenterKorea University Medicine Anam HospitalSeoulRepublic of Korea
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8
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Van Steenkiste G, De Clercq D, Boussy T, Vera L, Schauvliege S, Decloedt A, van Loon G. Three dimensional ultra-high-density electro-anatomical cardiac mapping in horses: methodology. Equine Vet J 2020; 52:765-772. [PMID: 31954064 DOI: 10.1111/evj.13229] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2019] [Revised: 11/26/2019] [Accepted: 01/07/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND Ultra-high-density cardiac mapping allows very accurate characterisation of atrial and ventricular electrophysiology and activation timing. OBJECTIVE To describe the technique and evaluate the feasibility of magnetic electro-anatomical mapping of the equine heart. STUDY DESIGN In vivo experimental method development. METHODS A mapping system using an 8.5F bidirectional deflectable catheter with a deployable mini-basket (3-22 mm) containing 64 electrodes divided over eight splines was evaluated. Based upon predefined beat acceptance criteria, the system automatically acquires endocardial electrograms and catheter location information. Electro-anatomical maps were acquired from four horses in sinus rhythm under general anaesthesia. RESULTS All endocardial areas within each chamber could be reached. Access to the left atrium required the use of a deflectable sheath. With the exception of the left atrial map of horse 1, all four chambers in all four horses could be mapped. Optimisation of the beat acceptance criteria led to a reduction in manual correction of the automatically accepted beats from 13.1% in the first horse to 0.4% of the beats in the last horse. MAIN LIMITATIONS Only a limited number of horses were included in the study. CONCLUSION Ultra-high-density 3D electro-anatomical mapping is feasible in adult horses and is a promising tool for electrophysiological research and characterisation of complex arrhythmias.
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Affiliation(s)
- Glenn Van Steenkiste
- Department of Large Animal Internal Medicine, Equine Cardioteam, Ghent University, Ghent, Belgium
| | - Dominique De Clercq
- Department of Large Animal Internal Medicine, Equine Cardioteam, Ghent University, Ghent, Belgium
| | - Tim Boussy
- Department of Cardiology, AZ Groeninge, Kortrijk, Belgium
| | - Lisse Vera
- Department of Large Animal Internal Medicine, Equine Cardioteam, Ghent University, Ghent, Belgium
| | - Stijn Schauvliege
- Department of Surgery and Anaesthesiology of Domestic Animals, Ghent University, Ghent, Belgium
| | - Annelies Decloedt
- Department of Large Animal Internal Medicine, Equine Cardioteam, Ghent University, Ghent, Belgium
| | - Gunther van Loon
- Department of Large Animal Internal Medicine, Equine Cardioteam, Ghent University, Ghent, Belgium
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9
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Qian Z, Hou X, Wang Y, Jiang H, Wu H, Chen X, Wang B, Zou J. Physiological Left Bundle Branch Pacing Validated by Ultra-High Density Ventricular Mapping in a Swine Model. Circ Arrhythm Electrophysiol 2020; 13:e007898. [PMID: 31935122 DOI: 10.1161/circep.119.007898] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Zhiyong Qian
- Department of Cardiology, the First Affiliated Hospital, Nanjing Medical University, China (Z.Q., X.H., Y.W., H.J., H.W., X.C., J.Z.)
| | - Xiaofeng Hou
- Department of Cardiology, the First Affiliated Hospital, Nanjing Medical University, China (Z.Q., X.H., Y.W., H.J., H.W., X.C., J.Z.)
| | - Yao Wang
- Department of Cardiology, the First Affiliated Hospital, Nanjing Medical University, China (Z.Q., X.H., Y.W., H.J., H.W., X.C., J.Z.)
| | - Hai Jiang
- Department of Cardiology, the First Affiliated Hospital, Nanjing Medical University, China (Z.Q., X.H., Y.W., H.J., H.W., X.C., J.Z.)
| | - Hongping Wu
- Department of Cardiology, the First Affiliated Hospital, Nanjing Medical University, China (Z.Q., X.H., Y.W., H.J., H.W., X.C., J.Z.)
| | - Xing Chen
- Department of Cardiology, the First Affiliated Hospital, Nanjing Medical University, China (Z.Q., X.H., Y.W., H.J., H.W., X.C., J.Z.)
| | - Benqi Wang
- EP Department, BSC International Medical Trading (Shanghai) Co, Ltd, China (B.W.)
| | - Jiangang Zou
- Department of Cardiology, the First Affiliated Hospital, Nanjing Medical University, China (Z.Q., X.H., Y.W., H.J., H.W., X.C., J.Z.)
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10
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Lee A, Walters TE, Alhede C, Vittinghoff E, Sievers R, Gerstenfeld EP. Standard peak-to-peak bipolar voltage amplitude criteria underestimate myocardial scar during substrate mapping with a novel microelectrode catheter. Heart Rhythm 2019; 17:476-484. [PMID: 31606463 DOI: 10.1016/j.hrthm.2019.10.013] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2019] [Indexed: 11/28/2022]
Abstract
BACKGROUND Ventricular bipolar voltage values <0.5 and <1.0/1.5 mV (epi- and endocardium) correlating with dense scar and border zone, respectively, were established using a 3.5-mm tip catheter. Novel microelectrode catheters promise improved mapping resolution; however, whether standard voltage criteria apply to catheters with smaller electrode size and interelectrode distance remains unclear. OBJECTIVE The purpose of this study was to determine whether traditional bipolar voltage criteria for scar apply during substrate mapping with a microelectrode catheter. METHODS Paired bipolar and microbipolar voltage values were acquired from control swine (n = 2) using the microelectrode catheter and assessed for systemic differences. In a postinfarction swine model (n = 6), scar characteristics were compared between the bipolar maps and microbipolar maps using both standard and adjusted voltage criteria derived from the control animals. RESULTS In control swine, although 5th percentile values for bipolar and microbipolar voltage were similar (1.12 vs 1.22 mV [left ventricular (LV) endo]; 0.88 mV vs 0.98 mV [epi]), median values were significantly greater when acquired by microbipolar electrodes (3.60 vs 6.76 mV, P = .002 [LV endo]; 2.61 vs 2.72 mV, P = .02 [epi]). Microbipolar values were systematically larger by 2.0× and 1.4× in the LV endocardium and epicardium, respectively. Application of standard voltage values to microbipolar maps in postinfarct swine underestimated scar area by approximately 41% in the LV endocardium (13.7 vs 33.4 cm2, P = .004). CONCLUSION Bipolar voltage values acquired from microelectrodes are systemically larger than those acquired from standard catheters. New reference values should be established for these novel catheters.
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Affiliation(s)
- Adam Lee
- Section of Cardiac Electrophysiology, Division of Cardiology, Department of Medicine, University of California San Francisco, San Francisco, California
| | - Tomos E Walters
- Section of Cardiac Electrophysiology, Division of Cardiology, Department of Medicine, University of California San Francisco, San Francisco, California
| | - Christina Alhede
- Section of Cardiac Electrophysiology, Division of Cardiology, Department of Medicine, University of California San Francisco, San Francisco, California
| | - Eric Vittinghoff
- Section of Cardiac Electrophysiology, Division of Cardiology, Department of Medicine, University of California San Francisco, San Francisco, California
| | - Richard Sievers
- Section of Cardiac Electrophysiology, Division of Cardiology, Department of Medicine, University of California San Francisco, San Francisco, California
| | - Edward P Gerstenfeld
- Section of Cardiac Electrophysiology, Division of Cardiology, Department of Medicine, University of California San Francisco, San Francisco, California.
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11
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Rottmann M, Kleber AG, Barkagan M, Sroubek J, Leshem E, Shapira-Daniels A, Buxton AE, Anter E. Activation During Sinus Rhythm in Ventricles With Healed Infarction: Differentiation Between Arrhythmogenic and Nonarrhythmogenic Scar. Circ Arrhythm Electrophysiol 2019; 12:e007879. [PMID: 31597477 DOI: 10.1161/circep.119.007879] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND In infarct-related ventricular tachycardia (VT), the circuit often corresponds to a location characterized by activation slowing during sinus rhythm (SR). However, the relationship between activation slowing during SR and vulnerability for reentry and correlation to components of the VT circuit are unknown. This study examined the relationship between activation slowing during SR and vulnerability for reentry and correlated these areas with components of the circuit. METHODS In a porcine model of healed infarction, the spatial distribution of endocardial activation velocity was compared between SR and VT. Isthmus sites were defined using activation and entrainment mapping as areas exhibiting diastolic activity within the circuit while bystanders were defined as areas displaying diastolic activity outside the circuit. RESULTS Of 15 swine, 9 had inducible VT (5.2±3.0 per animal) while in 6 swine VT could not be induced despite stimulation from 4 RV and LV sites at 2 drive trains with 6 extra-stimuli down to refractoriness. Infarcts with VT had a greater magnitude of activation slowing during SR. A minimal endocardial activation velocity cutoff ≤0.1 m/s differentiated inducible from noninducible infarctions (P=0.015). Regions of maximal endocardial slowing during SR corresponded to the VT isthmus (area under curve=0.84 95% CI, 0.78-0.90) while bystander sites exhibited near-normal activation during SR. VT circuits were complex with 41.7% exhibiting discontinuous propagation with intramural bridges of slow conduction and delayed quasi-simultaneous endocardial activation. Regions forming the VT isthmus borders had faster activation during SR while regions forming the inner isthmus were activated faster during VT. CONCLUSIONS Endocardial activation slowing during SR may differentiate infarctions vulnerable for VT from those less vulnerable for VT. Sites of slow activation during SR correspond to sites forming the VT isthmus but not to bystander sites.
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Affiliation(s)
- Markus Rottmann
- Harvard-Thorndike Electrophysiology Institute, Cardiovascular Division, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
| | - Andre G Kleber
- Harvard-Thorndike Electrophysiology Institute, Cardiovascular Division, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
| | - Michael Barkagan
- Harvard-Thorndike Electrophysiology Institute, Cardiovascular Division, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
| | - Jakub Sroubek
- Harvard-Thorndike Electrophysiology Institute, Cardiovascular Division, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
| | - Eran Leshem
- Harvard-Thorndike Electrophysiology Institute, Cardiovascular Division, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
| | - Ayelet Shapira-Daniels
- Harvard-Thorndike Electrophysiology Institute, Cardiovascular Division, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
| | - Alfred E Buxton
- Harvard-Thorndike Electrophysiology Institute, Cardiovascular Division, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
| | - Elad Anter
- Harvard-Thorndike Electrophysiology Institute, Cardiovascular Division, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
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12
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Laţcu DG, Saoudi N. High-resolution/Density Mapping in Patients with Atrial and Ventricular Arrhythmias. Card Electrophysiol Clin 2019; 11:511-524. [PMID: 31400875 DOI: 10.1016/j.ccep.2019.05.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
High-definition/ultra-high-definition mapping, owing to an impressive increase of the point density of electroanatomic maps, provides improved substrate characterization, better understanding of the arrhythmia mechanism, and a better selection of the ablation target in patients with atrial and ventricular arrhythmias. Despite the scarce comparative data on ablation results versus standard mapping, ultra-high-definition mapping is increasingly used by the electrophysiology community.
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Affiliation(s)
| | - Nadir Saoudi
- Centre Hospitalier Princesse Grace, Avenue Pasteur, 98000 Monaco
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13
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Launer H, Clark T, Dewland T, Henrikson CA, Nazer B. An automated fractionation mapping algorithm for mapping of scar-based ventricular tachycardia. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2019; 42:1133-1140. [PMID: 31257596 DOI: 10.1111/pace.13758] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/08/2018] [Revised: 05/14/2019] [Accepted: 06/20/2019] [Indexed: 01/11/2023]
Abstract
BACKGROUND Mapping and ablation of fractionated electrograms is a common treatment for scar-based ventricular tachycardia (VT). An automated algorithm has been developed for rapid "fractionation mapping." METHODS Electroanatomic maps from 21 ablation procedures (14 scar-based VT and seven control idiopathic VT/premature ventricular contractions with normal voltage) were retrospectively analyzed using the Ensite Precision fractionation map (fMap; Abbott Laboratories; Abbott Park, IL, USA) algorithm. For each study, voltage maps and 30 fMaps were generated using combinations of parameters: width (5, 10, 20 ms), refractory time (15, 30 ms), sensitivity (0.1, 0.2 mV), and fractionation threshold (2, 3, 5). Parameter sensitivity was assessed by overlap of fractionated areas (fArea) with successful VT ablation sites (defined by entrainment and/or pace mapping). Specificity was assessed by presence of fractionated areas in control patients. RESULTS Of the 30 fMap parameter sets tested, seven identified >50% of scar-based VT ablation sites, and 26 contained <5 cm2 fractionation on control fMaps. Three combinations of fMap width/refractory/sensitivity/threshold parameters met both of the above criteria, and 20/30/0.1/2 identified the most VT ablation sites (79%) and generated 42.3 ± 28.2 cm2 of fArea on scar-based VT maps compared with 4.9 ± 3.2 cm2 on control maps (P = .001). None of the control patients and 23% of the scar-based VT patients had VT recurrence at mean 15 month follow-up. CONCLUSION Careful selection of signal processing parameters optimizes sensitivity and specificity of automated fractionation mapping for scar-based VT. Real-time use of fMap algorithms may reduce VT ablation procedure time and improve substrate modification, which may improve outcomes.
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Affiliation(s)
- Hunter Launer
- Rosalind Franklin University of Medicine and Science, Chicago, Illinois
| | - Tom Clark
- Knight Cardiovascular Institute, Oregon Health and Science University, Portland, Oregon
| | - Thomas Dewland
- Knight Cardiovascular Institute, Oregon Health and Science University, Portland, Oregon
| | - Charles A Henrikson
- Knight Cardiovascular Institute, Oregon Health and Science University, Portland, Oregon
| | - Babak Nazer
- Rosalind Franklin University of Medicine and Science, Chicago, Illinois
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14
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Nguyen DT, Tumolo AZ. Narrowing the Field: Closely Spaced Bipoles for Enhanced Detection of Low Voltage EGM. JACC Clin Electrophysiol 2019; 5:78-80. [PMID: 30678789 DOI: 10.1016/j.jacep.2018.09.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2018] [Accepted: 09/27/2018] [Indexed: 11/16/2022]
Affiliation(s)
- Duy T Nguyen
- University of Colorado, Section of Cardiac Electrophysiology, Division of Cardiology, Aurora, Colorado.
| | - Alexis Z Tumolo
- University of Colorado, Section of Cardiac Electrophysiology, Division of Cardiology, Aurora, Colorado
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15
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Determinants of atrial bipolar voltage: Inter electrode distance and wavefront angle. Comput Biol Med 2018; 102:449-457. [DOI: 10.1016/j.compbiomed.2018.07.011] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2018] [Revised: 07/16/2018] [Accepted: 07/16/2018] [Indexed: 11/18/2022]
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16
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Lackermair K, Kellner S, Kellnar A, Riesinger LM, Wakili R, Sinner MF, Rizas KD, Fichtner S, Estner HL. Initial single centre experience with the novel Rhythmia© high density mapping system in an all comer collective of 400 electrophysiological patients. Int J Cardiol 2018; 272:168-174. [PMID: 30126655 DOI: 10.1016/j.ijcard.2018.07.141] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2018] [Revised: 07/10/2018] [Accepted: 07/30/2018] [Indexed: 11/16/2022]
Abstract
BACKGROUND A novel, automatically annotating ultra-high density mapping system (Rhythmia©, Boston Scientific) collects a high number and quality of electrograms (EGMs). So far, data on general use in the electrophysiological laboratory are sparse. METHODS We retrospectively analyzed all our ablations using Rhythmia and recorded patient clinical data, procedural parameters, and mapping parameters including the count of EGMs, mapping time, and mapping volume. Where appropriate, procedural parameters were compared over time to assess a learning curve. RESULTS 400 patients underwent ablation of atrial fibrillation (n = 202), typical (n = 16) or atypical atrial flutter (n = 49), VT (n = 48), PVC (n = 35), accessory pathways (n = 14), AVNRT (n = 4), and focal atrial tachycardia (n = 32). System use was feasible, as no procedure had to be stopped for technical reasons and no ablation had to be withheld because of mapping failure, and safe, with an overall complication rate of 2.25%. Initial restrictions in manoeuvrability of the mapping catheter were overcome rapidly, as indicated by a significant decrease of fluoroscopy time (20 vs. 14 min, p = 0.02), use of contrast agent (50 vs. 40 ml; p < 0.01), and (not significant) lower procedure times (194 vs. 170 min; p = 0.12; comparing the first with the last third of patients undergoing pulmonary vein isolation only procedure). Ablation of complex left atrial, focal and ventricular tachycardias benefited from the reliable automatic annotation of a high number of EGMs. CONCLUSION The use of the Rhythmia is feasible and safe. Initial restrictions in manoeuvrability of the Orion mapping catheter were overcome rapidly. The procedures that benefit the most from ultra-high density mapping are complex left atrial tachycardias, focal tachycardias, and ventricular tachycardias.
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Affiliation(s)
- Korbinian Lackermair
- Department of Medicine I, University Hospital Munich, Ludwig Maximilians University, Munich, Germany.
| | - Stefanie Kellner
- Department of Medicine I, University Hospital Munich, Ludwig Maximilians University, Munich, Germany
| | - Antonia Kellnar
- Department of Medicine I, University Hospital Munich, Ludwig Maximilians University, Munich, Germany
| | - Lisa M Riesinger
- Department of Medicine I, University Hospital Munich, Ludwig Maximilians University, Munich, Germany
| | - Reza Wakili
- Department of Medicine I, University Hospital Munich, Ludwig Maximilians University, Munich, Germany; Department of Cardiology and Vascular Medicine, West-German Heart and Vascular Center Essen, University of Essen Medical School, University Duisburg-Essen, Essen, Germany; German Cardiovascular Research Centre (DZHK), partner site: Munich Heart Alliance, Munich, Germany
| | - Moritz F Sinner
- Department of Medicine I, University Hospital Munich, Ludwig Maximilians University, Munich, Germany; German Cardiovascular Research Centre (DZHK), partner site: Munich Heart Alliance, Munich, Germany
| | - Konstantinos D Rizas
- Department of Medicine I, University Hospital Munich, Ludwig Maximilians University, Munich, Germany; German Cardiovascular Research Centre (DZHK), partner site: Munich Heart Alliance, Munich, Germany
| | - Stephanie Fichtner
- Department of Medicine I, University Hospital Munich, Ludwig Maximilians University, Munich, Germany
| | - Heidi L Estner
- Department of Medicine I, University Hospital Munich, Ludwig Maximilians University, Munich, Germany
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17
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Anter E, Kleber AG, Rottmann M, Leshem E, Barkagan M, Tschabrunn CM, Contreras-Valdes FM, Buxton AE. Infarct-Related Ventricular Tachycardia. JACC Clin Electrophysiol 2018; 4:1033-1048. [DOI: 10.1016/j.jacep.2018.04.007] [Citation(s) in RCA: 43] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2018] [Revised: 04/19/2018] [Accepted: 04/26/2018] [Indexed: 10/28/2022]
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18
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Tanaka Y, Takahashi A, Takagi T, Nakajima J, Takagi K, Hikita H, Goya M, Hirao K. Novel Ablation Strategy for Isolating the Superior Vena Cava Using Ultra High-Resolution Mapping. Circ J 2018; 82:2007-2015. [DOI: 10.1253/circj.cj-17-1352] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
| | | | | | - Jun Nakajima
- The Cardiovascular Center, Yokosuka Kyosai Hospital
| | | | | | - Masahiko Goya
- The Heart Rhythm Center, Tokyo Medical and Dental University
| | - Kenzo Hirao
- The Heart Rhythm Center, Tokyo Medical and Dental University
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19
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Sommer P, Albenque J, Driel V, Pierre B, Tondo C, Roithinger FX, Poty H, Miller A, Della Bella P. Arrhythmia‐specific settings for automated high‐density mapping: A multicenter experience. J Cardiovasc Electrophysiol 2018; 29:1210-1220. [DOI: 10.1111/jce.13649] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2018] [Revised: 05/14/2018] [Accepted: 05/16/2018] [Indexed: 01/04/2023]
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20
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Sahli Costabal F, Yao J, Kuhl E. Predicting drug-induced arrhythmias by multiscale modeling. INTERNATIONAL JOURNAL FOR NUMERICAL METHODS IN BIOMEDICAL ENGINEERING 2018; 34:e2964. [PMID: 29424967 DOI: 10.1002/cnm.2964] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/20/2017] [Revised: 01/23/2018] [Accepted: 01/27/2018] [Indexed: 06/08/2023]
Abstract
Drugs often have undesired side effects. In the heart, they can induce lethal arrhythmias such as torsades de pointes. The risk evaluation of a new compound is costly and can take a long time, which often hinders the development of new drugs. Here, we establish a high-resolution, multiscale computational model to quickly assess the cardiac toxicity of new and existing drugs. The input of the model is the drug-specific current block from single cell electrophysiology; the output is the spatio-temporal activation profile and the associated electrocardiogram. We demonstrate the potential of our model for a low-risk drug, ranolazine, and a high-risk drug, quinidine: For ranolazine, our model predicts a prolonged QT interval of 19.4% compared with baseline and a regular sinus rhythm at 60.15 beats per minute. For quinidine, our model predicts a prolonged QT interval of 78.4% and a spontaneous development of torsades de pointes both in the activation profile and in the electrocardiogram. Our model reveals the mechanisms by which electrophysiological abnormalities propagate across the spatio-temporal scales, from specific channel blockage, via altered single cell action potentials and prolonged QT intervals, to the spontaneous emergence of ventricular tachycardia in the form of torsades de pointes. Our model could have important implications for researchers, regulatory agencies, and pharmaceutical companies on rationalizing safe drug development and reducing the time-to-market of new drugs.
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Affiliation(s)
| | - Jiang Yao
- Dassault Systèmes Simulia Corporation, Johnston, RI, USA
| | - Ellen Kuhl
- Departments of Mechanical Engineering, Bioengineering, and Cardiothoracic Surgery, Stanford University, Stanford, CA, USA
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21
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Aziz Z, Tung R. Novel Mapping Strategies for Ventricular Tachycardia Ablation. CURRENT TREATMENT OPTIONS IN CARDIOVASCULAR MEDICINE 2018; 20:34. [PMID: 29572643 DOI: 10.1007/s11936-018-0615-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Despite advances in antiarrhythmic and device therapy, ventricular tachycardia (VT) continues to be a major cause of increased morbidity and mortality. During scar-mediated monomorphic ventricular tachycardia ablation, the search for critical isthmus sites continues to be the primary goal during successful ablative procedures. However, given the overwhelming hemodynamic instability of most ventricular arrhythmias (> 70%), VT ablation is increasingly performed during sinus rhythm. This technique requires either a greater reliance on isthmus surrogates, or more extensive ablation techniques and is a more probabilistic approach to substrate modification. We believe that a better understanding of scar physiology and activation during sinus rhythm has important implications for clinical workflow and mechanistic improvements with current ablation strategies. With advancements in high-density mapping and multi-electrode catheter technology, mapping of VT substrates is performed with higher resolution, with improved visualization of local abnormal ventricular activities (LAVA), and with a more nuanced functional understanding of late potentials. As a prerequisite, our practice for VT ablation starts with a high-density structural map to identify voltage abnormalities as well as an isochronal functional map of sinus rhythm activation to identify region of discontinuous wavefront propagation. As the era of increased automation has emerged, there continues to be vast array of customizable features, and we have adopted the use of multiple wavefront mapping to further elucidate possible arrhythmogenic substrate. Our emerging understanding of how scar propagation patterns relate to areas of abnormal signals and critical isthmuses may greatly improve the ability to identify surrogates during sinus rhythm and help localize the most arrhythmogenic regions within a given scar. In the hemodynamically unstable patients, we routinely integrate isochronal late activation mapping (ILAM) to identify areas of slow conduction to initiate our targeted ablation and substrate modification. Multi-electrode delineation of the entire reentrant VT circuit has value in understanding the size of the circuit, rotational nature, and transmural extent of human reentry. Correlative studies between the activation of the complete VT circuit and sinus rhythm are likely to provide important mechanistic insights on where fixed and/or functional block occurs within a complex scar substrate.
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Affiliation(s)
- Zaid Aziz
- Center for Arrhythmia Care, Pritzker School of Medicine, The University of Chicago Medicine, 5841 S. Maryland Ave. MC 6080, Chicago, IL, 60637, USA
| | - Roderick Tung
- Center for Arrhythmia Care, Pritzker School of Medicine, The University of Chicago Medicine, 5841 S. Maryland Ave. MC 6080, Chicago, IL, 60637, USA.
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22
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Koontz J, Daubert JP. Do new tools help us identify substrate to target for ablation in ventricular tachycardia? J Cardiovasc Electrophysiol 2017; 28:1068-1069. [PMID: 28730598 DOI: 10.1111/jce.13299] [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] [Received: 07/13/2017] [Accepted: 07/14/2017] [Indexed: 11/30/2022]
Affiliation(s)
- Jason Koontz
- Clinical Cardiac Electrophysiology, Cardiology Division, Department of Medicine, Duke University Medical Center, Durham, NC, USA
| | - James P Daubert
- Clinical Cardiac Electrophysiology, Cardiology Division, Department of Medicine, Duke University Medical Center, Durham, NC, USA.,Duke Clinical Research Institute, Duke University Medical Center, Durham, NC, USA
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23
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Nührich JM, Kaiser L, Akbulak RÖ, Schäffer BN, Eickholt C, Schwarzl M, Kuklik P, Moser J, Jularic M, Willems S, Meyer C. Substrate characterization and catheter ablation in patients with scar-related ventricular tachycardia using ultra high-density 3-D mapping. J Cardiovasc Electrophysiol 2017; 28:1058-1067. [DOI: 10.1111/jce.13270] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2017] [Revised: 05/02/2017] [Accepted: 05/18/2017] [Indexed: 11/29/2022]
Affiliation(s)
- Jana M. Nührich
- Department of Electrophysiology, University Heart Center; University Hospital Eppendorf; Hamburg Germany
| | - Lukas Kaiser
- Department of Electrophysiology, University Heart Center; University Hospital Eppendorf; Hamburg Germany
| | - Ruken Özge Akbulak
- Department of Electrophysiology, University Heart Center; University Hospital Eppendorf; Hamburg Germany
| | - Benjamin N. Schäffer
- Department of Electrophysiology, University Heart Center; University Hospital Eppendorf; Hamburg Germany
| | - Christian Eickholt
- Department of Electrophysiology, University Heart Center; University Hospital Eppendorf; Hamburg Germany
| | - Michael Schwarzl
- Department of Interventional Cardiology, University Heart Center; University Hospital Eppendorf; Hamburg Germany
- DZHK (German Center for Cardiovascular Research); Partner Site Hamburg/Kiel/Lübeck; 13347 Berlin Germany
| | - Pawel Kuklik
- Department of Electrophysiology, University Heart Center; University Hospital Eppendorf; Hamburg Germany
| | - Julia Moser
- Department of Electrophysiology, University Heart Center; University Hospital Eppendorf; Hamburg Germany
| | - Mario Jularic
- Department of Electrophysiology, University Heart Center; University Hospital Eppendorf; Hamburg Germany
| | - Stephan Willems
- Department of Electrophysiology, University Heart Center; University Hospital Eppendorf; Hamburg Germany
- DZHK (German Center for Cardiovascular Research); Partner Site Hamburg/Kiel/Lübeck; 13347 Berlin Germany
| | - Christian Meyer
- Department of Electrophysiology, University Heart Center; University Hospital Eppendorf; Hamburg Germany
- DZHK (German Center for Cardiovascular Research); Partner Site Hamburg/Kiel/Lübeck; 13347 Berlin Germany
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24
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De Simone A, La Rocca V, Solimene F, Maddaluno F, Malacrida M, Stabile G. Cavotricuspid isthmus high-density mapping. HeartRhythm Case Rep 2017; 2:372-376. [PMID: 28491713 PMCID: PMC5419946 DOI: 10.1016/j.hrcr.2016.03.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
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25
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Nazer B, Walters TE, Duggirala S, Gerstenfeld EP. Feasibility of Rapid Linear-Endocardial and Epicardial Ventricular Ablation Using an Irrigated Multipolar Radiofrequency Ablation Catheter. Circ Arrhythm Electrophysiol 2017; 10:CIRCEP.116.004760. [DOI: 10.1161/circep.116.004760] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2016] [Accepted: 01/18/2017] [Indexed: 11/16/2022]
Abstract
Background—
A common strategy for ablation of scar-based ventricular tachycardia is delivering multiple lesions in a linear pattern.
Methods and Results—
We tested the efficacy of a novel linear irrigated multipolar ablation catheter capable of creating linear lesions with a single application. Healthy swine underwent endocardial and epicardial linear ablation using a novel linear irrigated ablation catheter; control animals underwent focal lesions in a linear pattern over 3.5 cm with an irrigated radiofrequency catheter. The linear catheter contained 7 irrigated electrodes spaced over 3.5 cm and could deliver ≤25 W to each electrode. Linear ablation required significantly less radiofrequency time than focal ablation (56±11 versus 497±110 seconds;
P
<0.0001). At gross pathology, linear (n=18) epicardial lines were longer than focal (n=8) epicardial lines (3.3±0.7 versus 2.1±0.9 cm;
P
<0.0005), with greater volume (3.8±2.9 versus 1.5±1.6 cm
3
;
P
=0.002). There was no difference between linear (n=22) and focal (n=7) endocardial line length or volume. Gaps (length 2.8±0.9 mm) were present in 53% of focal lines and 0% of linear ablation lines. No perforations, steam pops, or thrombus were noted.
Conclusions—
Compared with sequential focal radiofrequency ablation in a linear pattern, an irrigated multipolar linear ablation catheter safely delivers contiguous endocardial or epicardial lesions without gaps in a single ablation. This catheter shows promise for decreasing ventricular tachycardia ablation procedure time and improving outcome.
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Affiliation(s)
- Babak Nazer
- From the Electrophysiology Section, Division of Cardiology, Department of Medicine, University of California San Francisco
| | - Tomos E. Walters
- From the Electrophysiology Section, Division of Cardiology, Department of Medicine, University of California San Francisco
| | - Srikant Duggirala
- From the Electrophysiology Section, Division of Cardiology, Department of Medicine, University of California San Francisco
| | - Edward P. Gerstenfeld
- From the Electrophysiology Section, Division of Cardiology, Department of Medicine, University of California San Francisco
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26
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Evaluation of a novel high-resolution mapping system for catheter ablation of ventricular arrhythmias. Heart Rhythm 2017; 14:176-183. [DOI: 10.1016/j.hrthm.2016.11.018] [Citation(s) in RCA: 55] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2016] [Indexed: 11/22/2022]
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27
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Graham AJ, Orini M, Lambiase PD. Limitations and Challenges in Mapping Ventricular Tachycardia: New Technologies and Future Directions. Arrhythm Electrophysiol Rev 2017; 6:118-124. [PMID: 29018519 DOI: 10.15420/aer.2017.20.1] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Recurrent episodes of ventricular tachycardia in patients with structural heart disease are associated with increased mortality and morbidity, despite the life-saving benefits of implantable cardiac defibrillators. Reducing implantable cardiac defibrillator therapies is important, as recurrent shocks can cause increased myocardial damage and stunning, despite the conversion of ventricular tachycardia/ventricular fibrillation. Catheter ablation has emerged as a potential therapeutic option either for primary or secondary prevention of these arrhythmias, particularly in post-myocardial infarction cases where the substrate is well defined. However, the outcomes of catheter ablation of ventricular tachycardia in structural heart disease remain unsatisfactory in comparison with other electrophysiological procedures. The disappointing efficacy of ventricular tachycardia ablation in structural heart disease is multifactorial. In this review, we discuss the issues surrounding this and examine the limitations of current mapping approaches, as well as newer technologies that might help address them.
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Affiliation(s)
| | - Michele Orini
- Barts Heart Centre, London.,Institute of Cardiovascular Science, UCL, London, United Kingdom
| | - Pier D Lambiase
- Barts Heart Centre, London.,Institute of Cardiovascular Science, UCL, London, United Kingdom
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28
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Abstract
PURPOSE OF REVIEW This article summarizes current understanding of the arrhythmia substrate and effect of catheter ablation for infarct-related ventricular tachycardia, focusing on recent findings. RECENT FINDINGS Clinical studies support the use of catheter ablation earlier in the course of ischemic disease with moderate success in reducing arrhythmia recurrence and shocks from implantable defibrillators, although mortality remains unchanged. Ablation can be lifesaving for patients presenting with electrical storm. Advanced mapping systems with image integration facilitate identification of potential substrate, and several different approaches to manage hemodynamically unstable ventricular tachycardia have emerged. Novel ablation techniques that allow deeper lesion formation are in development. SUMMARY Catheter ablation is an important therapeutic option for preventing or reducing episodes of ventricular tachycardia in patients with ischemic cardiomyopathy. Present technologies allow successful ablation in the majority of patients, even when the arrhythmia is hemodynamically unstable. Failure of the procedure is often because of anatomic challenges that will hopefully be addressed with technological progress.
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29
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Affiliation(s)
- Roderick Tung
- From the Center for Arrhythmia Care, Heart and Vascular Center, The University of Chicago Medicine, IL (R.T.); and Division of Cardiology, Virginia Commonwealth University Medical Center, Richmond (K.A.E.)
| | - Kenneth A. Ellenbogen
- From the Center for Arrhythmia Care, Heart and Vascular Center, The University of Chicago Medicine, IL (R.T.); and Division of Cardiology, Virginia Commonwealth University Medical Center, Richmond (K.A.E.)
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30
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Anter E, Li J, Tschabrunn CM, Nezafat R, Josephson ME. Mapping of a Post-Infarction Left Ventricular Aneurysm-Dependent Macroreentrant Ventricular Tachycardia. HeartRhythm Case Rep 2015; 1:472-476. [PMID: 26664826 PMCID: PMC4671300 DOI: 10.1016/j.hrcr.2015.07.011] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Affiliation(s)
- Elad Anter
- Harvard-Thorndike Electrophysiology Institute, Cardiovascular Division, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Jianqing Li
- Harvard-Thorndike Electrophysiology Institute, Cardiovascular Division, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Cory M Tschabrunn
- Harvard-Thorndike Electrophysiology Institute, Cardiovascular Division, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Reza Nezafat
- Cardiovascular Division, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Mark E Josephson
- Harvard-Thorndike Electrophysiology Institute, Cardiovascular Division, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
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31
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Mantziari L, Butcher C, Kontogeorgis A, Panikker S, Roy K, Markides V, Wong T. Utility of a Novel Rapid High-Resolution Mapping System in the Catheter Ablation of Arrhythmias. JACC Clin Electrophysiol 2015; 1:411-420. [DOI: 10.1016/j.jacep.2015.06.002] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2015] [Revised: 05/11/2015] [Accepted: 06/17/2015] [Indexed: 11/28/2022]
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32
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Genet M, Chuan Lee L, Ge L, Acevedo-Bolton G, Jeung N, Martin A, Cambronero N, Boyle A, Yeghiazarians Y, Kozerke S, Guccione JM. A Novel Method for Quantifying Smooth Regional Variations in Myocardial Contractility Within an Infarcted Human Left Ventricle Based on Delay-Enhanced Magnetic Resonance Imaging. J Biomech Eng 2015; 137:081009. [PMID: 25994000 DOI: 10.1115/1.4030667] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2014] [Indexed: 11/08/2022]
Abstract
Heart failure is increasing at an alarming rate, making it a worldwide epidemic. As the population ages and life expectancy increases, this trend is not likely to change. Myocardial infarction (MI)-induced adverse left ventricular (LV) remodeling is responsible for nearly 70% of heart failure cases. The adverse remodeling process involves an extension of the border zone (BZ) adjacent to an MI, which is normally perfused but shows myofiber contractile dysfunction. To improve patient-specific modeling of cardiac mechanics, we sought to create a finite element model of the human LV with BZ and MI morphologies integrated directly from delayed-enhancement magnetic resonance (DE-MR) images. Instead of separating the LV into discrete regions (e.g., the MI, BZ, and remote regions) with each having a homogeneous myocardial material property, we assumed a functional relation between the DE-MR image pixel intensity and myocardial stiffness and contractility--we considered a linear variation of material properties as a function of DE-MR image pixel intensity, which is known to improve the accuracy of the model's response. The finite element model was then calibrated using measurements obtained from the same patient--namely, 3D strain measurements-using complementary spatial modulation of magnetization magnetic resonance (CSPAMM-MR) images. This led to an average circumferential strain error of 8.9% across all American Heart Association (AHA) segments. We demonstrate the utility of our method for quantifying smooth regional variations in myocardial contractility using cardiac DE-MR and CSPAMM-MR images acquired from a 78-yr-old woman who experienced an MI approximately 1 yr prior. We found a remote myocardial diastolic stiffness of C(0) = 0.102 kPa, and a remote myocardial contractility of T(max) = 146.9 kPa, which are both in the range of previously published normal human values. Moreover, we found a normalized pixel intensity range of 30% for the BZ, which is consistent with the literature. Based on these regional myocardial material properties, we used our finite element model to compute patient-specific diastolic and systolic LV myofiber stress distributions, which cannot be measured directly. One of the main driving forces for adverse LV remodeling is assumed to be an abnormally high level of ventricular wall stress, and many existing and new treatments for heart failure fundamentally attempt to normalize LV wall stress. Thus, our noninvasive method for estimating smooth regional variations in myocardial contractility should be valuable for optimizing new surgical or medical strategies to limit the chronic evolution from infarction to heart failure.
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