1
|
Ladas TP, Sugrue A, Nan J, Vaidya VR, Padmanabhan D, Venkatachalam KL, Asirvatham SJ. Fundamentals of Cardiac Mapping. Card Electrophysiol Clin 2020; 11:433-448. [PMID: 31400868 DOI: 10.1016/j.ccep.2019.05.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
To characterize cardiac activity and arrhythmias, electrophysiologists can record the electrical activity of the heart in relation to its anatomy through a process called cardiac mapping (electroanatomic mapping, EAM). A solid understanding of the basic cardiac biopotentials, called electrograms, is imperative to construct and interpret the cardiac EAM correctly. There are several mapping approaches available to the electrophysiologist, each optimized for specific arrhythmia mechanisms. This article provides an overview of the fundamentals of EAM.
Collapse
Affiliation(s)
- Thomas P Ladas
- Department of Cardiovascular Medicine, Division of Heart Rhythm Services, Mayo Clinic, Rochester, MN, USA
| | - Alan Sugrue
- Department of Cardiovascular Medicine, Division of Heart Rhythm Services, Mayo Clinic, Rochester, MN, USA
| | - John Nan
- Department of Cardiovascular Medicine, Division of Heart Rhythm Services, Mayo Clinic, Rochester, MN, USA
| | - Vaibhav R Vaidya
- Department of Cardiovascular Medicine, Division of Heart Rhythm Services, Mayo Clinic, Rochester, MN, USA
| | - Deepak Padmanabhan
- Department of Cardiovascular Medicine, Division of Heart Rhythm Services, Mayo Clinic, Rochester, MN, USA
| | - K L Venkatachalam
- Department of Cardiovascular Medicine, Division of Heart Rhythm Services, Mayo Clinic, Jacksonville, Florida, USA
| | - Samuel J Asirvatham
- Department of Cardiovascular Medicine, Division of Heart Rhythm Services, Mayo Clinic, Rochester, MN, USA; Department of Pediatric and Adolescent Medicine, Division of Pediatric Cardiology, Mayo Clinic, Rochester, MN, USA; Physiology and Biomedical Engineering, Mayo Clinic, Rochester, MN, USA.
| |
Collapse
|
2
|
Syed FF, Ackerman MJ, McLeod CJ, Kapa S, Mulpuru SK, Sriram CS, Cannon BC, Asirvatham SJ, Noseworthy PA. Sites of Successful Ventricular Fibrillation Ablation in Bileaflet Mitral Valve Prolapse Syndrome. Circ Arrhythm Electrophysiol 2016; 9:CIRCEP.116.004005. [PMID: 27103091 DOI: 10.1161/circep.116.004005] [Citation(s) in RCA: 88] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2015] [Accepted: 03/22/2016] [Indexed: 12/31/2022]
Abstract
BACKGROUND Although the vast majority of mitral valve prolapse (MVP) is benign, a small subset of patients, predominantly women, with bileaflet prolapse, complex ventricular ectopy (VE), and abnormal T waves comprise the recently described bileaflet MVP syndrome. We compared findings on electrophysiological study in bileaflet MVP syndrome patients with and without cardiac arrest to identify factors that may predispose to malignant ventricular arrhythmia. METHODS AND RESULTS Fourteen consecutive bileaflet MVP syndrome patients (n=13 women; median [limits], age at index ablation, 33.8 [21.0-58.7] years; ejection fraction, 60% [45%-67%]; all ≤ moderate mitral regurgitation; n=6 with previous cardiac arrest and implantable cardioverter defibrillator shocks for ventricular fibrillation; and n=8 without implantable cardioverter defibrillator although with symptomatic complex VE) were included. The 2 groups had similar baseline echocardiographic and electrocardiographic characteristics. All patients had at least 1 left ventricular papillary or fascicular VE focus. Purkinje origin VE was identified as the ventricular fibrillation trigger in 6 of 6 cardiac arrest patients (4 from papillary muscle) and Purkinje origin of dominant VE was seen in 5 of 8 (3 from papillary muscle) nonarrest patients. Acute success was seen in 17 of 19 procedures, and a ventricular fibrillation storm occurred within 24 hours of ablation in a single patient. Repeat ablation for recurrent symptomatic arrhythmia was performed in 6 patients. At 478 (39-2099) days of follow-up, 2 cardiac arrest patients received appropriate shocks. Symptoms from VE were reduced in 12 of 14. CONCLUSIONS Bileaflet MVP syndrome is characterized by fascicular and papillary muscle VE that triggers ventricular fibrillation. Ablation of clinically dominant VE foci improves symptoms and reduces appropriate implantable cardioverter defibrillator shocks.
Collapse
Affiliation(s)
- Faisal F Syed
- From the Division of Cardiovascular Diseases/Department of Medicine (F.F.S., M.J.A., C.J.M., S.K., S.K.M., C.S.S., B.C.C., S.J.A., P.A.N.), Windland Smith Rice Sudden Death Genomics Laboratory/Department of Molecular Pharmacology & Experimental Therapeutics (M.J.A.), and Division of Pediatric Cardiology/Department of Pediatrics (B.C.C., S.J.A.), Mayo Clinic, Rochester, MN
| | - Michael J Ackerman
- From the Division of Cardiovascular Diseases/Department of Medicine (F.F.S., M.J.A., C.J.M., S.K., S.K.M., C.S.S., B.C.C., S.J.A., P.A.N.), Windland Smith Rice Sudden Death Genomics Laboratory/Department of Molecular Pharmacology & Experimental Therapeutics (M.J.A.), and Division of Pediatric Cardiology/Department of Pediatrics (B.C.C., S.J.A.), Mayo Clinic, Rochester, MN.
| | - Christopher J McLeod
- From the Division of Cardiovascular Diseases/Department of Medicine (F.F.S., M.J.A., C.J.M., S.K., S.K.M., C.S.S., B.C.C., S.J.A., P.A.N.), Windland Smith Rice Sudden Death Genomics Laboratory/Department of Molecular Pharmacology & Experimental Therapeutics (M.J.A.), and Division of Pediatric Cardiology/Department of Pediatrics (B.C.C., S.J.A.), Mayo Clinic, Rochester, MN
| | - Suraj Kapa
- From the Division of Cardiovascular Diseases/Department of Medicine (F.F.S., M.J.A., C.J.M., S.K., S.K.M., C.S.S., B.C.C., S.J.A., P.A.N.), Windland Smith Rice Sudden Death Genomics Laboratory/Department of Molecular Pharmacology & Experimental Therapeutics (M.J.A.), and Division of Pediatric Cardiology/Department of Pediatrics (B.C.C., S.J.A.), Mayo Clinic, Rochester, MN
| | - Siva K Mulpuru
- From the Division of Cardiovascular Diseases/Department of Medicine (F.F.S., M.J.A., C.J.M., S.K., S.K.M., C.S.S., B.C.C., S.J.A., P.A.N.), Windland Smith Rice Sudden Death Genomics Laboratory/Department of Molecular Pharmacology & Experimental Therapeutics (M.J.A.), and Division of Pediatric Cardiology/Department of Pediatrics (B.C.C., S.J.A.), Mayo Clinic, Rochester, MN
| | - Chenni S Sriram
- From the Division of Cardiovascular Diseases/Department of Medicine (F.F.S., M.J.A., C.J.M., S.K., S.K.M., C.S.S., B.C.C., S.J.A., P.A.N.), Windland Smith Rice Sudden Death Genomics Laboratory/Department of Molecular Pharmacology & Experimental Therapeutics (M.J.A.), and Division of Pediatric Cardiology/Department of Pediatrics (B.C.C., S.J.A.), Mayo Clinic, Rochester, MN
| | - Bryan C Cannon
- From the Division of Cardiovascular Diseases/Department of Medicine (F.F.S., M.J.A., C.J.M., S.K., S.K.M., C.S.S., B.C.C., S.J.A., P.A.N.), Windland Smith Rice Sudden Death Genomics Laboratory/Department of Molecular Pharmacology & Experimental Therapeutics (M.J.A.), and Division of Pediatric Cardiology/Department of Pediatrics (B.C.C., S.J.A.), Mayo Clinic, Rochester, MN
| | - Samuel J Asirvatham
- From the Division of Cardiovascular Diseases/Department of Medicine (F.F.S., M.J.A., C.J.M., S.K., S.K.M., C.S.S., B.C.C., S.J.A., P.A.N.), Windland Smith Rice Sudden Death Genomics Laboratory/Department of Molecular Pharmacology & Experimental Therapeutics (M.J.A.), and Division of Pediatric Cardiology/Department of Pediatrics (B.C.C., S.J.A.), Mayo Clinic, Rochester, MN
| | - Peter A Noseworthy
- From the Division of Cardiovascular Diseases/Department of Medicine (F.F.S., M.J.A., C.J.M., S.K., S.K.M., C.S.S., B.C.C., S.J.A., P.A.N.), Windland Smith Rice Sudden Death Genomics Laboratory/Department of Molecular Pharmacology & Experimental Therapeutics (M.J.A.), and Division of Pediatric Cardiology/Department of Pediatrics (B.C.C., S.J.A.), Mayo Clinic, Rochester, MN
| |
Collapse
|