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Jiang Z, Liu Q, Tian Y, Zhao Y, Liu W, Tian L, Huang J, Tian S, Zheng Y, Yang L. Investigating Origins of Ventricular Arrhythmia Arising From Right Ventricular Outflow Tract and Comparing Initial Ablation Strategies. Front Cardiovasc Med 2021; 8:727546. [PMID: 34692782 PMCID: PMC8531264 DOI: 10.3389/fcvm.2021.727546] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2021] [Accepted: 09/01/2021] [Indexed: 12/04/2022] Open
Abstract
Background: The origin distribution in right ventricular outflow tract (RVOT) ventricular arrhythmias (VAs), as well as the initial ablation effectiveness of reversed U-curve method and antegrade method, remains unclear. Objectives: To investigate the origin distribution of RVOT-type VAs and compare the initial ablation effectiveness of the two methods. Method: Consecutive patients who had idiopathic RVOT-type VAs were prospectively enrolled. After activation mapping, patients were randomly assigned to supravalvular strategy using the reversed U-curve or subvalvular strategy using the antegrade method. The primary outcome was initial ablation (IA) success, defined as the successful ablation within the first three attempts. Results: Sixty-one patients were enrolled from November 2018 to June 2020. Activation mapping revealed that 34/61 (55.7%) of the earliest ventricular activating (EVA) sites were above the pulmonary valves (PVs). The IA success rate was 25/33 (75.8%) in the patients assigned to supravalvular strategy as compared with 16/28 (57.1%) in those assigned to subvalvular strategy (p = 0.172). Multivariate analysis revealed a substantial and qualitative interaction between the EVA sites and IA strategies (pinteraction < 0.001). Either strategy had a remarkably higher IA success rate in treating its ipsilateral EVA sites than contralateral ones (p < 0.0083). Conclusion: Of the idiopathic RVOT-type VA origins, half were located above the PV. The supravalvular and subvalvular strategies did not differ in IA success rates. However, they were complementary to reveal the EVA sites and facilitate ipsilateral ablation, which produces a significantly higher IA success rate. Clinical Trial Registration: Chinese Clinical Trial Registry number, https://www.chictr.org.cn/showproj.aspx?proj=45623, ChiCTR2000029331.
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Affiliation(s)
- Zhi Jiang
- Cardiology Department, Guizhou Provincial People's Hospital, Guiyang, China.,Guizhou Provincial Cardiovascular Disease Institute, Guiyang, China
| | - Qifang Liu
- Cardiology Department, Guizhou Provincial People's Hospital, Guiyang, China.,Guizhou Provincial Cardiovascular Disease Institute, Guiyang, China
| | - Ye Tian
- Cardiology Department, Guizhou Provincial People's Hospital, Guiyang, China.,Guizhou Provincial Cardiovascular Disease Institute, Guiyang, China
| | | | - Wei Liu
- Cardiology Department, Guizhou Provincial People's Hospital, Guiyang, China.,Guizhou Provincial Cardiovascular Disease Institute, Guiyang, China
| | - Longhai Tian
- Cardiology Department, Guizhou Provincial People's Hospital, Guiyang, China.,Guizhou Provincial Cardiovascular Disease Institute, Guiyang, China
| | - Jing Huang
- Cardiology Department, Guizhou Provincial People's Hospital, Guiyang, China.,Guizhou Provincial Cardiovascular Disease Institute, Guiyang, China
| | - Shui Tian
- Cardiology Department, Guizhou Provincial People's Hospital, Guiyang, China.,Guizhou Provincial Cardiovascular Disease Institute, Guiyang, China
| | - Yaxi Zheng
- Cardiology Department, Guizhou Provincial People's Hospital, Guiyang, China.,Guizhou Provincial Cardiovascular Disease Institute, Guiyang, China
| | - Long Yang
- Cardiology Department, Guizhou Provincial People's Hospital, Guiyang, China.,Guizhou Provincial Cardiovascular Disease Institute, Guiyang, China
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Di C, Letsas KP, Gao P, Wang Q, Wu Y, Lin W. Electrocardiographic and electrophysiological characteristics of idiopathic ventricular arrhythmias with acute successful ablation at the superior portion of the mitral annulus. BMC Cardiovasc Disord 2021; 21:397. [PMID: 34407753 PMCID: PMC8371855 DOI: 10.1186/s12872-021-02205-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Accepted: 08/12/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND We sought to identify the electrocardiographic and electrophysiological characteristics of ventricular arrhythmias (VAs), including idiopathic ventricular tachycardia (VT) and premature ventricular contractions (PVCs), with acute successful radiofrequency catheter ablation (RFCA) at the superior portion of the mitral annulus (SP-MA). METHODS AND RESULTS Among 437 consecutive patients who presented with VAs for RFCA, twenty-six patients with acute successful RFCA at the SP-MA were included in this study. The ratio of the amplitude of the first positive peak (if present) versus the nadir in the unipolar electrogram (EGM) was 0.00-0.03 (0.00) at the acute successful RFCA site. The time interval between the QRS onset and the maximum descending slope (D-Max) in the unipolar EGM (QRS-Uni) was 18.8 ± 13.6 ms. With bipolar mapping, the ventricular QRS (V-QRS) interval was 3.75-17.3 (11) ms, 6 (23.1%) patients showed the earliest V-QRS interval of 0 ms, and the other 20 patients (76.9%) showed a V-QRS interval of 10-54 ms. The RFCA start-to-effect time was 14.1 ± 7.2 s in 23 patients (88.5%). In the remaining 3 patients (11.5%), the mean duration of successful RFCA was not well defined due to the infrequent nature of clinical VAs during RFCA. Early (within 3 days) and late (1-year) recurrence rates were 23.1% (6 patients) and 26.9% (7 patients), respectively. VAs disappeared 3 days later due to delayed RFCA efficacy in 2 patients (7.7%). No complications occurred during the RFCA procedure or the one-year follow-up. CONCLUSIONS SP-MA VAs are a rare but distinct subgroup of VAs. Bipolar and unipolar EGM features can help to determine the optimal RFCA site, and the QRS-Uni interval may serve as a marker that could be used to guide RFCA.
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Affiliation(s)
- Chengye Di
- Cardiac Electrophysiology Unit, First Department of Cardiology, TEDA International Cardiovascular Hospital, 3rd Street, Tianjin Economic-Technological Development Area, Tianjin, 300457, China.,College of Clinical Cardiology, Tianjin Medical University, Tianjin, China.,Cardiovascular Institute, Tianjin University, Tianjin, China
| | - Konstantinos P Letsas
- Second Department of Cardiology, Laboratory of Cardiac Electrophysiology, Evangelismos General Hospital of Athens, 10676, Athens, Greece
| | - Peng Gao
- Cardiac Electrophysiology Unit, First Department of Cardiology, TEDA International Cardiovascular Hospital, 3rd Street, Tianjin Economic-Technological Development Area, Tianjin, 300457, China.,College of Clinical Cardiology, Tianjin Medical University, Tianjin, China.,Cardiovascular Institute, Tianjin University, Tianjin, China
| | - Qun Wang
- Cardiac Electrophysiology Unit, First Department of Cardiology, TEDA International Cardiovascular Hospital, 3rd Street, Tianjin Economic-Technological Development Area, Tianjin, 300457, China.,College of Clinical Cardiology, Tianjin Medical University, Tianjin, China.,Cardiovascular Institute, Tianjin University, Tianjin, China
| | - Yanxi Wu
- Cardiac Electrophysiology Unit, First Department of Cardiology, TEDA International Cardiovascular Hospital, 3rd Street, Tianjin Economic-Technological Development Area, Tianjin, 300457, China.,College of Clinical Cardiology, Tianjin Medical University, Tianjin, China.,Cardiovascular Institute, Tianjin University, Tianjin, China
| | - Wenhua Lin
- Cardiac Electrophysiology Unit, First Department of Cardiology, TEDA International Cardiovascular Hospital, 3rd Street, Tianjin Economic-Technological Development Area, Tianjin, 300457, China. .,College of Clinical Cardiology, Tianjin Medical University, Tianjin, China. .,Cardiovascular Institute, Tianjin University, Tianjin, China.
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Choi JH, Kwon HJ, Kim HR, Park SJ, Kim JS, On YK, Park KM. Earliest activation time is a good predictor of successful ablation of idiopathic outflow tract ventricular arrhythmias. Clin Cardiol 2021; 44:573-579. [PMID: 33609058 PMCID: PMC8027574 DOI: 10.1002/clc.23578] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2020] [Revised: 02/01/2021] [Accepted: 02/11/2021] [Indexed: 11/07/2022] Open
Abstract
BACKGROUND In idiopathic outflow tract ventricular arrhythmias (OT-VAs), identifying the site with the earliest activation time (EAT) using activation mapping is critical to eliminating the arrhythmogenic focus. However, the optimal EAT for predicting successful radiofrequency catheter ablation (RFCA) has not been established. HYPOTHESIS To evaluate the association between EAT and successful RFCA in idiopathic OT-VAs and to determine the optimal cut-off value of EAT for successful ablation. METHODS We retrospectively analyzed patients undergoing RFCA for idiopathic OT-VAs at a single center from January 2015 to December 2019. RESULTS Acute procedural success was achieved in 168 patients (87.0%). Among these patients, 158 patients (81.9%) were classified in the clinical success group according to the recurrence of clinical VAs during median (Q1, Q3) follow-up (330 days [182, 808]). EAT was significantly earlier in the clinical success group compared with the recurrence (p = .006) and initial failure (p < .0001) groups. The optimal EAT cut-off value predicting clinical success was -30 ms in the right ventricular outflow tract (RVOT) with 77.4% sensitivity and 96.4% specificity. In all cases of successful ablation in the left ventricular outflow tract (LVOT), EAT in the RVOT was not earlier than -29 ms. CONCLUSIONS EAT in patients with successful catheter ablation was significantly earlier than that in patients with recurrence and initial failure. EAT earlier than -30 ms could be used as a key predictor of successful catheter ablation as well as an indicator of the need to shift focus from the RVOT to the LVOT.
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Affiliation(s)
- Ji-Hoon Choi
- Division of Cardiology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Hee-Jin Kwon
- Division of Cardiology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Hye Ree Kim
- Division of Cardiology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Seung-Jung Park
- Division of Cardiology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - June Soo Kim
- Division of Cardiology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Young Keun On
- Division of Cardiology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Kyoung-Min Park
- Division of Cardiology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
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Huang LH, Gao MY, Zeng LJ, Xie BQ, Shi L, Wang YJ, Yin XD, Wang YX, Liu XQ, Tian Y, Yang XC, Liu XP. Role of the notched unipolar electrogram in guiding catheter ablation of frequent premature ventricular contractions originating from the ventricular outflow tract. J Int Med Res 2020; 48:300060520977634. [PMID: 33327831 PMCID: PMC7747111 DOI: 10.1177/0300060520977634] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2020] [Accepted: 11/09/2020] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE To investigate the value of a notched unipolar electrogram (N-uniEGM) in confirming the origin of premature ventricular contractions originating from the ventricular outflow tract (VOT-PVC) during mapping and ablation procedures. METHODS This retrospective study enrolled consecutive patients with symptomatic idiopathic frequent VOT-PVCs that underwent radiofrequency ablation. The characteristics of the uniEGM of the successful ablation targets were analysed. N-uniEGM was defined as the uniEGM presenting a QS morphology with ≥1 steep notches on the downstroke deflection. All patients were followed-up for 3 months post-ablation. RESULTS The study enrolled 190 patients with a mean ± SD age of 49.0 ± 15.3 years. N-uniEGMs were recorded in 124 of 190 (65.3%) patients. The N-uniEGM distribution area was limited to a mean ± SD of 0.8 ± 0.4 cm2. N-uniEGM showed consistency with the outcomes of activation mapping and pace mapping. Patients with an N-uniEGM had an ablation success rate of 98.4% (122 of 124) and their ablation times were significantly shorter than those without an N-uniEGM (7.6 ± 3.8 s versus 15.8 ± 8.8 s, respectively). The sensitivity and specificity of N-uniEGM in predicting successful ablation of VOT-PVCs were 72.6% and 91.7%, respectively. CONCLUSION N-uniEGM was a highly specific and moderately sensitive predictor of successful radiofrequency ablation in patients with VOT-PVCs.
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Affiliation(s)
- Li-Hong Huang
- Heart Centre, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Ming-Yang Gao
- Heart Centre, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Li-Jun Zeng
- Heart Centre, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Bo-Qia Xie
- Heart Centre, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Liang Shi
- Heart Centre, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Yan-Jiang Wang
- Heart Centre, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Xian-Dong Yin
- Heart Centre, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Yu-Xing Wang
- Heart Centre, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Xiao-Qing Liu
- Heart Centre, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Ying Tian
- Heart Centre, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Xin-Chun Yang
- Heart Centre, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Xing-Peng Liu
- Heart Centre, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
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Chieng D, Lahiri A, Sugumar H, Al‐Kaisey A, Parameswaran R, Anderson RD, Prabhu S, Ling L, Morton JB, McLellan AJ, Lee G, Kalman JM, McGavigan AD, Kistler PM. Multipolar mapping with the high‐density grid catheter compared with conventional point‐by‐point mapping to guide catheter ablation for focal arrhythmias. J Cardiovasc Electrophysiol 2020; 31:2288-2297. [DOI: 10.1111/jce.14636] [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] [Received: 04/30/2020] [Revised: 06/02/2020] [Accepted: 06/06/2020] [Indexed: 11/28/2022]
Affiliation(s)
- David Chieng
- Clinical Electrophysiology Laboratory The Baker Heart Research Institute Melbourne Australia
- Department of Cardiology The Alfred Hospital Melbourne Australia
- Department of Medicine University of Melbourne Melbourne Australia
| | | | - Hariharan Sugumar
- Clinical Electrophysiology Laboratory The Baker Heart Research Institute Melbourne Australia
- Department of Cardiology The Alfred Hospital Melbourne Australia
- Department of Medicine University of Melbourne Melbourne Australia
| | - Ahmed Al‐Kaisey
- Department of Medicine University of Melbourne Melbourne Australia
- Department of Cardiology Royal Melbourne Hospital Melbourne Australia
| | - Ramanathan Parameswaran
- Department of Medicine University of Melbourne Melbourne Australia
- Department of Cardiology Royal Melbourne Hospital Melbourne Australia
| | - Robert D. Anderson
- Department of Medicine University of Melbourne Melbourne Australia
- Department of Cardiology Royal Melbourne Hospital Melbourne Australia
| | - Sandeep Prabhu
- Clinical Electrophysiology Laboratory The Baker Heart Research Institute Melbourne Australia
- Department of Cardiology The Alfred Hospital Melbourne Australia
- Department of Medicine University of Melbourne Melbourne Australia
| | - Liang‐Han Ling
- Clinical Electrophysiology Laboratory The Baker Heart Research Institute Melbourne Australia
- Department of Cardiology The Alfred Hospital Melbourne Australia
- Department of Medicine University of Melbourne Melbourne Australia
| | - Joseph B. Morton
- Department of Medicine University of Melbourne Melbourne Australia
- Department of Cardiology Royal Melbourne Hospital Melbourne Australia
| | - Alex J. McLellan
- Clinical Electrophysiology Laboratory The Baker Heart Research Institute Melbourne Australia
- Department of Cardiology Royal Melbourne Hospital Melbourne Australia
| | - Geoffrey Lee
- Department of Medicine University of Melbourne Melbourne Australia
- Department of Cardiology Royal Melbourne Hospital Melbourne Australia
| | - Jonathan M. Kalman
- Department of Medicine University of Melbourne Melbourne Australia
- Department of Cardiology Royal Melbourne Hospital Melbourne Australia
- Department of Medicine Monash Health Melbourne Australia
| | - Andrew D. McGavigan
- Department of Cardiology Flinders Medical Centre Adelaide Australia
- Faculty of Medicine Flinders University Adelaide Australia
| | - Peter M. Kistler
- Clinical Electrophysiology Laboratory The Baker Heart Research Institute Melbourne Australia
- Department of Cardiology The Alfred Hospital Melbourne Australia
- Department of Medicine University of Melbourne Melbourne Australia
- Department of Medicine Monash Health Melbourne Australia
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Sato T, Soejima K, Maeda A, Mohri T, Tashiro M, Momose Y, Komeda M, Nonoguchi N, Hoshida K, Miwa Y, Ueda A, Togashi I. Deep Negative Deflection in Unipolar His-Bundle Electrogram as a Predictor of Excellent His-Bundle Pacing Threshold Postimplant. Circ Arrhythm Electrophysiol 2019; 12:e007415. [DOI: 10.1161/circep.119.007415] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Toshiaki Sato
- Division of Advanced Arrhythmia Management (T.S., A.U.), the Second Department of Internal Medicine, Kyorin University School of Medicine, Mitaka, Japan
| | - Kyoko Soejima
- Division of Cardiology (K.S., A.M., T.M., M.T., Y.M., M.K., N.N., K.H., Y.M., I.T.), the Second Department of Internal Medicine, Kyorin University School of Medicine, Mitaka, Japan
| | - Akiko Maeda
- Division of Cardiology (K.S., A.M., T.M., M.T., Y.M., M.K., N.N., K.H., Y.M., I.T.), the Second Department of Internal Medicine, Kyorin University School of Medicine, Mitaka, Japan
| | - Takato Mohri
- Division of Cardiology (K.S., A.M., T.M., M.T., Y.M., M.K., N.N., K.H., Y.M., I.T.), the Second Department of Internal Medicine, Kyorin University School of Medicine, Mitaka, Japan
| | - Mika Tashiro
- Division of Cardiology (K.S., A.M., T.M., M.T., Y.M., M.K., N.N., K.H., Y.M., I.T.), the Second Department of Internal Medicine, Kyorin University School of Medicine, Mitaka, Japan
| | - Yuichi Momose
- Division of Cardiology (K.S., A.M., T.M., M.T., Y.M., M.K., N.N., K.H., Y.M., I.T.), the Second Department of Internal Medicine, Kyorin University School of Medicine, Mitaka, Japan
| | - Michitsugu Komeda
- Division of Cardiology (K.S., A.M., T.M., M.T., Y.M., M.K., N.N., K.H., Y.M., I.T.), the Second Department of Internal Medicine, Kyorin University School of Medicine, Mitaka, Japan
| | - Noriko Nonoguchi
- Division of Cardiology (K.S., A.M., T.M., M.T., Y.M., M.K., N.N., K.H., Y.M., I.T.), the Second Department of Internal Medicine, Kyorin University School of Medicine, Mitaka, Japan
| | - Kyoko Hoshida
- Division of Cardiology (K.S., A.M., T.M., M.T., Y.M., M.K., N.N., K.H., Y.M., I.T.), the Second Department of Internal Medicine, Kyorin University School of Medicine, Mitaka, Japan
| | - Yosuke Miwa
- Division of Cardiology (K.S., A.M., T.M., M.T., Y.M., M.K., N.N., K.H., Y.M., I.T.), the Second Department of Internal Medicine, Kyorin University School of Medicine, Mitaka, Japan
| | - Akiko Ueda
- Division of Advanced Arrhythmia Management (T.S., A.U.), the Second Department of Internal Medicine, Kyorin University School of Medicine, Mitaka, Japan
| | - Ikuko Togashi
- Division of Cardiology (K.S., A.M., T.M., M.T., Y.M., M.K., N.N., K.H., Y.M., I.T.), the Second Department of Internal Medicine, Kyorin University School of Medicine, Mitaka, Japan
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