1
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Stevenson WG, Richardson TD, Kanagasundram AN, Tandri H. State of the Art: Mapping Strategies to Guide Ablation in Ischemic Heart Disease. JACC Clin Electrophysiol 2024:S2405-500X(24)00787-4. [PMID: 39520431 DOI: 10.1016/j.jacep.2024.09.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2024] [Revised: 09/06/2024] [Accepted: 09/12/2024] [Indexed: 11/16/2024]
Abstract
Catheter ablation to prevent ventricular tachycardia (VT) that emerges late after a myocardial infarction aims to interrupt the re-entry substrate. Interruption of potential channels and regions of slow conduction that can be identified during stable sinus or paced rhythm is often effective and a number of substrate markers for guiding this approach have been described. While there is substantial agreement with different markers in some patients, the different markers select different regions for ablation in others. Mapping during VT to identify critical re-entry circuit isthmuses is likely more specific, and most useful when VT is incessant or frequent during the procedure or when sinus rhythm substrate ablation fails. Both approaches are often combined. These methods for identifying and characterizing post-infarct-related arrhythmia substrate and the re-entry circuits are reviewed.
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Affiliation(s)
- William G Stevenson
- Cardiac Electrophysiology Section, Vanderbilt University Medical Center, Nashville, Tennessee, USA.
| | - Travis D Richardson
- Cardiac Electrophysiology Section, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Arvindh N Kanagasundram
- Cardiac Electrophysiology Section, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Harikrishna Tandri
- Cardiac Electrophysiology Section, Vanderbilt University Medical Center, Nashville, Tennessee, USA
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2
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Kuo MJ, Lo LW, Lin YJ, Kim S, Chen SA. The novel automated peak frequency annotation algorithm for identifying high frequency electrogram activity following pulmonary vein isolation in atrial fibrillation ablation. Europace 2024; 26:euae114. [PMID: 38708526 DOI: 10.1093/europace/euae114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2024] [Accepted: 04/18/2024] [Indexed: 05/07/2024] Open
Affiliation(s)
- Ming-Jen Kuo
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, No. 201, Sec. 2, Shipai Rd., Beitou, Taipei, 11217 Taiwan, R.O.C
- Institute of Clinical Medicine and Cardiovascular Research Institute, National Yang-Ming Chiao-Tung University, No. 155, Sec. 2, Linong Street, 112 Taipei, Taiwan
- Cardiovascular Center, Taichung Veterans General Hospital, 1650 Taiwan Boulevard Sect. 4, Taichung, 407219 Taiwan, R.O.C
| | - Li-Wei Lo
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, No. 201, Sec. 2, Shipai Rd., Beitou, Taipei, 11217 Taiwan, R.O.C
- Institute of Clinical Medicine and Cardiovascular Research Institute, National Yang-Ming Chiao-Tung University, No. 155, Sec. 2, Linong Street, 112 Taipei, Taiwan
| | - Yenn-Jiang Lin
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, No. 201, Sec. 2, Shipai Rd., Beitou, Taipei, 11217 Taiwan, R.O.C
- Institute of Clinical Medicine and Cardiovascular Research Institute, National Yang-Ming Chiao-Tung University, No. 155, Sec. 2, Linong Street, 112 Taipei, Taiwan
| | - Steven Kim
- Advanced Applications Department, Abbott, Plymouth, MN, USA
| | - Shih-Ann Chen
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, No. 201, Sec. 2, Shipai Rd., Beitou, Taipei, 11217 Taiwan, R.O.C
- Institute of Clinical Medicine and Cardiovascular Research Institute, National Yang-Ming Chiao-Tung University, No. 155, Sec. 2, Linong Street, 112 Taipei, Taiwan
- Cardiovascular Center, Taichung Veterans General Hospital, 1650 Taiwan Boulevard Sect. 4, Taichung, 407219 Taiwan, R.O.C
- National Chung Hsing University, 145 Xingda Rd., South Dist., 402 Taichung, Taiwan
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3
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Karatela MF, Dowell RS, Friedman DJ, Jackson KP, Thomas KL, Piccini JP. Peak frequency mapping of atypical atrial flutter. J Cardiovasc Electrophysiol 2024; 35:950-964. [PMID: 38477184 DOI: 10.1111/jce.16221] [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: 10/06/2023] [Revised: 02/05/2024] [Accepted: 02/09/2024] [Indexed: 03/14/2024]
Abstract
INTRODUCTION Peak frequency (PF) mapping is a novel method that may identify critical portions of myocardial substrate supporting reentry. The aim of this study was to describe and evaluate PF mapping combined with omnipolar voltage mapping in the identification of critical isthmuses of left atrial (LA) atypical flutters. METHODS AND RESULTS LA omnipolar voltage and PF maps were generated in flutter using the Advisor HD-Grid catheter (Abbott) and EnSite Precision Mapping System (Abbott) in 12 patients. Normal voltage was defined as ≥0.5 mV, low-voltage as 0.1-0.5 mV, and scar as <0.1 mV. PF distributions were compared with ANOVA and post hoc Tukey analyses. The 1 cm radius from arrhythmia termination was compared to global myocardium with unpaired t-testing. The mean age was 65.8 ± 9.7 years and 50% of patients were female. Overall, 34 312 points were analyzed. Atypical flutters most frequently involved the mitral isthmus (58%) or anterior wall (25%). Mean PF varied significantly by myocardial voltage: normal (335.5 ± 115.0 Hz), low (274.6 ± 144.0 Hz), and scar (71.6 ± 140.5 Hz) (p < .0001 for all pairwise comparisons). All termination sites resided in low-voltage regions containing intermediate or high PF. Overall, mean voltage in the 1 cm radius from termination was significantly lower than the remaining myocardium (0.58 vs. 0.95 mV, p < .0001) and PF was significantly higher (326.4 vs. 245.1 Hz, p < .0001). CONCLUSION Low-voltage, high-PF areas may be critical targets during catheter ablation of atypical atrial flutter.
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Affiliation(s)
- Maham F Karatela
- Cardiac Electrophysiology Section, Division of Cardiology, Duke University Medical Center, Durham, North Carolina, USA
- Duke Clinical Research Institute, Durham, North Carolina, USA
| | - Robert S Dowell
- Cardiac Electrophysiology Section, Division of Cardiology, Duke University Medical Center, Durham, North Carolina, USA
- Abbott, St. Paul, Minnesota, USA
| | - Daniel J Friedman
- Cardiac Electrophysiology Section, Division of Cardiology, Duke University Medical Center, Durham, North Carolina, USA
- Duke Clinical Research Institute, Durham, North Carolina, USA
| | - Kevin P Jackson
- Cardiac Electrophysiology Section, Division of Cardiology, Duke University Medical Center, Durham, North Carolina, USA
| | - Kevin L Thomas
- Cardiac Electrophysiology Section, Division of Cardiology, Duke University Medical Center, Durham, North Carolina, USA
- Duke Clinical Research Institute, Durham, North Carolina, USA
| | - Jonathan P Piccini
- Cardiac Electrophysiology Section, Division of Cardiology, Duke University Medical Center, Durham, North Carolina, USA
- Duke Clinical Research Institute, Durham, North Carolina, USA
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4
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Simultaneous Entrainment Response Assessment at Multiple Sites. JACC Clin Electrophysiol 2022; 8:1381-1390. [PMID: 36424006 DOI: 10.1016/j.jacep.2022.07.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Revised: 07/15/2022] [Accepted: 07/17/2022] [Indexed: 12/24/2022]
Abstract
BACKGROUND The entrainment response, defined as the difference between the postpacing interval and the tachycardia cycle length (TCL) recorded from a mapping catheter, allows to track down the components of the tachycardia loop. OBJECTIVES The aim of this study was to evaluate if the postpacing interval measured simultaneously from multiple sites that are remote from the pacing site (PPIR) could be clinically useful in mapping re-entrant circuits. METHODS Ninety-two episodes of entrainment response in 29 patients with different macro-re-entrant tachycardias were evaluated using a standardized entrainment protocol. The spatial distribution of different values of PPIR-TCL in a simulation and a computational model of an entrained re-entrant tachycardia was also analyzed. RESULTS The PPIR exceeded TCL by more than 20 milliseconds only if both pacing and recording sites were outside the tachycardia circuit. The PPIR-TCL at in-circuit sites was always ≤20 milliseconds. Sites with negative PPIR-TCL values were found either outside or inside the tachycardia circuit. CONCLUSIONS Assessment of entrainment response from catheters remote from the pacing site may enhance spatial mapping of the tachycardia circuit. The PPIR-TCL above 20 milliseconds has an excellent positive predictive value in identifying sites outside the tachycardia circuit.
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5
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Nasu T, Toba M, Nekomiya N, Itasaka R, Mafune S, Nakata T, Ikeda H, Yokoshiki H. Successful Application of Stereotactic Body Radiation Therapy for Ventricular Tachycardia Substrate in a Patient With Nonischemic Cardiomyopathy. Am J Cardiol 2022; 184:149-153. [PMID: 36163052 DOI: 10.1016/j.amjcard.2022.08.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Revised: 08/07/2022] [Accepted: 08/10/2022] [Indexed: 11/01/2022]
Abstract
Cardiac stereotactic body radiotherapy (SBRT) has been gaining attention as a potential treatment for patients with ventricular tachycardia (VT). Here, we describe a nonischemic patient with severe heart failure and VTs originating from the deep anteroseptal substrate that was refractory to standard and bipolar catheter ablations, and was successfully managed with SBRT. In conclusion, anteroseptal VTs resistant to catheter ablation in severe nonischemic heart failure might be an indication for cardiac SBRT as palliative therapy.
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Affiliation(s)
- Toshihiro Nasu
- Department of Clinical Engineering, Sapporo City General Hospital, Sapporo, Japan
| | - Masahiro Toba
- Department of Cardiovascular Medicine, Sapporo City General Hospital, Sapporo, Japan
| | - Nobuyoshi Nekomiya
- Department of Clinical Engineering, Sapporo City General Hospital, Sapporo, Japan
| | - Ryo Itasaka
- Department of Clinical Engineering, Sapporo City General Hospital, Sapporo, Japan
| | - Shoh Mafune
- Department of Radiation Oncology, Sapporo City General Hospital, Sapporo, Japan
| | - Takeo Nakata
- Department of Radiation Oncology, Sapporo City General Hospital, Sapporo, Japan
| | - Hikaru Ikeda
- Department of Radiation Oncology, Hakodate Goryokaku Hospital, Sapporo, Japan
| | - Hisashi Yokoshiki
- Department of Cardiovascular Medicine, Sapporo City General Hospital, Sapporo, Japan.
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Tuncez A, Aslan AO, Merovci I, Oksuz F, Dogru CY, Kara M, Ozcan Cetin EH, Korkmaz A, Ozeke O, Cay S, Ozcan F, Aras D, Topaloglu S. Entrainment of ventricular tachycardia with V‐shaped diastolic activation pattern: Is the pacing site in or out? J Cardiovasc Electrophysiol 2022; 33:1609-1613. [DOI: 10.1111/jce.15570] [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: 05/18/2022] [Revised: 05/24/2022] [Accepted: 05/26/2022] [Indexed: 11/26/2022]
Affiliation(s)
| | - Ahmet Oguz Aslan
- Health Sciences UniversityAhi Evren Thoracic, and Cardiovascular Surgery Training and Research HospitalTrabzonTurkey
| | - Idriz Merovci
- University Clinical Center of KosovoDepartment of CardiologyPrishtina, Kosovo
| | - Fatih Oksuz
- Health Sciences UniversityAnkara Education and Research Hospital, Department of CardiologyAnkaraTurkey
| | - Ceren Yagmur Dogru
- Health Sciences UniversityAnkara City Hospital, Department of CardiologyAnkaraTurkey
| | - Meryem Kara
- Health Sciences UniversityAnkara City Hospital, Department of CardiologyAnkaraTurkey
| | | | - Ahmet Korkmaz
- Health Sciences UniversityAnkara City Hospital, Department of CardiologyAnkaraTurkey
| | - Ozcan Ozeke
- Health Sciences UniversityAnkara City Hospital, Department of CardiologyAnkaraTurkey
| | - Serkan Cay
- Health Sciences UniversityAnkara City Hospital, Department of CardiologyAnkaraTurkey
| | - Firat Ozcan
- Selcuk UniversityDepartment of CardiologyKonyaTurkey
| | - Dursun Aras
- İstanbul Medipol UniversityDepartment of CardiologyİstanbulTurkey
| | - Serkan Topaloglu
- Health Sciences UniversityAnkara City Hospital, Department of CardiologyAnkaraTurkey
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7
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Advances in Mapping of Ventricular Tachycardia. CURRENT TREATMENT OPTIONS IN CARDIOVASCULAR MEDICINE 2021. [DOI: 10.1007/s11936-021-00951-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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8
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Cronin EM, Bogun FM, Maury P, Peichl P, Chen M, Namboodiri N, Aguinaga L, Leite LR, Al-Khatib SM, Anter E, Berruezo A, Callans DJ, Chung MK, Cuculich P, d'Avila A, Deal BJ, Della Bella P, Deneke T, Dickfeld TM, Hadid C, Haqqani HM, Kay GN, Latchamsetty R, Marchlinski F, Miller JM, Nogami A, Patel AR, Pathak RK, Sáenz Morales LC, Santangeli P, Sapp JL, Sarkozy A, Soejima K, Stevenson WG, Tedrow UB, Tzou WS, Varma N, Zeppenfeld K. 2019 HRS/EHRA/APHRS/LAHRS expert consensus statement on catheter ablation of ventricular arrhythmias. Europace 2020; 21:1143-1144. [PMID: 31075787 DOI: 10.1093/europace/euz132] [Citation(s) in RCA: 242] [Impact Index Per Article: 60.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Ventricular arrhythmias are an important cause of morbidity and mortality and come in a variety of forms, from single premature ventricular complexes to sustained ventricular tachycardia and fibrillation. Rapid developments have taken place over the past decade in our understanding of these arrhythmias and in our ability to diagnose and treat them. The field of catheter ablation has progressed with the development of new methods and tools, and with the publication of large clinical trials. Therefore, global cardiac electrophysiology professional societies undertook to outline recommendations and best practices for these procedures in a document that will update and replace the 2009 EHRA/HRS Expert Consensus on Catheter Ablation of Ventricular Arrhythmias. An expert writing group, after reviewing and discussing the literature, including a systematic review and meta-analysis published in conjunction with this document, and drawing on their own experience, drafted and voted on recommendations and summarized current knowledge and practice in the field. Each recommendation is presented in knowledge byte format and is accompanied by supportive text and references. Further sections provide a practical synopsis of the various techniques and of the specific ventricular arrhythmia sites and substrates encountered in the electrophysiology lab. The purpose of this document is to help electrophysiologists around the world to appropriately select patients for catheter ablation, to perform procedures in a safe and efficacious manner, and to provide follow-up and adjunctive care in order to obtain the best possible outcomes for patients with ventricular arrhythmias.
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Affiliation(s)
| | | | | | - Petr Peichl
- Institute for Clinical and Experimental Medicine, Prague, Czech Republic
| | - Minglong Chen
- Jiangsu Province Hospital, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Narayanan Namboodiri
- Sree Chitra Institute for Medical Sciences and Technology, Thiruvananthapuram, India
| | | | | | | | - Elad Anter
- Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | | | | | | | | | - Andre d'Avila
- Hospital Cardiologico SOS Cardio, Florianopolis, Brazil
| | - Barbara J Deal
- Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | | | | | | | - Claudio Hadid
- Hospital General de Agudos Cosme Argerich, Buenos Aires, Argentina
| | - Haris M Haqqani
- University of Queensland, The Prince Charles Hospital, Chermside, Australia
| | - G Neal Kay
- University of Alabama at Birmingham, Birmingham, Alabama
| | | | | | - John M Miller
- Indiana University School of Medicine, Krannert Institute of Cardiology, Indianapolis, Indiana
| | | | - Akash R Patel
- University of California San Francisco Benioff Children's Hospital, San Francisco, California
| | | | | | | | - John L Sapp
- Queen Elizabeth II Health Sciences Centre, Halifax, Canada
| | - Andrea Sarkozy
- University Hospital Antwerp, University of Antwerp, Antwerp, Belgium
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9
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Cronin EM, Bogun FM, Maury P, Peichl P, Chen M, Namboodiri N, Aguinaga L, Leite LR, Al-Khatib SM, Anter E, Berruezo A, Callans DJ, Chung MK, Cuculich P, d'Avila A, Deal BJ, Bella PD, Deneke T, Dickfeld TM, Hadid C, Haqqani HM, Kay GN, Latchamsetty R, Marchlinski F, Miller JM, Nogami A, Patel AR, Pathak RK, Saenz Morales LC, Santangeli P, Sapp JL, Sarkozy A, Soejima K, Stevenson WG, Tedrow UB, Tzou WS, Varma N, Zeppenfeld K. 2019 HRS/EHRA/APHRS/LAHRS expert consensus statement on catheter ablation of ventricular arrhythmias. J Interv Card Electrophysiol 2020; 59:145-298. [PMID: 31984466 PMCID: PMC7223859 DOI: 10.1007/s10840-019-00663-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Ventricular arrhythmias are an important cause of morbidity and mortality and come in a variety of forms, from single premature ventricular complexes to sustained ventricular tachycardia and fibrillation. Rapid developments have taken place over the past decade in our understanding of these arrhythmias and in our ability to diagnose and treat them. The field of catheter ablation has progressed with the development of new methods and tools, and with the publication of large clinical trials. Therefore, global cardiac electrophysiology professional societies undertook to outline recommendations and best practices for these procedures in a document that will update and replace the 2009 EHRA/HRS Expert Consensus on Catheter Ablation of Ventricular Arrhythmias. An expert writing group, after reviewing and discussing the literature, including a systematic review and meta-analysis published in conjunction with this document, and drawing on their own experience, drafted and voted on recommendations and summarized current knowledge and practice in the field. Each recommendation is presented in knowledge byte format and is accompanied by supportive text and references. Further sections provide a practical synopsis of the various techniques and of the specific ventricular arrhythmia sites and substrates encountered in the electrophysiology lab. The purpose of this document is to help electrophysiologists around the world to appropriately select patients for catheter ablation, to perform procedures in a safe and efficacious manner, and to provide follow-up and adjunctive care in order to obtain the best possible outcomes for patients with ventricular arrhythmias.
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Affiliation(s)
| | | | | | - Petr Peichl
- Institute for Clinical and Experimental Medicine, Prague, Czech Republic
| | - Minglong Chen
- Jiangsu Province Hospital, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Narayanan Namboodiri
- Sree Chitra Institute for Medical Sciences and Technology, Thiruvananthapuram, India
| | | | | | | | - Elad Anter
- Beth Israel Deaconess Medical Center, Boston, MA, USA
| | | | | | | | | | - Andre d'Avila
- Hospital Cardiologico SOS Cardio, Florianopolis, Brazil
| | - Barbara J Deal
- Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | | | | | | | - Claudio Hadid
- Hospital General de Agudos Cosme Argerich, Buenos Aires, Argentina
| | - Haris M Haqqani
- University of Queensland, The Prince Charles Hospital, Chermside, Australia
| | - G Neal Kay
- University of Alabama at Birmingham, Birmingham, AL, USA
| | | | | | - John M Miller
- Indiana University School of Medicine, Krannert Institute of Cardiology, Indianapolis, IN, USA
| | | | - Akash R Patel
- University of California San Francisco Benioff Children's Hospital, San Francisco, CA, USA
| | | | | | | | - John L Sapp
- Queen Elizabeth II Health Sciences Centre, Halifax, Canada
| | - Andrea Sarkozy
- University Hospital Antwerp, University of Antwerp, Antwerp, Belgium
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10
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Cronin EM, Bogun FM, Maury P, Peichl P, Chen M, Namboodiri N, Aguinaga L, Leite LR, Al-Khatib SM, Anter E, Berruezo A, Callans DJ, Chung MK, Cuculich P, d'Avila A, Deal BJ, Della Bella P, Deneke T, Dickfeld TM, Hadid C, Haqqani HM, Kay GN, Latchamsetty R, Marchlinski F, Miller JM, Nogami A, Patel AR, Pathak RK, Saenz Morales LC, Santangeli P, Sapp JL, Sarkozy A, Soejima K, Stevenson WG, Tedrow UB, Tzou WS, Varma N, Zeppenfeld K. 2019 HRS/EHRA/APHRS/LAHRS expert consensus statement on catheter ablation of ventricular arrhythmias. Heart Rhythm 2019; 17:e2-e154. [PMID: 31085023 PMCID: PMC8453449 DOI: 10.1016/j.hrthm.2019.03.002] [Citation(s) in RCA: 199] [Impact Index Per Article: 39.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2019] [Indexed: 01/10/2023]
Abstract
Ventricular arrhythmias are an important cause of morbidity and mortality and come in a variety of forms, from single premature ventricular complexes to sustained ventricular tachycardia and fibrillation. Rapid developments have taken place over the past decade in our understanding of these arrhythmias and in our ability to diagnose and treat them. The field of catheter ablation has progressed with the development of new methods and tools, and with the publication of large clinical trials. Therefore, global cardiac electrophysiology professional societies undertook to outline recommendations and best practices for these procedures in a document that will update and replace the 2009 EHRA/HRS Expert Consensus on Catheter Ablation of Ventricular Arrhythmias. An expert writing group, after reviewing and discussing the literature, including a systematic review and meta-analysis published in conjunction with this document, and drawing on their own experience, drafted and voted on recommendations and summarized current knowledge and practice in the field. Each recommendation is presented in knowledge byte format and is accompanied by supportive text and references. Further sections provide a practical synopsis of the various techniques and of the specific ventricular arrhythmia sites and substrates encountered in the electrophysiology lab. The purpose of this document is to help electrophysiologists around the world to appropriately select patients for catheter ablation, to perform procedures in a safe and efficacious manner, and to provide follow-up and adjunctive care in order to obtain the best possible outcomes for patients with ventricular arrhythmias.
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Affiliation(s)
| | | | | | - Petr Peichl
- Institute for Clinical and Experimental Medicine, Prague, Czech Republic
| | - Minglong Chen
- Jiangsu Province Hospital, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Narayanan Namboodiri
- Sree Chitra Institute for Medical Sciences and Technology, Thiruvananthapuram, India
| | | | | | | | - Elad Anter
- Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | | | | | | | | | - Andre d'Avila
- Hospital Cardiologico SOS Cardio, Florianopolis, Brazil
| | - Barbara J Deal
- Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | | | | | | | - Claudio Hadid
- Hospital General de Agudos Cosme Argerich, Buenos Aires, Argentina
| | - Haris M Haqqani
- University of Queensland, The Prince Charles Hospital, Chermside, Australia
| | - G Neal Kay
- University of Alabama at Birmingham, Birmingham, Alabama
| | | | | | - John M Miller
- Indiana University School of Medicine, Krannert Institute of Cardiology, Indianapolis, Indiana
| | | | - Akash R Patel
- University of California San Francisco Benioff Children's Hospital, San Francisco, California
| | | | | | | | - John L Sapp
- Queen Elizabeth II Health Sciences Centre, Halifax, Canada
| | - Andrea Sarkozy
- University Hospital Antwerp, University of Antwerp, Antwerp, Belgium
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11
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Johner N, Shah DC, Jousset F, Dall’Aglio PB, Namdar M. Electrophysiological and Anatomical Correlates of Sites With Postpacing Intervals Shorter Than Tachycardia Cycle Length in Atypical Atrial Flutter. Circ Arrhythm Electrophysiol 2019; 12:e006955. [DOI: 10.1161/circep.118.006955] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Nicolas Johner
- Cardiology Division, University Hospitals of Geneva (N.J., D.C.S., P.B.D., M.N.)
| | - Dipen C. Shah
- Cardiology Division, University Hospitals of Geneva (N.J., D.C.S., P.B.D., M.N.)
| | - Florian Jousset
- Boston Scientific, Rhythm Management, Solothurn, Switzerland (F.J.)
| | | | - Mehdi Namdar
- Cardiology Division, University Hospitals of Geneva (N.J., D.C.S., P.B.D., M.N.)
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12
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Tung R. Challenges and Pitfalls of Entrainment Mapping of Ventricular Tachycardia: Ten Illustrative Concepts. Circ Arrhythm Electrophysiol 2019; 10:CIRCEP.116.004560. [PMID: 28408650 DOI: 10.1161/circep.116.004560] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2016] [Accepted: 02/28/2017] [Indexed: 11/16/2022]
Affiliation(s)
- Roderick Tung
- From the Center for Arrhythmia Care and Heart and Vascular Center, Pritzker School of Medicine, University of Chicago Medicine, IL.
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13
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Martin CA, Martin R, Gajendragadkar PR, Maury P, Takigawa M, Cheniti G, Frontera A, Kitamura T, Duchateau J, Vlachos K, Bourier F, Lam A, Lord S, Murray S, Shephard E, Pambrun T, Denis A, Derval N, Hocini M, Haissaguerre M, Jais P, Sacher F. First clinical use of novel ablation catheter incorporating local impedance data. J Cardiovasc Electrophysiol 2018; 29:1197-1206. [PMID: 29858882 DOI: 10.1111/jce.13654] [Citation(s) in RCA: 54] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2018] [Revised: 05/02/2018] [Accepted: 05/15/2018] [Indexed: 12/31/2022]
Abstract
INTRODUCTION Successful catheter ablation is limited by both poor spatial resolution of abnormal local signals and inability to deliver an effective lesion due to poor tissue contact. We report first worldwide use of the Intellanav MiFi OI catheter (Boston Scientific), providing ultra-high density mapping and incorporating a "DirectSense" algorithm to measure local tissue impedance (LI). METHODS AND RESULTS 31 patients (65±6 years, 20 male) underwent ablation. LI from the catheter, generator impedance (GI) and maximum electrogram amplitude were recorded in the blood pool, and in regions from healthy to dense scar before, during and after ablation. The catheter demonstrated clear nearfield signal where standard bipolar recordings included farfield signal. LI was lower in dense scar than either healthy tissue or blood pool, and demonstrated an exponential relationship with maximum electrogram amplitude. Maximum LI drop on ablation linearly correlated with initial LI. The median LI drop for successful lesions, resulting in lack of local tissue capture, was 16.0Ω (12.1-19.8 Ω) for LV and 14.6 Ω (10.0-18.3 Ω) for LA, which was larger than for unsuccessful lesions (LV: 9.4 Ω [5.4-15.6 Ω] P = 0.001; LA: 6.8 Ω [4.7-13.0 Ω], P = 0.049). LI percentage drop was also significantly larger for successful than unsuccessful lesions (LV: 17.1 Ω [14.0-19.6 Ω] vs. 10.6 Ω (7.1-16.5 Ω) P = 0.002; LA: 14.2 Ω [10.8-19.5 Ω] vs. 7.5Ω [5.1-11.0 Ω], P = 0.005). CONCLUSION This novel catheter gives reproducible recordings of local impedance, which are dependent on scar level. Absolute LI drop, and also percentage drop, on ablation may give an indication of tissue contact and subsequent effective lesion formation.
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Affiliation(s)
- Claire A Martin
- LIRYC/Hopital du Haut Leveque, Bordeaux, France.,Papworth Hospital NHS Foundation Trust, Cambridge, UK.,Barts Heart Centre, London, UK
| | - Ruairidh Martin
- LIRYC/Hopital du Haut Leveque, Bordeaux, France.,Freeman Hospital, Newcastle Upon Tyne, UK
| | | | | | | | | | | | | | | | | | | | - Anna Lam
- LIRYC/Hopital du Haut Leveque, Bordeaux, France
| | | | | | | | | | | | | | | | | | - Pierre Jais
- LIRYC/Hopital du Haut Leveque, Bordeaux, France
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14
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Schaeffer B, Stevenson WG. Entrainment mapping: Theoretical considerations and practical implementation. J Cardiovasc Electrophysiol 2017; 29:204-213. [DOI: 10.1111/jce.13348] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2017] [Revised: 09/18/2017] [Accepted: 09/19/2017] [Indexed: 10/18/2022]
Affiliation(s)
- Benjamin Schaeffer
- Cardiovascular Division, Department of Medicine; Brigham and Women's Hospital; Boston MA USA
| | - William G. Stevenson
- Cardiovascular Division, Department of Medicine; Brigham and Women's Hospital; Boston MA USA
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15
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Abstract
Mapping during ventricular tachycardia (VT) aims to elucidate mechanism, describe myocardial propagation, and identify the origin and critical regions of VT that can be targeted for ablation, most commonly with radiofrequency ablation. Most VTs in structural heart disease are due to macro-reentry in and around scar. A combination of mapping techniques, including mapping to identify the arrhythmia substrate, activation sequence mapping, pace-mapping, and entrainment mapping, may be used to identify putative ablation targets. This review describes the principles of entrainment mapping as it pertains to catheter ablation of scar-related VT.
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Affiliation(s)
- Saurabh Kumar
- Arrhythmia Service, Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA 02115, USA
| | - Usha B Tedrow
- Arrhythmia Service, Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA 02115, USA
| | - William G Stevenson
- Arrhythmia Service, Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA 02115, USA.
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16
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Beaser AD, Chua KC, Upadhyay GA, Tung R. Entrainment of ventricular tachycardia: Is the pacing site in or out? Heart Rhythm 2016; 13:2399-2400. [DOI: 10.1016/j.hrthm.2016.08.016] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2016] [Indexed: 11/26/2022]
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17
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Kaneko Y, Kato ‘R, Nakahara S, Tobiume T, Morishima I, Tanaka K, Nakajima T, Irie T, Kusano KF, Kamakura S, Nagase T, Takayanagi K, Matsumoto K, Kurabayashi M. Characteristics and Catheter Ablation of Focal Atrial Tachycardia Originating From the Interatrial Septum. Heart Lung Circ 2015; 24:988-95. [DOI: 10.1016/j.hlc.2015.03.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2014] [Revised: 02/20/2015] [Accepted: 03/05/2015] [Indexed: 10/23/2022]
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18
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Asirvatham SJ, Stevenson WG. Lockstep. Circ Arrhythm Electrophysiol 2015; 8:1289-90. [DOI: 10.1161/circep.115.003224] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Samuel J. Asirvatham
- From the Division of Cardiovascular Diseases, Department of Medicine—Department of Pediatrics and Adolescent Medicine, Mayo Clinic, Rochester, MN (S.J.A.); and Cardiovascular Division, Brigham and Women’s Hospital Boston (W.G.S.)
| | - William G. Stevenson
- From the Division of Cardiovascular Diseases, Department of Medicine—Department of Pediatrics and Adolescent Medicine, Mayo Clinic, Rochester, MN (S.J.A.); and Cardiovascular Division, Brigham and Women’s Hospital Boston (W.G.S.)
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19
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Asirvatham SJ, Stevenson WG. Editor's perspective: Reentry, pseudo-reentry, and pseudo-pseudo-reentry. Circ Arrhythm Electrophysiol 2014; 7:557-8. [PMID: 24951574 DOI: 10.1161/circep.114.001675] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Samuel J Asirvatham
- From the Division of Cardiovascular Diseases, Department of Internal Medicine and Division of Pediatric Cardiology, Department of Pediatrics and Adolescent Medicine, Mayo Clinic, Rochester, MN (S.J.A.); and Department of Medicine, Cardiovascular Division, Brigham and Women's Hospital, Boston, MA (W.G.S.).
| | - William G Stevenson
- From the Division of Cardiovascular Diseases, Department of Internal Medicine and Division of Pediatric Cardiology, Department of Pediatrics and Adolescent Medicine, Mayo Clinic, Rochester, MN (S.J.A.); and Department of Medicine, Cardiovascular Division, Brigham and Women's Hospital, Boston, MA (W.G.S.)
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20
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Derejko P, Podziemski P, Zebrowski JJ, Walczak F, Szumowski LJ. Effect of the restitution properties of cardiac tissue on the repeatability of entrainment mapping response. Circ Arrhythm Electrophysiol 2014; 7:497-504. [PMID: 24771542 DOI: 10.1161/circep.113.001032] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND The difference between the postpacing interval (PPI) and the tachycardia cycle length (TCL; PPI-TCL) is a useful tool in mapping macro-reentrant tachycardias. However, entrainment pacing causes some perturbation of the conduction velocity within the tachycardia circuit, which may affect the repeatability and consequently the accuracy of the measurement of PPI-TCL. The aim of this study was to assess PPI-TCL repeatability both in vivo and in silico. METHODS AND RESULTS In the experimental part, entrainment pacing was performed twice at each of the 124 tested sites for 30 patients undergoing radiofrequency ablation of atrial and ventricular re-entrant arrhythmias. A similar protocol was used in a simplified computer model of the cardiac tachycardia circuit in a 2-dimensional tissue strip using a Fenton-Karma model of cardiac tissue. In vivo, in the case of fast tachycardias (<350 ms), PPI-TCL variability observed was doubled compared with slow tachycardias (>350 ms; 95% Limits of Agreement ranged from -21.4 to 21.6 ms for TCL<350 ms and from -10.8 to 11.5 ms for TCL>350 ms). Simulations show that this increase of variability may be because of the oscillations of the conduction velocity inside the tachycardia circuits. The effect of the restitution properties of cardiac tissue on the outcome of entrainment pacing is discussed. CONCLUSIONS PPI-TCL is characterized by a high repeatability with the differences between the results for individual stimulations of ≤20 ms. The variability of this parameter is significantly lower in the case of slow tachycardias.
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Affiliation(s)
- Paweł Derejko
- From the Cardiac Arrhythmias Department, Institute of Cardiology, Warsaw, Poland (P.D., F.W., L.J.S.); and Faculty of Physics, Warsaw University of Technology, Poland (P.P., J.J.Z.)
| | - Piotr Podziemski
- From the Cardiac Arrhythmias Department, Institute of Cardiology, Warsaw, Poland (P.D., F.W., L.J.S.); and Faculty of Physics, Warsaw University of Technology, Poland (P.P., J.J.Z.).
| | - Jan Jacek Zebrowski
- From the Cardiac Arrhythmias Department, Institute of Cardiology, Warsaw, Poland (P.D., F.W., L.J.S.); and Faculty of Physics, Warsaw University of Technology, Poland (P.P., J.J.Z.)
| | - Franciszek Walczak
- From the Cardiac Arrhythmias Department, Institute of Cardiology, Warsaw, Poland (P.D., F.W., L.J.S.); and Faculty of Physics, Warsaw University of Technology, Poland (P.P., J.J.Z.)
| | - Lukasz Jan Szumowski
- From the Cardiac Arrhythmias Department, Institute of Cardiology, Warsaw, Poland (P.D., F.W., L.J.S.); and Faculty of Physics, Warsaw University of Technology, Poland (P.P., J.J.Z.)
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21
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Maruyama M, Yamamoto T, Abe J, Yodogawa K, Seino Y, Atarashi H, Shimizu W. Number needed to entrain: a new criterion for entrainment mapping in patients with intra-atrial reentrant tachycardia. Circ Arrhythm Electrophysiol 2014; 7:490-6. [PMID: 24762806 DOI: 10.1161/circep.113.001416] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Measuring postpacing intervals (PPIs) is the standard maneuver for localizing reentrant tachycardia circuits. However, changes or termination of the tachycardia during entrainment pacing, or difficulties in defining the correct local activity, limit the use of PPIs. METHODS AND RESULTS We hypothesized that the number of pacing stimuli needed to entrain (NNE) was useful for mapping intra-atrial reentrant tachycardias. First, 10 patients with typical atrial flutter were studied to characterize the NNE. Next, 317 entrainment attempts in 30 patients with 76 intra-atrial reentrant tachycardias were analyzed to determine the efficacy of the NNE. The NNE was small at sites within the reentrant circuit (median 2) and large at remote sites during typical atrial flutter. The NNE depended on the pacing cycle length and coupling interval of the initial paced beat, where the NNE became smaller at shorter pacing cycle lengths and coupling intervals. The NNE highly correlated with the difference between the PPI and tachycardia cycle length (r = 0.906; P<0.001). When the pacing cycle length and coupling interval were 16 to 30 ms below the tachycardia cycle length, a NNE ≤2 and >3 predicted a PPI-tachycardia cycle length ≤20 and >20 ms, respectively, with 100% accuracy. Thirty-six (11%) entrainment attempts changed or terminated intra-atrial reentrant tachycardia. Importantly, the NNE remained valid in those cases. Furthermore, the NNE provided additional information in cases with some difficulties with PPI measurements. CONCLUSIONS The NNE is a simple and reliable criterion, which facilitates mapping intra-atrial reentrant tachycardia. CLINICAL TRIAL REGISTRATION URL http://www.clinicaltrials.gov. Unique identifier: NCT001747.
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Affiliation(s)
- Mitsunori Maruyama
- From the Cardiovascular Center, Chiba-Hokusoh Hospital (M.M., T.Y., J.A., Y.S.) and Department of Cardiovascular Medicine (K.Y., W.S.), Nippon Medical School, Tokyo, Japan; and Tama-Nagayama Hospital & Nippon Medical School, Tokyo, Japan (H.A.).
| | - Teppei Yamamoto
- From the Cardiovascular Center, Chiba-Hokusoh Hospital (M.M., T.Y., J.A., Y.S.) and Department of Cardiovascular Medicine (K.Y., W.S.), Nippon Medical School, Tokyo, Japan; and Tama-Nagayama Hospital & Nippon Medical School, Tokyo, Japan (H.A.)
| | - Junko Abe
- From the Cardiovascular Center, Chiba-Hokusoh Hospital (M.M., T.Y., J.A., Y.S.) and Department of Cardiovascular Medicine (K.Y., W.S.), Nippon Medical School, Tokyo, Japan; and Tama-Nagayama Hospital & Nippon Medical School, Tokyo, Japan (H.A.)
| | - Kenji Yodogawa
- From the Cardiovascular Center, Chiba-Hokusoh Hospital (M.M., T.Y., J.A., Y.S.) and Department of Cardiovascular Medicine (K.Y., W.S.), Nippon Medical School, Tokyo, Japan; and Tama-Nagayama Hospital & Nippon Medical School, Tokyo, Japan (H.A.)
| | - Yoshihiko Seino
- From the Cardiovascular Center, Chiba-Hokusoh Hospital (M.M., T.Y., J.A., Y.S.) and Department of Cardiovascular Medicine (K.Y., W.S.), Nippon Medical School, Tokyo, Japan; and Tama-Nagayama Hospital & Nippon Medical School, Tokyo, Japan (H.A.)
| | - Hirotsugu Atarashi
- From the Cardiovascular Center, Chiba-Hokusoh Hospital (M.M., T.Y., J.A., Y.S.) and Department of Cardiovascular Medicine (K.Y., W.S.), Nippon Medical School, Tokyo, Japan; and Tama-Nagayama Hospital & Nippon Medical School, Tokyo, Japan (H.A.)
| | - Wataru Shimizu
- From the Cardiovascular Center, Chiba-Hokusoh Hospital (M.M., T.Y., J.A., Y.S.) and Department of Cardiovascular Medicine (K.Y., W.S.), Nippon Medical School, Tokyo, Japan; and Tama-Nagayama Hospital & Nippon Medical School, Tokyo, Japan (H.A.)
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22
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Tung R, Shivkumar K. Unusual response to entrainment of ventricular tachycardia: In or out? Heart Rhythm 2014; 11:725-7. [DOI: 10.1016/j.hrthm.2013.09.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2013] [Indexed: 11/25/2022]
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23
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Betensky BP, Kapa S, Desjardins B, Garcia FC, Callans DJ, Dixit S, Frankel DS, Hutchinson MD, Supple GE, Zado ES, Marchlinski FE. Characterization of Trans-septal Activation During Septal Pacing. Circ Arrhythm Electrophysiol 2013; 6:1123-30. [DOI: 10.1161/circep.113.000682] [Citation(s) in RCA: 51] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
Background—
Identification of intramural basal-septal ventricular tachycardia (VT) substrate is challenging in nonischemic cardiomyopathy. We sought to (1) characterize normal/abnormal trans-septal right ventricular (RV) to left ventricular activation; (2) assess the effect of opposite RV pacing on left ventricular septal bipolar electrograms (EGMs); and (3) establish criteria for the identification of intramural septal VT substrate.
Methods and Results—
Endocardial activation mapping and local EGM assessment of the left interventricular septum was performed during RV basal septal pacing in 40 patients undergoing VT ablation with no evidence of septal scar (group 1, n=14) and with septal scar (group 2, n=26) defined by low septal unipolar voltage (<8.3 mV) and delayed enhancement on cardiac MRI with/without abnormal bipolar voltage (<1.5 mV) in sinus rhythm. Left ventricular trans-septal activation time was prolonged in Group 2 compared with Group 1 (55.3±33.0 versus 25.7±8.8 ms;
P
=0.003). In 6 group 2 patients, left ventricular septal breakthrough was displaced to the scar border. During RV pacing, group 2 had fractionated (8.8%), late (2.8%), and split (5.7%) EGMs not seen in group 1. Trans-septal activation >40 ms (sensitivity 60%, specificity 100%;
P
<0.001) and EGM duration >95 ms during pacing (sensitivity 22%, specificity 91%;
P
<0.001) identified septal scar (13/26 pts).
Conclusions—
In patients with nonischemic cardiomyopathy, VT and septal scar, delayed transmural conduction time (>40 ms) and fractionated, late, split, and wide (>95 ms) bipolar EGMs during RV basal pacing identify intramural VT substrate. In select cases, the basal septum appears compartmentalized as the stimulated wavefront is rerouted to the scar border.
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Affiliation(s)
- Brian P. Betensky
- From the Division of Cardiac Electrophysiology (B.P.B., S.K., F.C.G., D.J.C., S.D., D.S.F., M.D.H., G.E.S., E.S.Z., F.E.M.) and Department of Radiology (B.D.), Hospital of the University of Pennsylvania, Philadelphia
| | - Suraj Kapa
- From the Division of Cardiac Electrophysiology (B.P.B., S.K., F.C.G., D.J.C., S.D., D.S.F., M.D.H., G.E.S., E.S.Z., F.E.M.) and Department of Radiology (B.D.), Hospital of the University of Pennsylvania, Philadelphia
| | - Benoit Desjardins
- From the Division of Cardiac Electrophysiology (B.P.B., S.K., F.C.G., D.J.C., S.D., D.S.F., M.D.H., G.E.S., E.S.Z., F.E.M.) and Department of Radiology (B.D.), Hospital of the University of Pennsylvania, Philadelphia
| | - Fermin C. Garcia
- From the Division of Cardiac Electrophysiology (B.P.B., S.K., F.C.G., D.J.C., S.D., D.S.F., M.D.H., G.E.S., E.S.Z., F.E.M.) and Department of Radiology (B.D.), Hospital of the University of Pennsylvania, Philadelphia
| | - David J. Callans
- From the Division of Cardiac Electrophysiology (B.P.B., S.K., F.C.G., D.J.C., S.D., D.S.F., M.D.H., G.E.S., E.S.Z., F.E.M.) and Department of Radiology (B.D.), Hospital of the University of Pennsylvania, Philadelphia
| | - Sanjay Dixit
- From the Division of Cardiac Electrophysiology (B.P.B., S.K., F.C.G., D.J.C., S.D., D.S.F., M.D.H., G.E.S., E.S.Z., F.E.M.) and Department of Radiology (B.D.), Hospital of the University of Pennsylvania, Philadelphia
| | - David S. Frankel
- From the Division of Cardiac Electrophysiology (B.P.B., S.K., F.C.G., D.J.C., S.D., D.S.F., M.D.H., G.E.S., E.S.Z., F.E.M.) and Department of Radiology (B.D.), Hospital of the University of Pennsylvania, Philadelphia
| | - Mathew D. Hutchinson
- From the Division of Cardiac Electrophysiology (B.P.B., S.K., F.C.G., D.J.C., S.D., D.S.F., M.D.H., G.E.S., E.S.Z., F.E.M.) and Department of Radiology (B.D.), Hospital of the University of Pennsylvania, Philadelphia
| | - Gregory E. Supple
- From the Division of Cardiac Electrophysiology (B.P.B., S.K., F.C.G., D.J.C., S.D., D.S.F., M.D.H., G.E.S., E.S.Z., F.E.M.) and Department of Radiology (B.D.), Hospital of the University of Pennsylvania, Philadelphia
| | - Erica S. Zado
- From the Division of Cardiac Electrophysiology (B.P.B., S.K., F.C.G., D.J.C., S.D., D.S.F., M.D.H., G.E.S., E.S.Z., F.E.M.) and Department of Radiology (B.D.), Hospital of the University of Pennsylvania, Philadelphia
| | - Francis E. Marchlinski
- From the Division of Cardiac Electrophysiology (B.P.B., S.K., F.C.G., D.J.C., S.D., D.S.F., M.D.H., G.E.S., E.S.Z., F.E.M.) and Department of Radiology (B.D.), Hospital of the University of Pennsylvania, Philadelphia
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24
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Pseudo-postpacing interval of diastolic potential after entrainment pacing of remote bystander pathway in reentrant ventricular tachycardia. Heart Vessels 2013; 29:703-8. [PMID: 24062184 PMCID: PMC4160568 DOI: 10.1007/s00380-013-0411-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2013] [Accepted: 09/06/2013] [Indexed: 11/07/2022]
Abstract
After entrainment pacing, the postpacing interval of a diastolic potential may be misinterpreted if the distal tip of the ablation catheter captures a remote bystander pathway adjacent to the critical isthmus of a complex reentrant circuit in a structurally diseased heart. We discuss this possible pitfall of entrainment mapping of reentrant ventricular tachycardia, observed after a healed myocardial infarction.
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25
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KAPA SURAJ, HUTCHINSON MATHEWD. Bipolar Mapping, Revisited Or: These Aren't the Electrograms You're Looking For. J Cardiovasc Electrophysiol 2013; 24:655-7. [DOI: 10.1111/jce.12118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- SURAJ KAPA
- Division of Cardiology, Department of Medicine, Perelman School of Medicine; University of Pennsylvania; Philadelphia Pennsylvania USA
| | - MATHEW D. HUTCHINSON
- Division of Cardiology, Department of Medicine, Perelman School of Medicine; University of Pennsylvania; Philadelphia Pennsylvania USA
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26
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Kaneko Y, Nakajima T, Irie T, Ota M, Iijima T, Tamura M, Iizuka T, Tamura S, Kurabayashi M. Mechanism of shorter postpacing interval than the tachycardia cycle after high-output entrainment pacing of atrial flutter. J Cardiovasc Electrophysiol 2013; 24:936-8. [PMID: 23574046 DOI: 10.1111/jce.12133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Yoshiaki Kaneko
- Department of Medicine and Biological Science, Gunma University Graduate School of Medicine, Maebashi, Gunma, Japan.
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27
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TZOU WENDYS, NGUYEN DUYT, ALEONG RYANG, VAROSY PAULD, KATZ DAVIDF, HEATH RUSSELLR, SCHULLER JOSEPHL, LOWERY CHRISTOPHERM, LEWKOWIEZ LAURENT, SAUER WILLIAMH. Endocardial Electrogram Characteristics of Epicardial Ventricular Arrhythmias. J Cardiovasc Electrophysiol 2013; 24:649-54. [DOI: 10.1111/jce.12096] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2012] [Revised: 12/19/2012] [Accepted: 01/02/2013] [Indexed: 11/28/2022]
Affiliation(s)
- WENDY S. TZOU
- Section of Cardiac Electrophysiology; University of Colorado School of Medicine; Aurora Colorado USA
| | - DUY T. NGUYEN
- Section of Cardiac Electrophysiology; University of Colorado School of Medicine; Aurora Colorado USA
| | - RYAN G. ALEONG
- Section of Cardiac Electrophysiology; University of Colorado School of Medicine; Aurora Colorado USA
| | - PAUL D. VAROSY
- Section of Cardiac Electrophysiology; University of Colorado School of Medicine; Aurora Colorado USA
| | - DAVID F. KATZ
- Section of Cardiac Electrophysiology; University of Colorado School of Medicine; Aurora Colorado USA
| | - RUSSELL R. HEATH
- Section of Cardiac Electrophysiology; University of Colorado School of Medicine; Aurora Colorado USA
| | - JOSEPH L. SCHULLER
- Section of Cardiac Electrophysiology; University of Colorado School of Medicine; Aurora Colorado USA
| | - CHRISTOPHER M. LOWERY
- Section of Cardiac Electrophysiology; University of Colorado School of Medicine; Aurora Colorado USA
| | - LAURENT LEWKOWIEZ
- Section of Cardiac Electrophysiology; University of Colorado School of Medicine; Aurora Colorado USA
| | - WILLIAM H. SAUER
- Section of Cardiac Electrophysiology; University of Colorado School of Medicine; Aurora Colorado USA
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28
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ALMENDRAL JESÚS. Resetting and Entrainment of Reentrant Arrhythmias: Part II: Informative Content and Practical Use of These Responses. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2013; 36:641-61. [DOI: 10.1111/pace.12075] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/18/2012] [Accepted: 11/24/2012] [Indexed: 11/27/2022]
Affiliation(s)
- JESÚS ALMENDRAL
- From the Cardiac Arrhythmia Unit; Grupo Hospital de Madrid; Universidad CEU-San Pablo; Madrid; Spain
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29
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Wong KC, Rajappan K, Bashir Y, Betts TR. Entrainment With Long Postpacing Intervals From Within the Flutter Circuit. Circ Arrhythm Electrophysiol 2012; 5:e90-1; discussion e92. [DOI: 10.1161/circep.111.969030] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Kelvin C.K. Wong
- From the Oxford Heart Centre, Oxford University Hospitals NHS Trust, Oxford, United Kingdom
| | - Kim Rajappan
- From the Oxford Heart Centre, Oxford University Hospitals NHS Trust, Oxford, United Kingdom
| | - Yaver Bashir
- From the Oxford Heart Centre, Oxford University Hospitals NHS Trust, Oxford, United Kingdom
| | - Timothy R. Betts
- From the Oxford Heart Centre, Oxford University Hospitals NHS Trust, Oxford, United Kingdom
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Sy RW, Thiagalingam A, Stiles MK. Modern Electrophysiology Mapping Techniques. Heart Lung Circ 2012; 21:364-75. [DOI: 10.1016/j.hlc.2012.04.007] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2011] [Revised: 04/05/2012] [Accepted: 04/14/2012] [Indexed: 11/26/2022]
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Park RE, Saghy L, Zado ES, Tschabrunn CM, Marchlinski FE. Influence of left ventricular hypertrophy on scar identification during bipolar voltage mapping. J Interv Card Electrophysiol 2011; 34:45-50. [PMID: 22170283 DOI: 10.1007/s10840-011-9642-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2011] [Accepted: 11/09/2011] [Indexed: 11/24/2022]
Abstract
PURPOSE Bipolar endocardial signal amplitude (BESA) <1.5 mV defines scar in the left ventricle (LV). It is not known if LV hypertrophy (LVH) increases overall bipolar signal amplitude and if scar identification with LVH requires a higher voltage cutoff. METHODS We compared the LV BESA of four patients with moderate LVH on echo (≥1.6 cm) to that of ten consecutive patients with no LVH with both groups having normal systolic function and no scar. Additionally, in 12 patients with ischemic scar (ICM) and moderate LVH (≥1.6 cm), we assessed scar area and percent abnormal electrograms (width >80 ms and/or split/fractionated) using 1.5 and 2.5 mV defined border zone cutoff values and compared results to those from 12 ICM patients with no LVH matched for age, sex, scar distribution, and LV ejection fraction. RESULTS Average BESA in the setting of normal systolic function/no scar was comparable in patients with (4.7 ± 3.0 mV, 95% signals >1.58 mV) and those without LVH (4.9 ± 1.6 mV, 95% signals >1.62 mV). In patients with ICM and LVH versus without LVH, there was a smaller area of dense scar <0.5 mV/total scar (15% versus 23%, p = 0.03) but no significant difference in the size of the border zone, or percentage of abnormal electrograms identified within border zones defined by either the 0.5-1.5 mV or 0.5-2.5 mV cutoff values. CONCLUSIONS Patients with and without LVH with normal systolic function show similar LV endocardial bipolar signal characteristics. Modifying the bipolar amplitude cutoff at the infarct border zone did not increase overall scar size in patients with versus those without LVH. A 1.5 mV-bipolar voltage cutoff used for scar definition seems appropriate even in patients with marked LVH.
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Affiliation(s)
- Robert E Park
- Electrophysiology Section, Cardiovascular Division, Department of Medicine, Hospital of the University of Pennsylvania, University of Pennsylvania School of Medicine, Philadelphia, PA, USA
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KANEKO YOSHIAKI, NAKAJIMA TADASHI, IRIE TADANOBU, KATO TOSHIMITSU, IIJIMA TAKAFUMI, KURABAYASHI MASAHIKO. Putative Mechanism of a Postpacing Interval Paradoxically Shorter Than the Tachycardia Cycle Length. J Cardiovasc Electrophysiol 2011; 23:666-8. [DOI: 10.1111/j.1540-8167.2011.02147.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Abstract
An electroanatomical mapping system is a useful tool for complex arrhythmia ablation. The system reconstructs the precise 3-dimensional chamber of interest with electrical and anatomical information. There are several technical aspects that physicians should be aware of to maximize its efficacy. This review provides relevant information on troubleshooting of the mapping system.
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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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Tung R, Shivkumar K. Ripple mapping: making electroanatomic mapping user-friendly. Heart Rhythm 2009; 6:1763-4. [PMID: 19959126 DOI: 10.1016/j.hrthm.2009.10.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2009] [Indexed: 10/20/2022]
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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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Raymond JM, Sacher F, Winslow R, Tedrow U, Stevenson WG. Catheter Ablation for Scar-related Ventricular Tachycardias. Curr Probl Cardiol 2009; 34:225-70. [DOI: 10.1016/j.cpcardiol.2009.01.002] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Sacher F, Tedrow UB, Field ME, Raymond JM, Koplan BA, Epstein LM, Stevenson WG. Ventricular Tachycardia Ablation. Circ Arrhythm Electrophysiol 2008; 1:153-61. [PMID: 19808409 DOI: 10.1161/circep.108.769471] [Citation(s) in RCA: 148] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Frédéric Sacher
- From Brigham and Women’s Hospital, Harvard Medical School, Boston, Mass
| | - Usha B. Tedrow
- From Brigham and Women’s Hospital, Harvard Medical School, Boston, Mass
| | - Michael E. Field
- From Brigham and Women’s Hospital, Harvard Medical School, Boston, Mass
| | - Jean-Marc Raymond
- From Brigham and Women’s Hospital, Harvard Medical School, Boston, Mass
| | - Bruce A. Koplan
- From Brigham and Women’s Hospital, Harvard Medical School, Boston, Mass
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ZEPPENFELD KATJA, STEVENSON WILLIAMG. Ablation of Ventricular Tachycardia in Patients with Structural Heart Disease. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2008; 31:358-74. [DOI: 10.1111/j.1540-8159.2008.00999.x] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Miyazaki H, Stevenson WG, Stephenson K, Soejima K, Epstein LM. Entrainment mapping for rapid distinction of left and right atrial tachycardias. Heart Rhythm 2006; 3:516-23. [PMID: 16648054 DOI: 10.1016/j.hrthm.2006.01.014] [Citation(s) in RCA: 51] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2005] [Accepted: 01/12/2006] [Indexed: 11/29/2022]
Abstract
BACKGROUND Distinguishing left from right atrial tachycardia is a critical step for guiding ablation. OBJECTIVES The purpose of this study was to develop and validate a simple algorithm predicting the location of macroreentrant atrial tachycardia (AT) circuits from limited entrainment mapping in right atrium (RA) and coronary sinus (CS). METHODS In 180 patients with organized reentrant AT, entrainment was performed at the high RA, proximal CS, and distal CS. The difference between the postpacing interval (PPI) and tachycardia cycle length (TCL) was calculated at each site. The location of the AT reentrant circuit was determined by mapping and ablation. An algorithm predicting AT regions was developed from 104 ATs in the first 90 patients (group I) and prospectively evaluated in a validation cohort of 106 ATs in the second 90 patients (group II). RESULTS In group I, PPI-TCL difference <50 or >50 ms at the high RA distinguished RA from LA reentrant circuits. For RA tachycardias, PPI-TCL difference at the proximal CS distinguished common flutter from lateral RA circuits. For LA circuits, PPI-TCL difference at the proximal and distal CS distinguished perimitral reentry from reentry involving the right pulmonary veins and septum. In group II, an algorithm based on PPI-TCL difference >50 or <50 ms at the high RA, proximal CS, or distal CS had sensitivity of 94%, specificity of 88%, and predictive accuracy of 93% for predicting the successful ablation region. CONCLUSION Limited entrainment from sites accessible from the RA can expeditiously suggest the AT location to guide more detailed mapping and potentially avoid unnecessary transseptal punctures in some patients.
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Affiliation(s)
- Hidekazu Miyazaki
- Cardiovascular Division, Department of Internal Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
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Bogun F, Kim HM, Han J, Tamirissa K, Tschopp D, Reich S, Elmouchi D, Igic P, Lemola K, Good E, Oral H, Chugh A, Pelosi F, Morady F. Comparison of mapping criteria for hemodynamically tolerated, postinfarction ventricular tachycardia. Heart Rhythm 2006; 3:20-6. [PMID: 16399047 DOI: 10.1016/j.hrthm.2005.09.014] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2005] [Accepted: 09/15/2005] [Indexed: 10/25/2022]
Abstract
BACKGROUND Mapping criteria for hemodynamically tolerated, postinfarction ventricular tachycardia (VT) have been evaluated in only small series of patients. OBJECTIVES The purpose of this study was to evaluate the utility of various mapping criteria for identifying a critical VT circuit isthmus in a post hoc analysis. METHODS Ninety VTs (cycle length 491 +/- 84 ms) were mapped in 48 patients with a prior myocardial infarction. The mapping catheter was positioned within a protected area of the reentrant circuit of the targeted VTs at 176 sites. All sites showed concealed entrainment. The predictive values of the following mapping criteria for a successful ablation site were compared: discrete isolated potential during VT, inability to dissociate the isolated potential from the VT, endocardial activation time >70 ms, matching electrogram-QRS and stimulus-QRS intervals, VT termination without global capture during pacing, stimulus-QRS/VT cycle length ratio <or=0.7, and postpacing interval. For each criterion, the receiver operating characteristic curve was constructed, and the area under the curve was calculated to assess the discriminatory value of the criterion. RESULTS Seventy-eight of 90 VTs (87%) were successfully ablated. The area under the receiver operating characteristic curve was largest (0.89) for matching stimulus-QRS and electrogram-QRS intervals. In combination with an isolated potential that could not be dissociated from the VT, the area under the receiver operating characteristic curve increased to 0.93. CONCLUSION At sites with concealed entrainment, matching stimulus-QRS and electrogram-QRS intervals were superior to other criteria in differentiating a critical isthmus from bystander or noncritical sites in postinfarction VT.
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Affiliation(s)
- Frank Bogun
- University of Michigan Medical Center, Ann Arbor, Michigan 48109-0366, USA.
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Abstract
The precise techniques employed in the electrophysiology laboratory influence the nature of the electrograms that are recorded during mapping procedures. Unipolar recordings that are minimally filtered can be useful for mapping focal arrhythmia sources, but have substantial far-field signal that can obscure low-amplitude signals of interest in abnormal regions. Bipolar recordings are standard in most laboratories because rejection of far-field signal facilitates identification of local potentials in abnormal areas, but the signal of interest can be beneath either recording electrode and far-field signals do occur. Simultaneously obtained unipolar recordings are a useful adjunct to bipolar recordings in some situations. High pass filtering and digital sampling also influence electrogram characteristics. High pass filtering of unipolar recordings can be useful to reduce far-field components, but limits inferences from electrogram morphology.
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Affiliation(s)
- William G Stevenson
- Cardiovascular Division, Brigham and Women's Hospital Boston, Massachusetts 02115, USA.
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Ikeguchi S, Peters NS. Novel use of postpacing interval mapping to guide radiofrequency ablation of focal atrial tachycardia with long intra-atrial conduction time. Heart Rhythm 2004; 1:88-93. [PMID: 15851124 DOI: 10.1016/j.hrthm.2004.02.016] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2003] [Accepted: 02/11/2004] [Indexed: 10/25/2022]
Abstract
If the intra-atrial conduction time of a focal tachycardia is prolonged and exceeds the tachycardia cycle length, isochronal electroanatomical maps may be confusing by not showing the classical centrifugal pattern of focal activation. In addressing the hypothesis that by mapping post pacing intervals (PPI), the shortest PPI (ideally identical to tachycardia cycle length) would clearly display the site of origin of a focal tachycardia; this technique was used successfully to identify the origin and ablate the atrial tachycardia of a patient with previously corrected Tetralogy of Fallot.
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