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Morellato J, Chik W, Barry MA, Lu J, Thiagalingam A, Kovoor P, Pouliopoulos J. Quantitative spectral assessment of intracardiac electrogram characteristics associated with post infarct fibrosis and ventricular tachycardia. PLoS One 2018; 13:e0204997. [PMID: 30289934 PMCID: PMC6173422 DOI: 10.1371/journal.pone.0204997] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2018] [Accepted: 09/18/2018] [Indexed: 12/15/2022] Open
Abstract
Background Post-myocardial infarction (MI) remodeling contributes to increased electrophysiological and structural heterogeneity and arrhythmogenesis. Utilising the post-infarct ovine model our aim was to determine unipolar electrogram frequency characteristics consequent to this remodeling and the development of Ventricular Tachycardia (VT). Methods and results Mapping studies were performed on 14 sheep at >1 month post-MI induction. Sheep were divided into VT inducible (n = 7) and non-inducible (n = 7) groups. Multielectrode needles (n = 20) were deployed within and surrounding ventricular scar for electrophysiological assessment of electrogram amplitude and width. Spectral analysis of electrograms was undertaken using wavelet and fast fourier transformations (WFFT) to calculate root mean square (RMS) power intervals spanning 0-300Hz in 20Hz intervals. Quantitative assessment between electrophysiological and histological parameters including collagen density, and structural organization of the myocardium was performed. Increasing myocardial scar density resulted in attenuation of electrogram amplitude and RMS values. (all p<0.01). Between groups there were no differences in electrogram amplitude (p = 0.37), however WFFT analysis revealed significantly higher RMS values in the VT group (p<0.05) in association with high frequency fractional components of the electrogram. As scar density increased, greater between-group differences in RMS were observed spanning this high frequency (200-280Hz) spectrum and which were proportionally dependent on the degree of structural disorganisation of the myocardium (p<0.001) and number of extrastimuli required to induce VT (p<0.05). Conclusion High frequency unipolar electrogram spectral characteristics were quantitatively co-influenced by the presence of fibrosis and degree of myocardial structural dissorganisation and were associated with the propensity for development of VT.
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Affiliation(s)
| | - William Chik
- University of Sydney, Sydney, Australia
- Department of Cardiology, Westmead Hospital, Sydney, Australia
| | - M. A. Barry
- Department of Cardiology, Westmead Hospital, Sydney, Australia
| | - Juntang Lu
- Department of Cardiology, Westmead Hospital, Sydney, Australia
| | - Aravinda Thiagalingam
- University of Sydney, Sydney, Australia
- Department of Cardiology, Westmead Hospital, Sydney, Australia
| | - Pramesh Kovoor
- University of Sydney, Sydney, Australia
- Department of Cardiology, Westmead Hospital, Sydney, Australia
| | - Jim Pouliopoulos
- University of Sydney, Sydney, Australia
- Department of Cardiology, Westmead Hospital, Sydney, Australia
- * E-mail: ,
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Shen W, Zhai L, Yang G, Liu H, Chen H, Ju W, Gu K, Li M, Zhang F, Chen M. Efficacy of sole pulmonary vein isolation in patients with nonparoxysmal atrial fibrillation without significant left atrium scar. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2018; 41:1356-1361. [PMID: 30055003 DOI: 10.1111/pace.13462] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/12/2018] [Revised: 07/01/2018] [Accepted: 07/05/2018] [Indexed: 11/30/2022]
Abstract
BACKGROUND Catheter ablation strategies for nonparoxysmal atrial fibrillation (NPAF) are in varied forms. The mechanisms that circumferential pulmonary vein isolation (CPVI) alone could achieve success in some of the patients with NPAF are not well studied. This study sought to assess the clinical outcome of only CPVI approach in NPAF patients without significant left atrium scar. METHODS AND RESULTS A total of 241 consecutive patients with NPAF undergoing an initial ablation procedure were studied. After CPVI, cavotricuspid isthmus ablation and direct current cardioversion, high-density atrial voltage mapping was performed during sinus rhythm. Transitional-voltage zone (TZ) was defined as 0.4-1.3 mV, and low-voltage zone (LVZ) as <0.4 mV. No LVZs were identified in 101 patients (41.9%), and only CPVI was performed. Among the patients without LVZs, single-procedure freedom from atrial fibrillation (AF)/atrial tachycardia was achieved in 73 patients (72%), while 28 patients (28%) had AF recurrence with mean follow-up of 29 ± 14 months. TZ index (TZi) was deduced by calculating the ratio of all TZ points over the total number of points and was found to be a univariate predictor of recurrence after a single procedure (P = 0.047). CONCLUSIONS The CPVI alone strategy for patients with NPAF can be performed in highly selective patients without LVZs. TZi may reflect healthy extent of left atrium, which has trend toward the association with AF recurrence.
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Affiliation(s)
- Wenzhi Shen
- Division of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Lishang Zhai
- Division of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Gang Yang
- Division of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Hailei Liu
- Division of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Hongwu Chen
- Division of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Weizhu Ju
- Division of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Kai Gu
- Division of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Mingfang Li
- Division of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Fengxiang Zhang
- Division of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Minglong Chen
- Division of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
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Yang G, Yang B, Wei Y, Zhang F, Ju W, Chen H, Li M, Gu K, Lin Y, Wang B, Cao K, Kojodjojo P, Chen M. Catheter Ablation of Nonparoxysmal Atrial Fibrillation Using Electrophysiologically Guided Substrate Modification During Sinus Rhythm After Pulmonary Vein Isolation. Circ Arrhythm Electrophysiol 2016; 9:e003382. [DOI: 10.1161/circep.115.003382] [Citation(s) in RCA: 119] [Impact Index Per Article: 14.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Gang Yang
- From the Division of Cardiology, First Affiliated Hospital of Nanjing Medical University, Nanjing, China (G.Y., B.Y., Y.W., F.Z., W.J., H.C., M.L., K.G., Y.L., B.W., K.C., M.C.); and Cardiac Department, National University Heart Centre, Singapore, Singapore (P.K.)
| | - Bing Yang
- From the Division of Cardiology, First Affiliated Hospital of Nanjing Medical University, Nanjing, China (G.Y., B.Y., Y.W., F.Z., W.J., H.C., M.L., K.G., Y.L., B.W., K.C., M.C.); and Cardiac Department, National University Heart Centre, Singapore, Singapore (P.K.)
| | - Youquan Wei
- From the Division of Cardiology, First Affiliated Hospital of Nanjing Medical University, Nanjing, China (G.Y., B.Y., Y.W., F.Z., W.J., H.C., M.L., K.G., Y.L., B.W., K.C., M.C.); and Cardiac Department, National University Heart Centre, Singapore, Singapore (P.K.)
| | - Fengxiang Zhang
- From the Division of Cardiology, First Affiliated Hospital of Nanjing Medical University, Nanjing, China (G.Y., B.Y., Y.W., F.Z., W.J., H.C., M.L., K.G., Y.L., B.W., K.C., M.C.); and Cardiac Department, National University Heart Centre, Singapore, Singapore (P.K.)
| | - Weizhu Ju
- From the Division of Cardiology, First Affiliated Hospital of Nanjing Medical University, Nanjing, China (G.Y., B.Y., Y.W., F.Z., W.J., H.C., M.L., K.G., Y.L., B.W., K.C., M.C.); and Cardiac Department, National University Heart Centre, Singapore, Singapore (P.K.)
| | - Hongwu Chen
- From the Division of Cardiology, First Affiliated Hospital of Nanjing Medical University, Nanjing, China (G.Y., B.Y., Y.W., F.Z., W.J., H.C., M.L., K.G., Y.L., B.W., K.C., M.C.); and Cardiac Department, National University Heart Centre, Singapore, Singapore (P.K.)
| | - Mingfang Li
- From the Division of Cardiology, First Affiliated Hospital of Nanjing Medical University, Nanjing, China (G.Y., B.Y., Y.W., F.Z., W.J., H.C., M.L., K.G., Y.L., B.W., K.C., M.C.); and Cardiac Department, National University Heart Centre, Singapore, Singapore (P.K.)
| | - Kai Gu
- From the Division of Cardiology, First Affiliated Hospital of Nanjing Medical University, Nanjing, China (G.Y., B.Y., Y.W., F.Z., W.J., H.C., M.L., K.G., Y.L., B.W., K.C., M.C.); and Cardiac Department, National University Heart Centre, Singapore, Singapore (P.K.)
| | - Yazhou Lin
- From the Division of Cardiology, First Affiliated Hospital of Nanjing Medical University, Nanjing, China (G.Y., B.Y., Y.W., F.Z., W.J., H.C., M.L., K.G., Y.L., B.W., K.C., M.C.); and Cardiac Department, National University Heart Centre, Singapore, Singapore (P.K.)
| | - Benqi Wang
- From the Division of Cardiology, First Affiliated Hospital of Nanjing Medical University, Nanjing, China (G.Y., B.Y., Y.W., F.Z., W.J., H.C., M.L., K.G., Y.L., B.W., K.C., M.C.); and Cardiac Department, National University Heart Centre, Singapore, Singapore (P.K.)
| | - Kejiang Cao
- From the Division of Cardiology, First Affiliated Hospital of Nanjing Medical University, Nanjing, China (G.Y., B.Y., Y.W., F.Z., W.J., H.C., M.L., K.G., Y.L., B.W., K.C., M.C.); and Cardiac Department, National University Heart Centre, Singapore, Singapore (P.K.)
| | - Pipin Kojodjojo
- From the Division of Cardiology, First Affiliated Hospital of Nanjing Medical University, Nanjing, China (G.Y., B.Y., Y.W., F.Z., W.J., H.C., M.L., K.G., Y.L., B.W., K.C., M.C.); and Cardiac Department, National University Heart Centre, Singapore, Singapore (P.K.)
| | - Minglong Chen
- From the Division of Cardiology, First Affiliated Hospital of Nanjing Medical University, Nanjing, China (G.Y., B.Y., Y.W., F.Z., W.J., H.C., M.L., K.G., Y.L., B.W., K.C., M.C.); and Cardiac Department, National University Heart Centre, Singapore, Singapore (P.K.)
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