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Raja DC, Shroff J, Nair A, Abhilash SP, Tuan LQ, Mehta A, Abhayaratna WP, Sanders P, Frankel DS, Marchlinski FE, Pathak RK. Correlation of extent of left ventricular endocardial unipolar low-voltage zones with ventricular tachycardia in nonischemic cardiomyopathy. Heart Rhythm 2024; 21:1970-1977. [PMID: 38636932 DOI: 10.1016/j.hrthm.2024.04.065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2024] [Revised: 04/12/2024] [Accepted: 04/13/2024] [Indexed: 04/20/2024]
Abstract
BACKGROUND Endocardial electrogram (EGM) characteristics in nonischemic cardiomyopathy (NICM) have not been explored adequately for prognostication. OBJECTIVE We aimed to study correlation of bipolar and unipolar EGM characteristics with left ventricular ejection fraction (LVEF) and ventricular tachycardia (VT) in NICM. METHODS Electroanatomic mapping of the left ventricle was performed. EGM characteristics were correlated with LVEF. Differences between groups with and without VT and predictors of VT were studied. RESULTS In 43 patients, unipolar EGM variables had better correlation with baseline LVEF than bipolar EGM variables: unipolar voltage (r = +0.36), peak negative unipolar voltage (r = -0.42), peak positive unipolar voltage (r = +0.38), and percentage area of unipolar low-voltage zone (LVZ; r = -0.41). Global mean unipolar voltage (hazard ratio [HR], 0.4; 95% confidence interval [CI], 0.2-0.8), extent of unipolar LVZ (HR, 1.6; 95% CI, 1.1-2.3), and percentage area of unipolar LVZ (HR, 1.6; 95% CI, 1.1-2.3) were significant predictors of VT. For classification of patients with VT, extent of unipolar LVZ had an area under the curve of 0.82 (95% CI, 0.69-0.95; P < .001), and percentage area of unipolar LVZ had an area under the curve of 0.83 (95% CI, 0.71-0.96; P = .01). Cutoff of >3 segments for extent of unipolar LVZ had the best diagnostic accuracy (sensitivity, 90%; specificity, 67%) and cutoff of 33% for percentage area of unipolar LVZ had the best diagnostic accuracy (sensitivity, 95%; specificity, 60%) for VT. CONCLUSION In NICM, extent and percentage area of unipolar LVZs are significant predictors of VT. Cutoffs of >3 segments of unipolar LVZ and >33% area of unipolar LVZ have good diagnostic accuracies for association with VT.
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Affiliation(s)
- Deep Chandh Raja
- The Australian National University, Australian Capital Territory, Australia; Canberra Heart Rhythm Centre, Australian Capital Territory, Australia
| | - Jenish Shroff
- The Australian National University, Australian Capital Territory, Australia; Canberra Heart Rhythm Centre, Australian Capital Territory, Australia
| | - Anugrah Nair
- The Australian National University, Australian Capital Territory, Australia; Canberra Heart Rhythm Centre, Australian Capital Territory, Australia
| | - Sreevilasam P Abhilash
- The Australian National University, Australian Capital Territory, Australia; Canberra Heart Rhythm Centre, Australian Capital Territory, Australia
| | - Lukah Q Tuan
- The Australian National University, Australian Capital Territory, Australia; Canberra Heart Rhythm Centre, Australian Capital Territory, Australia
| | - Abhinav Mehta
- The Australian National University, Australian Capital Territory, Australia
| | | | - Prashanthan Sanders
- Center for Heart Rhythm Disorders, University of Adelaide and Royal Adelaide Hospital, Adelaide, Australia
| | - David S Frankel
- Section of Cardiac Electrophysiology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Francis E Marchlinski
- Section of Cardiac Electrophysiology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Rajeev Kumar Pathak
- The Australian National University, Australian Capital Territory, Australia; Canberra Heart Rhythm Centre, Australian Capital Territory, Australia.
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2
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Lin CY, Chung FP, Lin YJ, Chen YY, Chang SL, Lo LW, Hu YF, Liao JN, Tuan TC, Chao TF, Te ALD, Yamada S, Kuo L, Vicera JJB, Chang TY, Salim S, Huang TC, Liu CM, Wu CI, Chen SA. Dynamic unipolar voltage criteria of right ventricular septum for identifying left ventricular septal scar. J Interv Card Electrophysiol 2019; 57:353-359. [PMID: 30694424 DOI: 10.1007/s10840-019-00512-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2018] [Accepted: 01/15/2019] [Indexed: 11/27/2022]
Abstract
PURPOSE The right ventricular (RV) septal unipolar voltage (UV) for predicting left ventricular (LV) septal scar wall thickness (WT) remains to be elucidated. METHODS From 2013 to 2015, data obtained from RV and LV electroanatomic maps of 28 patients (mean age, 53 ± 16 years; 19 men [67.9%]) with/without identified LV septal scars were reviewed. Patients with an RV septal scar were excluded (n = 90). Direct measurement of septal WT was conducted (mean distance, 10.4 ± 3.3 mm). Patients in group 1 had a normal LV substrate, while those in group 2 had an LV septal scar. Fisher's linear discriminant formula was used to determine the dynamic UV criteria. RESULTS A total of 552 points were collected: 323 in 12 patients from group 1 and 229 in 16 patients from group 2. The UV of the RV septum is capable of identifying the opposite LV endocardial bipolar scar and is proportional to the WT of the interventricular septum. In the absence of an RV endocardial scar, the formula of "RV septal cut-off value = 0.736 × WT - 0.117 mV" has better sensitivity and specificity for predicting the LV septal scar (0.96 vs. 0.68 and 0.91 vs. 0.80, respectively) than the predefined fixed criteria of 8.3 mV with a net reclassification improvement of 25.7% (P < 0.001). CONCLUSIONS The combined measurement of UV and WT is more sensitive than the predefined fixed UV criteria for defining deep scars.
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Affiliation(s)
- Chin-Yu Lin
- Institute of Clinical Medicine, and Cardiovascular Research Center, National Yang-Ming University, Taipei, Taiwan.,Heart Rhythm Center, Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.,Department of Medicine, Taipei Veterans General Hospital, Yuan-Shan Branch, Yilan, Taiwan
| | - Fa-Po Chung
- Institute of Clinical Medicine, and Cardiovascular Research Center, National Yang-Ming University, Taipei, Taiwan.,Heart Rhythm Center, Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Yenn-Jiang Lin
- Institute of Clinical Medicine, and Cardiovascular Research Center, National Yang-Ming University, Taipei, Taiwan. .,Heart Rhythm Center, Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.
| | - Yun-Yu Chen
- Heart Rhythm Center, Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.,Institute of Epidemiology and Preventive Medicine College of Public Health, National Taiwan University, Taipei, Taiwan
| | - Shih-Lin Chang
- Institute of Clinical Medicine, and Cardiovascular Research Center, National Yang-Ming University, Taipei, Taiwan.,Heart Rhythm Center, Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Li-Wei Lo
- Institute of Clinical Medicine, and Cardiovascular Research Center, National Yang-Ming University, Taipei, Taiwan.,Heart Rhythm Center, Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Yu-Feng Hu
- Institute of Clinical Medicine, and Cardiovascular Research Center, National Yang-Ming University, Taipei, Taiwan.,Heart Rhythm Center, Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Jo-Nan Liao
- Institute of Clinical Medicine, and Cardiovascular Research Center, National Yang-Ming University, Taipei, Taiwan.,Heart Rhythm Center, Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Ta-Chuan Tuan
- Institute of Clinical Medicine, and Cardiovascular Research Center, National Yang-Ming University, Taipei, Taiwan.,Heart Rhythm Center, Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Tze-Fan Chao
- Institute of Clinical Medicine, and Cardiovascular Research Center, National Yang-Ming University, Taipei, Taiwan.,Heart Rhythm Center, Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Abigail Louise D Te
- Heart Rhythm Center, Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Shinya Yamada
- Heart Rhythm Center, Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Ling Kuo
- Institute of Clinical Medicine, and Cardiovascular Research Center, National Yang-Ming University, Taipei, Taiwan.,Heart Rhythm Center, Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Jennifer Jeanne B Vicera
- Heart Rhythm Center, Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Ting-Yung Chang
- Institute of Clinical Medicine, and Cardiovascular Research Center, National Yang-Ming University, Taipei, Taiwan.,Heart Rhythm Center, Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Simon Salim
- Heart Rhythm Center, Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Ting-Chung Huang
- Heart Rhythm Center, Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Chih-Min Liu
- Heart Rhythm Center, Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Cheng-I Wu
- Institute of Clinical Medicine, and Cardiovascular Research Center, National Yang-Ming University, Taipei, Taiwan.,Heart Rhythm Center, Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Shih-Ann Chen
- Institute of Clinical Medicine, and Cardiovascular Research Center, National Yang-Ming University, Taipei, Taiwan.,Heart Rhythm Center, Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
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3
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Chrispin J, Keramati AR, Assis FR, Misra S, Zghaib T, Berger RD, Calkins H, Tandri H. Correlation of right ventricular multielectrode endocardial unipolar mapping and epicardial scar. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2018; 41:345-352. [DOI: 10.1111/pace.13299] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/19/2017] [Revised: 12/05/2017] [Accepted: 12/10/2017] [Indexed: 11/28/2022]
Affiliation(s)
- Jonathan Chrispin
- Center of Excellence For Complex Inherited Arrhythmias, Division of Cardiology; Johns Hopkins University School of Medicine; Baltimore MD USA
| | - Ali R. Keramati
- Center of Excellence For Complex Inherited Arrhythmias, Division of Cardiology; Johns Hopkins University School of Medicine; Baltimore MD USA
| | - Fabrizio R. Assis
- Center of Excellence For Complex Inherited Arrhythmias, Division of Cardiology; Johns Hopkins University School of Medicine; Baltimore MD USA
| | - Satish Misra
- Center of Excellence For Complex Inherited Arrhythmias, Division of Cardiology; Johns Hopkins University School of Medicine; Baltimore MD USA
| | - Tarek Zghaib
- Center of Excellence For Complex Inherited Arrhythmias, Division of Cardiology; Johns Hopkins University School of Medicine; Baltimore MD USA
| | - Ronald D. Berger
- Center of Excellence For Complex Inherited Arrhythmias, Division of Cardiology; Johns Hopkins University School of Medicine; Baltimore MD USA
| | - Hugh Calkins
- Center of Excellence For Complex Inherited Arrhythmias, Division of Cardiology; Johns Hopkins University School of Medicine; Baltimore MD USA
| | - Harikrishna Tandri
- Center of Excellence For Complex Inherited Arrhythmias, Division of Cardiology; Johns Hopkins University School of Medicine; Baltimore MD USA
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4
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Chung FP, Lin CY, Lin YJ, Chang SL, Lo LW, Hu YF, Tuan TC, Chao TF, Liao JN, Chang TY, Chen SA. Catheter Ablation of Ventricular Tachycardia in Arrhythmogenic Right Ventricular Dysplasia/Cardiomyopathy. Korean Circ J 2018; 48:890-905. [PMID: 30238706 PMCID: PMC6158456 DOI: 10.4070/kcj.2018.0268] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2018] [Revised: 09/11/2018] [Accepted: 09/12/2018] [Indexed: 12/14/2022] Open
Abstract
Arrhythmogenic right ventricular dysplasia/cardiomyopathy (ARVD/C) is predominantly an inherited cardiomyopathy with typical histopathological characteristics of fibro-fatty infiltration mainly involving the right ventricular (RV) inflow tract, RV outflow tract, and RV apex in the majority of patients. The above pathologic evolution frequently brings patients with ARVD/C to medical attention owing to the manifestation of syncope, sudden cardiac death (SCD), ventricular arrhythmogenesis, or heart failure. To prevent future or recurrent SCD, an implantable cardiac defibrillator (ICD) is highly desirable in patients with ARVD/C who had experienced unexplained syncope, hemodynamically intolerable ventricular tachycardia (VT), ventricular fibrillation, and/or aborted SCD. Notably, the management of frequent ventricular tachyarrhythmias in ARVD/C is challenging, and the use of antiarrhythmic drugs could be unsatisfactory or limited by the unfavorable side effects. Therefore, radiofrequency catheter ablation (RFCA) has been implemented to treat the drug-refractory VT in ARVD/C for decades. However, the initial understanding of the link between fibro-fatty pathogenesis and ventricular arrhythmogenesis in ARVD/C is scarce, the efficacy and prognosis of endocardial RFCA alone were limited and disappointing. The electrophysiologists had broken through this frontier after better illustration of epicardial substrates and broadly application of epicardial approaches in ARVD/C. In recent works of literature, the application of epicardial ablation also successfully results in higher procedural success and decreases VT recurrences in patients with ARVD/C who are refractory to the endocardial approach during long-term follow-up. In this article, we review the important evolution on the delineation of arrhythmogenic substrates, ablation strategies, and ablation outcome of VT in patients with ARVD/C.
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Affiliation(s)
- Fa Po Chung
- Heart Rhythm Center, Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.,Institute of Clinical Medicine, Cardiovascular Research Center, National Yang-Ming University, Taipei, Taiwan
| | - Chin Yu Lin
- Heart Rhythm Center, Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.,Institute of Clinical Medicine, Cardiovascular Research Center, National Yang-Ming University, Taipei, Taiwan.,Department of Internal Medicine, Taipei Veterans General Hospital, Yuan-Shan Branch, I-LAN, Taiwan
| | - Yenn Jiang Lin
- Heart Rhythm Center, Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.,Institute of Clinical Medicine, Cardiovascular Research Center, National Yang-Ming University, Taipei, Taiwan
| | - Shih Lin Chang
- Heart Rhythm Center, Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.,Institute of Clinical Medicine, Cardiovascular Research Center, National Yang-Ming University, Taipei, Taiwan
| | - Li Wei Lo
- Heart Rhythm Center, Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.,Institute of Clinical Medicine, Cardiovascular Research Center, National Yang-Ming University, Taipei, Taiwan
| | - Yu Feng Hu
- Heart Rhythm Center, Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.,Institute of Clinical Medicine, Cardiovascular Research Center, National Yang-Ming University, Taipei, Taiwan
| | - Ta Chuan Tuan
- Heart Rhythm Center, Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.,Institute of Clinical Medicine, Cardiovascular Research Center, National Yang-Ming University, Taipei, Taiwan
| | - Tze Fan Chao
- Heart Rhythm Center, Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.,Institute of Clinical Medicine, Cardiovascular Research Center, National Yang-Ming University, Taipei, Taiwan
| | - Jo Nan Liao
- Heart Rhythm Center, Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.,Institute of Clinical Medicine, Cardiovascular Research Center, National Yang-Ming University, Taipei, Taiwan
| | - Ting Yung Chang
- Heart Rhythm Center, Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.,Institute of Clinical Medicine, Cardiovascular Research Center, National Yang-Ming University, Taipei, Taiwan
| | - Shih Ann Chen
- Heart Rhythm Center, Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.,Institute of Clinical Medicine, Cardiovascular Research Center, National Yang-Ming University, Taipei, Taiwan.
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5
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Soto-Becerra R, Bazan V, Bautista W, Malavassi F, Altamar J, Ramirez JD, Everth A, Callans DJ, Marchlinski FE, Rodríguez D, García FC, Sáenz LC. Ventricular Tachycardia in the Setting of Chagasic Cardiomyopathy. Circ Arrhythm Electrophysiol 2017; 10:CIRCEP.116.004950. [DOI: 10.1161/circep.116.004950] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2016] [Accepted: 09/18/2017] [Indexed: 11/16/2022]
Affiliation(s)
- Richard Soto-Becerra
- From the International Arrhythmia Center at CardioInfantil Foundation-Cardiac Institute, Bogotá, Colombia (R.S.-B., W.B., F.M., J.A., J.D.R., A.E., D.R., L.C.S.); Electrophysiology Unit, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain (V.B.); and Division of Cardiology, Electrophysiology Program, Hospital of the University of Pennsylvania, Philadelphia (D.J.C., F.E.M., F.C.G.)
| | - Victor Bazan
- From the International Arrhythmia Center at CardioInfantil Foundation-Cardiac Institute, Bogotá, Colombia (R.S.-B., W.B., F.M., J.A., J.D.R., A.E., D.R., L.C.S.); Electrophysiology Unit, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain (V.B.); and Division of Cardiology, Electrophysiology Program, Hospital of the University of Pennsylvania, Philadelphia (D.J.C., F.E.M., F.C.G.)
| | - William Bautista
- From the International Arrhythmia Center at CardioInfantil Foundation-Cardiac Institute, Bogotá, Colombia (R.S.-B., W.B., F.M., J.A., J.D.R., A.E., D.R., L.C.S.); Electrophysiology Unit, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain (V.B.); and Division of Cardiology, Electrophysiology Program, Hospital of the University of Pennsylvania, Philadelphia (D.J.C., F.E.M., F.C.G.)
| | - Federico Malavassi
- From the International Arrhythmia Center at CardioInfantil Foundation-Cardiac Institute, Bogotá, Colombia (R.S.-B., W.B., F.M., J.A., J.D.R., A.E., D.R., L.C.S.); Electrophysiology Unit, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain (V.B.); and Division of Cardiology, Electrophysiology Program, Hospital of the University of Pennsylvania, Philadelphia (D.J.C., F.E.M., F.C.G.)
| | - Jhancarlo Altamar
- From the International Arrhythmia Center at CardioInfantil Foundation-Cardiac Institute, Bogotá, Colombia (R.S.-B., W.B., F.M., J.A., J.D.R., A.E., D.R., L.C.S.); Electrophysiology Unit, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain (V.B.); and Division of Cardiology, Electrophysiology Program, Hospital of the University of Pennsylvania, Philadelphia (D.J.C., F.E.M., F.C.G.)
| | - Juan David Ramirez
- From the International Arrhythmia Center at CardioInfantil Foundation-Cardiac Institute, Bogotá, Colombia (R.S.-B., W.B., F.M., J.A., J.D.R., A.E., D.R., L.C.S.); Electrophysiology Unit, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain (V.B.); and Division of Cardiology, Electrophysiology Program, Hospital of the University of Pennsylvania, Philadelphia (D.J.C., F.E.M., F.C.G.)
| | - Arlen Everth
- From the International Arrhythmia Center at CardioInfantil Foundation-Cardiac Institute, Bogotá, Colombia (R.S.-B., W.B., F.M., J.A., J.D.R., A.E., D.R., L.C.S.); Electrophysiology Unit, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain (V.B.); and Division of Cardiology, Electrophysiology Program, Hospital of the University of Pennsylvania, Philadelphia (D.J.C., F.E.M., F.C.G.)
| | - David J. Callans
- From the International Arrhythmia Center at CardioInfantil Foundation-Cardiac Institute, Bogotá, Colombia (R.S.-B., W.B., F.M., J.A., J.D.R., A.E., D.R., L.C.S.); Electrophysiology Unit, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain (V.B.); and Division of Cardiology, Electrophysiology Program, Hospital of the University of Pennsylvania, Philadelphia (D.J.C., F.E.M., F.C.G.)
| | - Francis E. Marchlinski
- From the International Arrhythmia Center at CardioInfantil Foundation-Cardiac Institute, Bogotá, Colombia (R.S.-B., W.B., F.M., J.A., J.D.R., A.E., D.R., L.C.S.); Electrophysiology Unit, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain (V.B.); and Division of Cardiology, Electrophysiology Program, Hospital of the University of Pennsylvania, Philadelphia (D.J.C., F.E.M., F.C.G.)
| | - Diego Rodríguez
- From the International Arrhythmia Center at CardioInfantil Foundation-Cardiac Institute, Bogotá, Colombia (R.S.-B., W.B., F.M., J.A., J.D.R., A.E., D.R., L.C.S.); Electrophysiology Unit, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain (V.B.); and Division of Cardiology, Electrophysiology Program, Hospital of the University of Pennsylvania, Philadelphia (D.J.C., F.E.M., F.C.G.)
| | - Fermin C. García
- From the International Arrhythmia Center at CardioInfantil Foundation-Cardiac Institute, Bogotá, Colombia (R.S.-B., W.B., F.M., J.A., J.D.R., A.E., D.R., L.C.S.); Electrophysiology Unit, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain (V.B.); and Division of Cardiology, Electrophysiology Program, Hospital of the University of Pennsylvania, Philadelphia (D.J.C., F.E.M., F.C.G.)
| | - Luis C. Sáenz
- From the International Arrhythmia Center at CardioInfantil Foundation-Cardiac Institute, Bogotá, Colombia (R.S.-B., W.B., F.M., J.A., J.D.R., A.E., D.R., L.C.S.); Electrophysiology Unit, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain (V.B.); and Division of Cardiology, Electrophysiology Program, Hospital of the University of Pennsylvania, Philadelphia (D.J.C., F.E.M., F.C.G.)
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6
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Do VBD, Tsai WC, Lin YJ, Higa S, Yagi N, Chang SL, Lo LW, Chung FP, Liao JN, Huang YC, Chan CS, Huang HK, Hu YF, Tsao HM, Chen SA. The Different Substrate Characteristics of Arrhythmogenic Triggers in Idiopathic Right Ventricular Outflow Tract Tachycardia and Arrhythmogenic Right Ventricular Dysplasia: New Insight from Noncontact Mapping. PLoS One 2015; 10:e0140167. [PMID: 26488594 PMCID: PMC4619190 DOI: 10.1371/journal.pone.0140167] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2015] [Accepted: 09/02/2015] [Indexed: 11/19/2022] Open
Abstract
Background The aim of this study was to investigate the different substrate characteristics of repetitive premature ventricular complexed (PVC) trigger sites by the non-contact mapping (NCM). Methods Thirty-five consecutive patients, including 14 with arrhythmogenic right ventricular cardiomyopathy/dysplasia (ARVC) and 21 with idiopathic right ventricular outflow tract tachycardia (RVOT VT), were enrolled for electrophysiological study and catheter ablation guided by the NCM. Substrate and electrogram (Eg) characteristics of the earliest activation (EA) and breakout (BO) sites of PVCs were investigated, and these were confirmed by successful PVC elimination. Results Overall 35 dominant focal PVCs were identified. PVCs arose from the focal origins with preferential conduction, breakout, and spread to the whole right ventricle. The conduction time and distance from EA to BO site were both longer in the ARVC than the RVOT group. The conduction velocity was similar between the 2 groups. The negative deflection of local unipolar Eg at the EA site (EA slope3,5,10ms values) was steeper in the RVOT, compared to ARVC patients. The PVCs of ARVC occurred in the diseased substrate in the ARVC patients. More radiofrequency applications were required to eliminate the triggers in ARVC patients. Conclusions/Interpretation The substrate characteristics of PVC trigger may help to differentiate between idiopathic RVOT VT and ARVC. The slowing and slurred QS unipolar electrograms and longer distance from EA to BO in RVOT endocardium suggest that the triggers of ARVC may originate from mid- or sub-epicardial myocardium. More extensive ablation to the trigger site was required in order to create deeper lesions for a successful outcome.
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Affiliation(s)
- Van Buu Dan Do
- Division of Cardiology, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Wen-Chin Tsai
- Division of Cardiology, Department of Medicine, Hualien Tzu-Chi General Hospital, Taipei, Taiwan
| | - Yenn-Jiang Lin
- Division of Cardiology, Taipei Veterans General Hospital, Taipei, Taiwan
- Faculty of Medicine, Institute of Clinical Medicine, and Cardiovascular Research Institute, National Yang-Ming University, Taipei, Taiwan
- * E-mail:
| | - Satoshi Higa
- Cardiac Electrophysiology and Pacing Laboratory, Division of Cardiovascular Medicine, Makiminato Central Hospital, Okinawa, Japan
| | - Nobumori Yagi
- Division of Cardiovascular Medicine, Nakagami Hospital, Okinawa, Japan
| | - Shih-Lin Chang
- Division of Cardiology, Taipei Veterans General Hospital, Taipei, Taiwan
- Faculty of Medicine, Institute of Clinical Medicine, and Cardiovascular Research Institute, National Yang-Ming University, Taipei, Taiwan
| | - Li-Wei Lo
- Division of Cardiology, Taipei Veterans General Hospital, Taipei, Taiwan
- Faculty of Medicine, Institute of Clinical Medicine, and Cardiovascular Research Institute, National Yang-Ming University, Taipei, Taiwan
| | - Fa-Po Chung
- Division of Cardiology, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Jo-Nan Liao
- Division of Cardiology, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Yen-Chang Huang
- Division of Cardiology, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Chao-Shun Chan
- Division of Cardiology, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Hung-Kai Huang
- Division of Cardiology, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Yu-Feng Hu
- Division of Cardiology, Taipei Veterans General Hospital, Taipei, Taiwan
- Faculty of Medicine, Institute of Clinical Medicine, and Cardiovascular Research Institute, National Yang-Ming University, Taipei, Taiwan
| | - Hsuan-Ming Tsao
- Cardiology, National Yang Ming University Hospital, I-Lan, Taiwan
| | - Shih-Ann Chen
- Division of Cardiology, Taipei Veterans General Hospital, Taipei, Taiwan
- Faculty of Medicine, Institute of Clinical Medicine, and Cardiovascular Research Institute, National Yang-Ming University, Taipei, Taiwan
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7
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Current and state of the art on the electrophysiologic characteristics and catheter ablation of arrhythmogenic right ventricular dysplasia/cardiomyopathy. J Cardiol 2015; 65:441-50. [PMID: 25818480 DOI: 10.1016/j.jjcc.2014.12.023] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2014] [Revised: 12/15/2014] [Accepted: 12/26/2014] [Indexed: 01/27/2023]
Abstract
Arrhythmogenic right ventricular dysplasia/cardiomyopathy (ARVD/C) is an inherited genetic disease caused by defective desmosomal proteins, and it has typical histopathological features characterized by predominantly progressive fibro-fatty infiltration of the right ventricle. Clinical presentations of ARVD/C vary from syncope, progressive heart failure (HF), ventricular tachyarrhythmias, and sudden cardiac death (SCD). The 2010 modified Task Force criteria were established to facilitate the recognition and diagnosis of ARVD/C. An implantable cardiac defibrillator (ICD) remains to be the cornerstone in prevention of SCD in patients fulfilling the diagnosis of definite ARVD/C, especially among ARVD/C patients with syncope, hemodynamically unstable ventricular tachycardia (VT), ventricular fibrillation, and aborted SCD. Further risk stratification is clinically valuable in the management of patients with borderline or possible ARVD/C and mutation carriers of family members. However, given the entity of heterogeneous penetrance and non-uniform phenotypes, the standardization of clinical practice guidelines for at-risk individuals will be the next frontier to breakthrough. Antiarrhythmic drugs are prescribed frequently to patients experiencing frequent ventricular tachyarrhythmias and/or appropriate ICD shocks. Amiodarone is the recommended drug of choice. Radiofrequency catheter ablation (RFCA) has been demonstrated to effectively eliminate the drug-refractory VT in patients with ARVD/C. However, the efficacy and clinical prognosis of RFCA via endocardial approach alone was disappointing prior to the era of epicardial approach. In recent years, it has been proven that the integration of endocardial and epicardial ablation by targeting the critical isthmus or eliminating abnormal electrograms within the diseased substrates could yield higher acute success and lower recurrence of ventricular tachyarrhythmias during long-term follow-up. Heart transplantation is the final option for patients with extensive disease, biventricular HF with uncontrollable hemodynamic compromise, and refractory ventricular tachyarrhythmias despite aggressive medical and ablation therapies.
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