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Shinoda Y, Komatsu Y, Hattori M, Oda Y, Iioka Y, Hanaki Y, Yamasaki H, Igarashi M, Ishizu T, Nogami A. Optimal cardiac rhythm during substrate mapping in scar-related ventricular tachycardia: Significance of wavefront direction on identifying critical sites. Heart Rhythm 2024; 21:1298-1307. [PMID: 38432425 DOI: 10.1016/j.hrthm.2024.02.060] [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: 10/16/2023] [Revised: 02/11/2024] [Accepted: 02/24/2024] [Indexed: 03/05/2024]
Abstract
BACKGROUND A rotational activation pattern (RAP) around the localized line of a conduction block often correlates with sites specific to the critical zones of ventricular tachycardia (VT). The wavefront direction during substrate mapping affects manifestation of the RAP and line of block. OBJECTIVE The purpose of this study was to investigate the most optimal cardiac rhythm for identifying RAP and line of block in substrate mapping. METHODS We retrospectively evaluated 71 maps (median 3205 points/map) in 46 patients (65 ± 15 years; 33% with ischemic cardiomyopathy) who underwent high-density substrate mapping and ablation of scar-related VT. Appearance of a RAP during sinus, right ventricular (RV)-paced, left ventricular (LV)-paced, and biventricular-paced rhythms was investigated. RESULTS RAP was identified in 24 of 71 maps (34%) in the region where wavefronts from a single direction reached but not in the region where wavefronts from multiple directions centripetally collided. The probability of identifying the RAP depended on scar location; that is, anteroseptal and inferoseptal, inferior and apical, and basal lateral RAPs were likely to be identified during sinus/atrial, RV-paced, and LV-paced rhythms, respectively. In 13 patients, the RAP was not evident in the baseline map but became apparent during remapping in the other rhythm, in which the wavefront reached the site earlier within the entire activation time. CONCLUSION The optimal rhythm for substrate mapping depends on the spatial distribution of the area of interest. A paced rhythm with pacing sites near the scar may facilitate the identification of critical VT zones.
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Affiliation(s)
- Yasutoshi Shinoda
- Department of Cardiology, Institute of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Yuki Komatsu
- Department of Cardiology, Institute of Medicine, University of Tsukuba, Tsukuba, Japan.
| | - Masayuki Hattori
- Department of Cardiology, Institute of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Yuka Oda
- Department of Cardiology, Institute of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Yuto Iioka
- Department of Cardiology, Institute of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Yuichi Hanaki
- Department of Cardiology, Institute of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Hiro Yamasaki
- Department of Cardiology, Institute of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Miyako Igarashi
- Department of Cardiology, Institute of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Tomoko Ishizu
- Department of Cardiology, Institute of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Akihiko Nogami
- Department of Cardiology, Institute of Medicine, University of Tsukuba, Tsukuba, Japan
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Hsue W, Gagnon AL. Treating Stubborn Cardiac Arrhythmias-Looking Toward the Future. Vet Clin North Am Small Anim Pract 2023; 53:1415-1428. [PMID: 37541824 DOI: 10.1016/j.cvsm.2023.06.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/06/2023]
Abstract
As animals can develop significant side effects or remain refractory while on antiarrhythmic medical therapy for tachyarrhythmias, interventional therapies are progressively being explored. This review will highlight the principles and utilities of implantable cardioverter-defibrillators, electrophysiological mapping and catheter ablation, three-dimensional electroanatomical mapping, and stereotactic arrhythmia radiotherapy. In particular, three-dimensional electroanatomical mapping is emerging as an adjunct electrophysiology tool to facilitate activation, substrate, and pace mapping for intuitive analysis of complex tachyarrhythmias. Unlike antiarrhythmic medications, these modalities offer potential for decreasing risk of sudden death and even permanent termination of tachyarrhythmias.
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Affiliation(s)
- Weihow Hsue
- Department of Clinical Sciences, College of Veterinary Medicine, Cornell University, 930 Campus Road, Ithaca, NY 14853, USA.
| | - Allison L Gagnon
- Department of Medicine and Epidemiology, School of Veterinary Medicine, University of California - Davis, One Shields Avenue, Davis, CA 95616, USA.
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Nishimura T, Shatz N, Weiss JP, Zawaneh M, Bai R, Beaser AD, Upadhyay GA, Aziz ZA, Nayak HM, Shatz DY, Miyazaki S, Goya M, Sasano T, Su W, Raiman M, Tung R. Identification of Human Ventricular Tachycardia Demarcated by Fixed Lines of Conduction Block in a 3-Dimensional Hyperboloid Circuit. Circulation 2023; 148:1354-1367. [PMID: 37638389 DOI: 10.1161/circulationaha.123.065525] [Citation(s) in RCA: 12] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Accepted: 08/01/2023] [Indexed: 08/29/2023]
Abstract
BACKGROUND The circuit boundaries for reentrant ventricular tachycardia (VT) have been historically conceptualized within a 2-dimensional (2D) construct, with their fixed or functional nature unresolved. This study aimed to examine the correlation between localized lines of conduction block (LOB) evident during baseline rhythm with lateral isthmus boundaries that 3-dimensionally constrain the VT isthmus as a hyperboloid structure. METHODS A total of 175 VT activation maps were correlated with isochronal late activation maps during baseline rhythm in 106 patients who underwent catheter ablation for scar-related VT from 3 centers (42% nonischemic cardiomyopathy). An overt LOB was defined by a deceleration zone with split potentials (≥20 ms isoelectric segment) during baseline rhythm. A novel application of pacing within deceleration zone (≥600 ms) was implemented to unmask a concealed LOB not evident during baseline rhythm. LOB identified during baseline rhythm or pacing were correlated with isthmus boundaries during VT. RESULTS Among 202 deceleration zones analyzed during baseline rhythm, an overt LOB was evident in 47%. When differential pacing was performed in 38 deceleration zones without overt LOB, an underlying concealed LOB was exposed in 84%. In 152 VT activation maps (2D=53, 3-dimensional [3D]=99), 69% of lateral boundaries colocalized with an LOB in 2D activation patterns, and the depth boundary during 3D VT colocalized with an LOB in 79%. In VT circuits with isthmus regions that colocalized with a U-shaped LOB (n=28), the boundary invariably served as both lateral boundaries in 2D and 3D. Overall, 74% of isthmus boundaries were identifiable as fixed LOB during baseline rhythm or differential pacing. CONCLUSIONS The majority of VT circuit boundaries can be identified as fixed LOB from intrinsic or paced activation during sinus rhythm. Analysis of activation while pacing within the scar substrate is a novel technique that may unmask concealed LOB, previously interpreted to be functional in nature. An LOB from the perspective of a myocardial surface is frequently associated with intramural conduction, supporting the existence of a 3D hyperboloid VT circuit structure. Catheter ablation may be simplified to targeting both sides around an identified LOB during sinus rhythm.
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Affiliation(s)
- Takuro Nishimura
- The University of Chicago Medicine, Pritzker School of Medicine, Illinois (T.N., A.D.B., G.A.U., Z.A.A., H.M.N., D.Y.S., R.T.)
- Tokyo Medical and Dental University, Department of Cardiovascular Medicine, Japan (T.N., S.M., M.G., T.S.)
| | - Nathan Shatz
- Abbott Laboratories, Abbott Park, Illinois (N.S., M.R.)
| | - J Peter Weiss
- The University of Arizona College of Medicine - Phoenix, Banner - University Medical Center, Phoenix (J.P.W., M.Z., R.B., D.Y.S., W.S., R.T.)
| | - Michael Zawaneh
- The University of Arizona College of Medicine - Phoenix, Banner - University Medical Center, Phoenix (J.P.W., M.Z., R.B., D.Y.S., W.S., R.T.)
| | - Rong Bai
- The University of Arizona College of Medicine - Phoenix, Banner - University Medical Center, Phoenix (J.P.W., M.Z., R.B., D.Y.S., W.S., R.T.)
| | - Andrew D Beaser
- The University of Chicago Medicine, Pritzker School of Medicine, Illinois (T.N., A.D.B., G.A.U., Z.A.A., H.M.N., D.Y.S., R.T.)
| | - Gaurav A Upadhyay
- The University of Chicago Medicine, Pritzker School of Medicine, Illinois (T.N., A.D.B., G.A.U., Z.A.A., H.M.N., D.Y.S., R.T.)
| | - Zaid A Aziz
- The University of Chicago Medicine, Pritzker School of Medicine, Illinois (T.N., A.D.B., G.A.U., Z.A.A., H.M.N., D.Y.S., R.T.)
| | - Hemal M Nayak
- The University of Chicago Medicine, Pritzker School of Medicine, Illinois (T.N., A.D.B., G.A.U., Z.A.A., H.M.N., D.Y.S., R.T.)
| | - Dalise Y Shatz
- The University of Chicago Medicine, Pritzker School of Medicine, Illinois (T.N., A.D.B., G.A.U., Z.A.A., H.M.N., D.Y.S., R.T.)
- The University of Arizona College of Medicine - Phoenix, Banner - University Medical Center, Phoenix (J.P.W., M.Z., R.B., D.Y.S., W.S., R.T.)
| | - Shinsuke Miyazaki
- Tokyo Medical and Dental University, Department of Cardiovascular Medicine, Japan (T.N., S.M., M.G., T.S.)
| | - Masahiko Goya
- Tokyo Medical and Dental University, Department of Cardiovascular Medicine, Japan (T.N., S.M., M.G., T.S.)
| | - Tetsuo Sasano
- Tokyo Medical and Dental University, Department of Cardiovascular Medicine, Japan (T.N., S.M., M.G., T.S.)
| | - Wilber Su
- The University of Arizona College of Medicine - Phoenix, Banner - University Medical Center, Phoenix (J.P.W., M.Z., R.B., D.Y.S., W.S., R.T.)
| | | | - Roderick Tung
- The University of Chicago Medicine, Pritzker School of Medicine, Illinois (T.N., A.D.B., G.A.U., Z.A.A., H.M.N., D.Y.S., R.T.)
- The University of Arizona College of Medicine - Phoenix, Banner - University Medical Center, Phoenix (J.P.W., M.Z., R.B., D.Y.S., W.S., R.T.)
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Zhou S, AbdelWahab A, Wang R, Dang H, Warren JW, Sapp JL. Optimization of a 12-Lead Electrocardiography Subset for Automated Early Left Ventricular Activation Localization Approach Based on Pace-Mapping Technology. Can J Cardiol 2023; 39:1410-1416. [PMID: 37270167 DOI: 10.1016/j.cjca.2023.05.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Revised: 05/15/2023] [Accepted: 05/25/2023] [Indexed: 06/05/2023] Open
Abstract
BACKGROUND We previously developed an automated approach based on pace mapping to localise early left ventricular (LV) activation origin. To avoid a singular system, we require pacing from at least 2 more known sites than the number of electrocardiography (ECG) leads used. Fewer leads used means fewer pacing sites required. We sought to identify an optimal minimal ECG lead set for the automated approach. METHODS We used 1715 LV endocardial pacing sites to create derivation and testing data sets. The derivation data set, consisting of 1012 known pacing sites pooled from 38 patients, was used to identify an optimal 3-lead set by means of random forest regression (RFR), and a second 3-lead set by means of exhaustive search. The performance of these sets and the calculated Frank leads was compared within the testing data set with 703 pacing sites pooled from 25 patients. RESULTS The RFR yielded III, V1, and V4, whereas the exhaustive search identified leads II, V2 and V6. Comparison of these sets and the calculated Frank leads demonstrated similar performance when using 5 or more known pacing sites. Accuracy improved with additional pacing sites, achieving mean accuracy of < 5 mm, after including up to 9 pacing sites when they were focused on a suspected area of ventricular activation origin (radius < 10 mm). CONCLUSIONS The RFR identified the quasi-orthogonal leads set to localise the source of LV activation, minimizing the training set of pacing sites. Localization accuracy was high with the use of these leads and was not significantly different from using leads identified by exhaustive search or empiric use of Frank leads.
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Affiliation(s)
- Shijie Zhou
- Department of Chemical, Paper, and Biomedical Engineering, College of Engineering and Computing, Miami University, Oxford, Ohio, USA; Department of Electrical and Computer Engineering, College of Engineering and Computing, Miami University, Oxford, Ohio, USA.
| | - Amir AbdelWahab
- Cardiology Division, Department of Medicine, Queen Elizabeth II Health Sciences Centre, Halifax, Nova Scotia, Canada
| | | | - Huan Dang
- Department of Electrical and Computer Engineering, College of Engineering and Computing, Miami University, Oxford, Ohio, USA
| | - James W Warren
- Department of Physiology and Biophysics, Dalhousie University, Halifax, Nova Scotia, Canada
| | - John L Sapp
- Cardiology Division, Department of Medicine, Queen Elizabeth II Health Sciences Centre, Halifax, Nova Scotia, Canada
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Tanawuttiwat T, Kellett E, Das MK, Fore LJ, Miller JM. Ventricular tachycardia exacerbated by left bundle branch area pacing. HeartRhythm Case Rep 2023; 9:653-658. [PMID: 37746573 PMCID: PMC10511898 DOI: 10.1016/j.hrcr.2023.06.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/26/2023] Open
Affiliation(s)
| | - Eric Kellett
- Division of Cardiovascular Medicine, Indiana University, Indianapolis, Indiana
| | - Mithilesh K. Das
- Division of Cardiovascular Medicine, Indiana University, Indianapolis, Indiana
| | | | - John M. Miller
- Division of Cardiovascular Medicine, Indiana University, Indianapolis, Indiana
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6
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Freedman BL, Maher TR, Tracey M, Santangeli P, d'Avila A. Procedural Adaptations to Avoid Haemodynamic Instability During Catheter Ablation of Scar-related Ventricular Tachycardia. Arrhythm Electrophysiol Rev 2023; 12:e20. [PMID: 37465104 PMCID: PMC10350657 DOI: 10.15420/aer.2022.24] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Accepted: 12/08/2022] [Indexed: 07/20/2023] Open
Abstract
Classically, catheter ablation for scar-related ventricular tachycardia (VT) relied upon activation and entrainment mapping of induced VT. Advances in post-MI therapies have led to VTs that are faster and haemodynamically less stable, because of more heterogeneous myocardial fibrosis patterns. The PAINESD score is one means of identifying patients at highest risk for haemodynamic decompensation during attempted VT induction, who may, therefore, benefit from alternative ablation strategies. One strategy is to use temporary mechanical circulatory support, although this warrants formal assessment of cost-effectiveness. A second strategy is to minimise or avoid VT induction altogether by employing a family of 'substrate'-based approaches aimed at identifying VT isthmuses during sinus or paced rhythm. Substrate mapping techniques are diverse, and focus on the timing, morphology and amplitude of local ventricular electrograms - sometimes aided by advanced non-invasive cardiac imaging modalities. In this review, the evolution of VT ablation over time is discussed, with an emphasis on procedural adaptations to the challenge of haemodynamic instability.
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Affiliation(s)
- Benjamin L Freedman
- Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, US
| | - Timothy R Maher
- Harvard-Thorndike Electrophysiology Institute and Arrhythmia Service, Division of Cardiovascular Medicine, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, US
| | | | - Pasquale Santangeli
- Cardiovascular Division, Department of Medicine, Hospital of the University of Pennsylvania, Philadelphia, PA, US
| | - Andre d'Avila
- Harvard-Thorndike Electrophysiology Institute and Arrhythmia Service, Division of Cardiovascular Medicine, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, US
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7
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Kowalewski C, Ascione C, Nuñez-Garcia M, Ly B, Sermesant M, Bustin A, Sridi S, Bouteiller X, Yokoyama M, Vlachos K, Monaco C, Bouyer B, Buliard S, Arnaud M, Tixier R, Chauvel R, Derval N, Pambrun T, Duchateau J, Bordachar P, Hocini M, Hindricks G, Haïssaguerre M, Sacher F, Jais P, Cochet H. Advanced Imaging Integration for Catheter Ablation of Ventricular Tachycardia. Curr Cardiol Rep 2023; 25:535-542. [PMID: 37115434 DOI: 10.1007/s11886-023-01872-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/23/2023] [Indexed: 04/29/2023]
Abstract
PURPOSE OF REVIEW Imaging plays a crucial role in the therapy of ventricular tachycardia (VT). We offer an overview of the different methods and provide information on their use in a clinical setting. RECENT FINDINGS The use of imaging in VT has progressed recently. Intracardiac echography facilitates catheter navigation and the targeting of moving intracardiac structures. Integration of pre-procedural CT or MRI allows for targeting the VT substrate, with major expected impact on VT ablation efficacy and efficiency. Advances in computational modeling may further enhance the performance of imaging, giving access to pre-operative simulation of VT. These advances in non-invasive diagnosis are increasingly being coupled with non-invasive approaches for therapy delivery. This review highlights the latest research on the use of imaging in VT procedures. Image-based strategies are progressively shifting from using images as an adjunct tool to electrophysiological techniques, to an integration of imaging as a central element of the treatment strategy.
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Affiliation(s)
- Christopher Kowalewski
- Hôpital Cardiologique du Haut-Lévêque, CHU Bordeaux, L'Institut de RYthmologie et modélisation Cardiaque (LIRYC), Université Bordeaux, Bordeaux, France.
| | - Ciro Ascione
- Hôpital Cardiologique du Haut-Lévêque, CHU Bordeaux, L'Institut de RYthmologie et modélisation Cardiaque (LIRYC), Université Bordeaux, Bordeaux, France
| | - Marta Nuñez-Garcia
- Hôpital Cardiologique du Haut-Lévêque, CHU Bordeaux, L'Institut de RYthmologie et modélisation Cardiaque (LIRYC), Université Bordeaux, Bordeaux, France
| | - Buntheng Ly
- Hôpital Cardiologique du Haut-Lévêque, CHU Bordeaux, L'Institut de RYthmologie et modélisation Cardiaque (LIRYC), Université Bordeaux, Bordeaux, France
| | - Maxime Sermesant
- Hôpital Cardiologique du Haut-Lévêque, CHU Bordeaux, L'Institut de RYthmologie et modélisation Cardiaque (LIRYC), Université Bordeaux, Bordeaux, France
| | - Aurélien Bustin
- Hôpital Cardiologique du Haut-Lévêque, CHU Bordeaux, L'Institut de RYthmologie et modélisation Cardiaque (LIRYC), Université Bordeaux, Bordeaux, France
| | - Soumaya Sridi
- Hôpital Cardiologique du Haut-Lévêque, CHU Bordeaux, L'Institut de RYthmologie et modélisation Cardiaque (LIRYC), Université Bordeaux, Bordeaux, France
| | - Xavier Bouteiller
- Hôpital Cardiologique du Haut-Lévêque, CHU Bordeaux, L'Institut de RYthmologie et modélisation Cardiaque (LIRYC), Université Bordeaux, Bordeaux, France
| | - Masaaki Yokoyama
- Hôpital Cardiologique du Haut-Lévêque, CHU Bordeaux, L'Institut de RYthmologie et modélisation Cardiaque (LIRYC), Université Bordeaux, Bordeaux, France
| | - Konstantinos Vlachos
- Hôpital Cardiologique du Haut-Lévêque, CHU Bordeaux, L'Institut de RYthmologie et modélisation Cardiaque (LIRYC), Université Bordeaux, Bordeaux, France
| | - Cinzia Monaco
- Hôpital Cardiologique du Haut-Lévêque, CHU Bordeaux, L'Institut de RYthmologie et modélisation Cardiaque (LIRYC), Université Bordeaux, Bordeaux, France
| | - Benjamin Bouyer
- Hôpital Cardiologique du Haut-Lévêque, CHU Bordeaux, L'Institut de RYthmologie et modélisation Cardiaque (LIRYC), Université Bordeaux, Bordeaux, France
| | - Samuel Buliard
- Hôpital Cardiologique du Haut-Lévêque, CHU Bordeaux, L'Institut de RYthmologie et modélisation Cardiaque (LIRYC), Université Bordeaux, Bordeaux, France
| | - Marine Arnaud
- Hôpital Cardiologique du Haut-Lévêque, CHU Bordeaux, L'Institut de RYthmologie et modélisation Cardiaque (LIRYC), Université Bordeaux, Bordeaux, France
| | - Romain Tixier
- Hôpital Cardiologique du Haut-Lévêque, CHU Bordeaux, L'Institut de RYthmologie et modélisation Cardiaque (LIRYC), Université Bordeaux, Bordeaux, France
| | - Remi Chauvel
- Hôpital Cardiologique du Haut-Lévêque, CHU Bordeaux, L'Institut de RYthmologie et modélisation Cardiaque (LIRYC), Université Bordeaux, Bordeaux, France
| | - Nicolas Derval
- Hôpital Cardiologique du Haut-Lévêque, CHU Bordeaux, L'Institut de RYthmologie et modélisation Cardiaque (LIRYC), Université Bordeaux, Bordeaux, France
| | - Thomas Pambrun
- Hôpital Cardiologique du Haut-Lévêque, CHU Bordeaux, L'Institut de RYthmologie et modélisation Cardiaque (LIRYC), Université Bordeaux, Bordeaux, France
| | - Josselin Duchateau
- Hôpital Cardiologique du Haut-Lévêque, CHU Bordeaux, L'Institut de RYthmologie et modélisation Cardiaque (LIRYC), Université Bordeaux, Bordeaux, France
| | - Pierre Bordachar
- Hôpital Cardiologique du Haut-Lévêque, CHU Bordeaux, L'Institut de RYthmologie et modélisation Cardiaque (LIRYC), Université Bordeaux, Bordeaux, France
| | - Mélèze Hocini
- Hôpital Cardiologique du Haut-Lévêque, CHU Bordeaux, L'Institut de RYthmologie et modélisation Cardiaque (LIRYC), Université Bordeaux, Bordeaux, France
| | - Gerhard Hindricks
- Department of Cardiology, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Michel Haïssaguerre
- Hôpital Cardiologique du Haut-Lévêque, CHU Bordeaux, L'Institut de RYthmologie et modélisation Cardiaque (LIRYC), Université Bordeaux, Bordeaux, France
| | - Frédéric Sacher
- Hôpital Cardiologique du Haut-Lévêque, CHU Bordeaux, L'Institut de RYthmologie et modélisation Cardiaque (LIRYC), Université Bordeaux, Bordeaux, France
| | - Pierre Jais
- Hôpital Cardiologique du Haut-Lévêque, CHU Bordeaux, L'Institut de RYthmologie et modélisation Cardiaque (LIRYC), Université Bordeaux, Bordeaux, France
| | - Hubert Cochet
- Hôpital Cardiologique du Haut-Lévêque, CHU Bordeaux, L'Institut de RYthmologie et modélisation Cardiaque (LIRYC), Université Bordeaux, Bordeaux, France
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Nakasone K, Fukuzawa K, Kiuchi K, Takami M, Sakai J, Nakamura T, Yatomi A, Sonoda Y, Takahara H, Yamamoto K, Suzuki Y, Tani K, Iwai H, Nakanishi Y, Hirata K. Predictors of recurrence in patients without non-inducibility of ventricular tachycardia at the end of ablation. J Arrhythm 2023; 39:52-60. [PMID: 36733320 PMCID: PMC9885314 DOI: 10.1002/joa3.12796] [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: 07/15/2022] [Revised: 10/26/2022] [Accepted: 11/03/2022] [Indexed: 11/17/2022] Open
Abstract
Background Ventricular tachycardia (VT) non-inducibility at the end of ablation is associated with a less likely VT recurrence. However, it is not clear whether we should use VT non-inducibility as a routine end point of VT ablation. The aim of this study was to evaluate VT recurrence in patients in whom VT non-inducibility was not achieved at the end of the radiofrequency (RF) ablation and the factors attributing to the VT recurrence. Methods We analyzed that 62 patients in whom VT non-inducibility was not achieved at the end of the RF ablation were studied. Results Over 2 years, 22 (35%) of the cases had VT recurrences. A multivariate analysis showed that an LVEF ≥35% (HR: 0.19; 95% CI: 0.06-0.49; p < .01) and elimination of the clinical VT as an acute ablation efficacy (HR: 0.23; 95% CI: 0.04-0.81; p = .02) were independent predictors of fewer VT recurrences. RF ablation was associated with a 91.1% reduction in VT episodes. Conclusion Even if VT non-inducibility was not achieved, patients with an LVEF ≥35% or in whom the clinical VT could be eliminated might be prevented from having VT recurrences. The validity of the VT non-inducibility of any VT should be evaluated considering each patient's background and the results of the procedure.
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Affiliation(s)
- Kazutaka Nakasone
- Division of Cardiovascular Medicine, Department of Internal MedicineKobe University Graduate School of MedicineKobeJapan
| | - Koji Fukuzawa
- Division of Cardiovascular Medicine, Department of Internal MedicineKobe University Graduate School of MedicineKobeJapan
- Section of Arrhythmia, Division of Cardiovascular Medicine, Department of Internal MedicineKobe University Graduate School of MedicineKobeJapan
| | - Kunihiko Kiuchi
- Division of Cardiovascular Medicine, Department of Internal MedicineKobe University Graduate School of MedicineKobeJapan
- Section of Arrhythmia, Division of Cardiovascular Medicine, Department of Internal MedicineKobe University Graduate School of MedicineKobeJapan
| | - Mitsuru Takami
- Division of Cardiovascular Medicine, Department of Internal MedicineKobe University Graduate School of MedicineKobeJapan
| | - Jun Sakai
- Division of Cardiovascular Medicine, Department of Internal MedicineKobe University Graduate School of MedicineKobeJapan
| | - Toshihiro Nakamura
- Division of Cardiovascular Medicine, Department of Internal MedicineKobe University Graduate School of MedicineKobeJapan
| | - Atsusuke Yatomi
- Division of Cardiovascular Medicine, Department of Internal MedicineKobe University Graduate School of MedicineKobeJapan
| | - Yusuke Sonoda
- Division of Cardiovascular Medicine, Department of Internal MedicineKobe University Graduate School of MedicineKobeJapan
| | - Hiroyuki Takahara
- Division of Cardiovascular Medicine, Department of Internal MedicineKobe University Graduate School of MedicineKobeJapan
| | - Kyoko Yamamoto
- Division of Cardiovascular Medicine, Department of Internal MedicineKobe University Graduate School of MedicineKobeJapan
| | - Yuya Suzuki
- Division of Cardiovascular Medicine, Department of Internal MedicineKobe University Graduate School of MedicineKobeJapan
| | - Ken‐ichi Tani
- Division of Cardiovascular Medicine, Department of Internal MedicineKobe University Graduate School of MedicineKobeJapan
| | - Hidehiro Iwai
- Division of Cardiovascular Medicine, Department of Internal MedicineKobe University Graduate School of MedicineKobeJapan
| | - Yusuke Nakanishi
- Division of Cardiovascular Medicine, Department of Internal MedicineKobe University Graduate School of MedicineKobeJapan
| | - Ken‐ichi Hirata
- Division of Cardiovascular Medicine, Department of Internal MedicineKobe University Graduate School of MedicineKobeJapan
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Shivkumar K, Qu Z, Harvey R. Cardiac fibrosis in three dimensions - mechanistic insights into arrhythmic risk due to hypertrophy. J Physiol 2023; 601:249-250. [PMID: 36511350 PMCID: PMC9846953 DOI: 10.1113/jp283710] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Accepted: 12/12/2022] [Indexed: 12/15/2022] Open
Affiliation(s)
- Kalyanam Shivkumar
- UCLA Cardiac Arrhythmia Center, Department of Medicine, UCLA Health System, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Zhilin Qu
- UCLA Cardiac Arrhythmia Center, Department of Medicine, UCLA Health System, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
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10
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Hawson J, Al-Kaisey A, Anderson RD, Watts T, Morton J, Kumar S, Kistler P, Kalman J, Lee G. Substrate-based approaches in ventricular tachycardia ablation. Indian Pacing Electrophysiol J 2022; 22:273-285. [PMID: 36007824 PMCID: PMC9649336 DOI: 10.1016/j.ipej.2022.08.002] [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: 06/24/2022] [Revised: 07/23/2022] [Accepted: 08/16/2022] [Indexed: 11/30/2022] Open
Abstract
Catheter ablation for ventricular tachycardia (VT) in patients with structural heart disease is now part of standard care. Mapping and ablation of the clinical VT is often limited when the VT is noninducible, nonsustained or not haemodynamically tolerated. Substrate-based ablation strategies have been developed in an aim to treat VT in this setting and, subsequently, have been shown to improve outcomes in VT ablation when compared to focused ablation of mapped VTs. Since the initial description of linear ablation lines targeting ventricular scar, many different approaches to substrate-based VT ablation have been developed. Strategies can broadly be divided into three categories: 1) targeting abnormal electrograms, 2) anatomical targeting of conduction channels between areas of myocardial scar, and 3) targeting areas of slow and/or decremental conduction, identified with “functional” substrate mapping techniques. This review summarises contemporary substrate-based ablation strategies, along with their strengths and weaknesses.
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Affiliation(s)
- Joshua Hawson
- Department of Cardiology, Royal Melbourne Hospital, Melbourne, Victoria, Australia; Faculty of Medicine, Dentistry and Health Science, University of Melbourne, Melbourne, Victoria, Australia
| | - Ahmed Al-Kaisey
- Department of Cardiology, Royal Melbourne Hospital, Melbourne, Victoria, Australia; Faculty of Medicine, Dentistry and Health Science, University of Melbourne, Melbourne, Victoria, Australia
| | - Robert D Anderson
- Department of Cardiology, Royal Melbourne Hospital, Melbourne, Victoria, Australia; Faculty of Medicine, Dentistry and Health Science, University of Melbourne, Melbourne, Victoria, Australia
| | - Troy Watts
- Department of Cardiology, Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - Joseph Morton
- Department of Cardiology, Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - Saurabh Kumar
- Department of Cardiology, Westmead Hospital and Westmead Applied Research Centre, Westmead, New South Wales, Australia; Western Clinical School, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Peter Kistler
- Faculty of Medicine, Dentistry and Health Science, University of Melbourne, Melbourne, Victoria, Australia; Department of Cardiology, The Alfred Hospital, Melbourne, Victoria, Australia
| | - Jonathan Kalman
- Department of Cardiology, Royal Melbourne Hospital, Melbourne, Victoria, Australia; Faculty of Medicine, Dentistry and Health Science, University of Melbourne, Melbourne, Victoria, Australia
| | - Geoffrey Lee
- Department of Cardiology, Royal Melbourne Hospital, Melbourne, Victoria, Australia; Faculty of Medicine, Dentistry and Health Science, University of Melbourne, Melbourne, Victoria, Australia.
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11
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Ueda A, Katsume Y, Miwa Y, Mohri T, Tashiro M, Nonoguchi N, Hoshida K, Togashi I, Sato T, Soejima K. Temporal and Spatial Pacemap Parameters for Identification of Cardiac Surfaces with Critical Sites for Ventricular Tachycardia. J Cardiovasc Electrophysiol 2022; 33:1791-1800. [PMID: 35748391 DOI: 10.1111/jce.15611] [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: 02/25/2022] [Revised: 06/07/2022] [Accepted: 06/22/2022] [Indexed: 11/27/2022]
Abstract
INTRODUCTION Multi-surface pacemapping may help identify the surface of interest in scar-related ventricular tachycardia. This study aimed to investigate the performance of pacemap parameters for detecting critical sites through multi-surface mapping. METHODS AND RESULTS In 26 patients who underwent scar-related ventricular tachycardia ablation, pacemap parameters including a matching score, the difference between the longest and shortest stimulus-QRS intervals (Δs-QRS), and the distance between the good pacemap sites were measured. The parameters were compared between surfaces with and without critical sites and ablation outcomes. A total of 941 pacemaps at 56 surfaces targeting 35 ventricular tachycardias were analyzed. A greater Δs-QRS (40 vs. 8 ms, P<0.001) and longer distance between two good pacemap sites (24 vs. 13 mm, P<0.001) were observed on the surfaces with critical sites. A similar trend was seen in multi-surface pacemapping for the same ventricular tachycardias (52 vs 18 ms in Δs-QRS, P=0.021; 37 vs. 12 mm in distance, P=0.019), although the best pacemap scores were comparable (94 vs. 87, P=0.295). The Δs-QRS >20 ms and the distance >19 mm showed high positive likelihood ratios (19.8 and 6.1, respectively) for discriminating the surface harboring the critical site. Ablation of ventricular tachycardias fulfilling these parameters was successful on the surfaces, but without the required multi-surface ablation. CONCLUSION Temporal (Δs-QRS) and spatial (distance) parameters for good pacemap match sites were excellent markers for detecting the surface harboring critical sites in scar-related ventricular tachycardia. A multi-surface pacemapping can successfully identify the surface of interest. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Akiko Ueda
- Division of Advanced Arrhythmia Management, Kyorin University Hospital, 6-20-2 Shinkawa, Mitaka, Tokyo, 181-0004, Japan
| | - Yumi Katsume
- Department of Cardiovascular Medicine, Kyorin University Hospital, 6-20-2 Shinkawa, Mitaka, Tokyo, 181-0004, Japan
| | - Yosuke Miwa
- Department of Cardiovascular Medicine, Kyorin University Hospital, 6-20-2 Shinkawa, Mitaka, Tokyo, 181-0004, Japan
| | - Takato Mohri
- Department of Cardiovascular Medicine, Kyorin University Hospital, 6-20-2 Shinkawa, Mitaka, Tokyo, 181-0004, Japan
| | - Mika Tashiro
- Department of Cardiovascular Medicine, Kyorin University Hospital, 6-20-2 Shinkawa, Mitaka, Tokyo, 181-0004, Japan
| | - Noriko Nonoguchi
- Department of Cardiovascular Medicine, Kyorin University Hospital, 6-20-2 Shinkawa, Mitaka, Tokyo, 181-0004, Japan
| | - Kyoko Hoshida
- Department of Cardiovascular Medicine, Kyorin University Hospital, 6-20-2 Shinkawa, Mitaka, Tokyo, 181-0004, Japan
| | - Ikuko Togashi
- Division of Advanced Arrhythmia Management, Kyorin University Hospital, 6-20-2 Shinkawa, Mitaka, Tokyo, 181-0004, Japan
| | - Toshiaki Sato
- Division of Advanced Arrhythmia Management, Kyorin University Hospital, 6-20-2 Shinkawa, Mitaka, Tokyo, 181-0004, Japan
| | - Kyoko Soejima
- Department of Cardiovascular Medicine, Kyorin University Hospital, 6-20-2 Shinkawa, Mitaka, Tokyo, 181-0004, Japan
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12
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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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13
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Tung R, Xue Y, Chen M, Jiang C, Shatz DY, Besser S, Hu H, Chung FP, Nakahara S, Kim YH, Satomi K, Shen L, Liang E, Liao H, Gu K, Jiang R, Jiang J, Hori Y, Choi JI, Ueda A, Komatsu Y, Kazawa S, Soejima K, Chen SA, Nogami A, Yao Y. First-Line Catheter Ablation of Monomorphic Ventricular Tachycardia in Cardiomyopathy Concurrent with Defibrillator Implantation: The PAUSE-SCD Randomized Trial. Circulation 2022; 145:1839-1849. [PMID: 35507499 DOI: 10.1161/circulationaha.122.060039] [Citation(s) in RCA: 72] [Impact Index Per Article: 36.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Background: Catheter ablation as first-line therapy for ventricular tachycardia (VT) at the time of implantable cardioverter defibrillator (ICD) implantation has not been adopted into clinical guidelines. Also, there is an unmet clinical need to prospectively examine the role of VT ablation in patients with non-ischemic cardiomyopathy (NICM), an increasingly prevalent population referred for advanced therapies globally. Methods: We conducted an international, multi-center, randomized controlled trial enrolling 180 patients with cardiomyopathy and monomorphic VT with an indication for implantable cardioverter defibrillator (ICD) implantation to assess the role of early, first-line ablation therapy. A total of 121 patients were randomized (1:1) to ablation + an ICD versus conventional medical therapy + an ICD. Patients who refused ICD (n=47) were followed in a prospective registry after stand-alone ablation treatment. The primary outcome was a composite endpoint of VT recurrence, cardiovascular hospitalization, or death. Results: Randomized patients had a mean age of 55 years old (IQR 46-64) and left ventricular ejection fraction of 40 % (IQR 30-49 %); 81 % were male. The underlying heart disease was ischemic cardiomyopathy (ICM) in 35 %, NICM in 30 %, and arrhythmogenic cardiomyopathy (ARVC) in 35 %. Ablation was performed a median of 2 days prior to ICD implantation (IQR 5 days prior to 14 days after). At 31-months, the primary outcome occurred in 49.3 %of the ablation group and 65.5 % in the control group (HR 0.58, 95 % CI, 0.35-0.96; P=0.04). The observed difference was driven by a reduction in VT recurrence in the ablation arm (HR 0.51 [95 %CI, 0.29-0.90 ]; P=0.02). A statistically significant reduction in both ICD shocks (10.0 vs 24.6 %; p=0.03) and anti-tachycardia pacing (16.2 % vs 32.8 %; p=0.04) was observed in patients who underwent ablation compared with control. No differences in cardiovascular hospitalization (32.0 % vs. 33.7 %; HR 0.82 [95 % CI, 0.43-1.56 ]; P=0.55) or mortality (8.9% vs 8.8 %, HR 1.40 [95 %CI, 0.38-5.22 ]; P=0.62]) were observed. Ablation-related complications occurred in 8.3 % of patients. Conclusions: Among patients with cardiomyopathy of varied etiologies, early catheter ablation performed at the time of ICD implantation significantly reduced the composite primary outcome of VT recurrence, cardiovascular hospitalization, or death. These findings were driven by a reduction in ICD therapies.
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Affiliation(s)
- Roderick Tung
- The University of Chicago, Center for Arrhythmia Care, Pritzker School of Medicine, Chicago, IL; Guangdong Provincial People's Hospital, China; Department of Cardiology, Sir Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Yumei Xue
- Guangdong Provincial People's Hospital, China
| | - Minglong Chen
- The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Chenyang Jiang
- Department of Cardiology, Sir Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Dalise Y Shatz
- The University of Chicago, Center for Arrhythmia Care, Pritzker School of Medicine, Chicago, IL
| | - Stephanie Besser
- The University of Chicago, Center for Arrhythmia Care, Pritzker School of Medicine, Chicago, IL
| | - Hongde Hu
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, China
| | - Fa-Po Chung
- Taipei Veterans General Hospital, National Yang Ming Chiao Tung University, Taiwan
| | | | - Young-Hoon Kim
- Department of Cardiology, Korea University Medicine, Seoul, South Korea
| | | | - Lishui Shen
- Fuwai Hospital, Arrhythmia Center, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China
| | - Erpeng Liang
- Fuwai Hospital, Arrhythmia Center, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China
| | | | - Kai Gu
- The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Ruhong Jiang
- Department of Cardiology, Sir Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Jian Jiang
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, China
| | - Yuichi Hori
- Dokkyo Medical University Saitama Medical Center, Japan
| | - Jong-Il Choi
- Department of Cardiology, Korea University Medicine, Seoul, South Korea
| | - Akiko Ueda
- Division of Advanced Arrhythmia Management, Kyorin University Hospital, Japan
| | - Yuki Komatsu
- Department of Cardiology, University of Tsukuba, Japan
| | | | - Kyoko Soejima
- Division of Advanced Arrhythmia Management, Kyorin University Hospital, Japan
| | - Shih-Ann Chen
- Taipei Veterans General Hospital, National Yang Ming Chiao Tung University, Taiwan
| | | | - Yan Yao
- Fuwai Hospital, Arrhythmia Center, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China
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14
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Cetin M, Ornek E, Bastug S, Kara M, Deveci B, Korkmaz A, Ozeke O, Cay S, Ozcan F, Topaloglu S, Aras D. An Incessant Tachycardia with Alternating QRS Complexes: What Is the Mechanism? J Innov Card Rhythm Manag 2022; 13:4900-4904. [PMID: 35251760 PMCID: PMC8887927 DOI: 10.19102/icrm.2022.130203] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Accepted: 08/02/2021] [Indexed: 11/15/2022] Open
Abstract
We present a patient with ischemic cardiomyopathy who had ventricular tachycardia (VT) with QRS morphology alternans. The electrophysiological findings, in this case, supported the occurrence of antegrade activation of the proximal His–Purkinje system during VT, with the ultimate electrocardiogram morphology dependent on fusion from intramyocardial and His–Purkinje activations.
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Affiliation(s)
- Mustafa Cetin
- Department of Cardiology, Health Sciences University, Ankara City Hospital, Ankara, Turkey
| | - Ender Ornek
- Department of Cardiology, Health Sciences University, Ankara City Hospital, Ankara, Turkey
| | - Serdal Bastug
- Department of Cardiology, Ankara Yıldırım Beyazıt University School of Medicine, Ankara City Hospital, Ankara, Turkey
| | - Meryem Kara
- Department of Cardiology, Health Sciences University, Ankara City Hospital, Ankara, Turkey
| | - Bulent Deveci
- Department of Cardiology, Health Sciences University, Ankara City Hospital, Ankara, Turkey
| | - Ahmet Korkmaz
- Department of Cardiology, Health Sciences University, Ankara City Hospital, Ankara, Turkey
| | - Ozcan Ozeke
- Department of Cardiology, Health Sciences University, Ankara City Hospital, Ankara, Turkey
| | - Serkan Cay
- Department of Cardiology, Health Sciences University, Ankara City Hospital, Ankara, Turkey
| | - Firat Ozcan
- Department of Cardiology, Health Sciences University, Ankara City Hospital, Ankara, Turkey
| | - Serkan Topaloglu
- Department of Cardiology, Health Sciences University, Ankara City Hospital, Ankara, Turkey
| | - Dursun Aras
- Department of Cardiology, Health Sciences University, Ankara City Hospital, Ankara, Turkey
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15
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Bourier F, Busch S, Sommer P, Maurer T, Althoff T, Shin DI, Duncker D, Johnson V, Estner H, Rillig A, Bertagnolli L, Iden L, Deneke T, Tilz R, Metzner A, Chun J, Steven D. [Catheter ablation of ventricular tachycardias in patients with ischemic cardiomyopathy]. Herzschrittmacherther Elektrophysiol 2022; 33:88-97. [PMID: 35157112 DOI: 10.1007/s00399-022-00845-z] [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: 02/02/2022] [Accepted: 02/03/2022] [Indexed: 10/19/2022]
Abstract
Radiofrequency (RF) ablation is an effective treatment option of scar-related ventricular tachycardias (VT) in patients with ischemic cardiomyopathy. Several studies proved the benefit of VT catheter ablation, which has become routine in most electrophysiology laboratories. This article provides practical instructions to perform a VT catheter ablation. The authors describe conventional and substrate-based mapping and ablation strategies as well as concepts for image integration. This article continues a series of publications created for education in advanced electrophysiology.
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Affiliation(s)
- Felix Bourier
- Abteilung für Elektrophysiologie, Deutsches Herzzentrum München, Technische Universität München, München, Deutschland.
| | - Sonia Busch
- Medizinische Klinik, Klinikum Coburg GmbH, Coburg, Deutschland
| | - Philipp Sommer
- Klinik für Elektrophysiologie/Rhythmologie, Herz- und Diabeteszentrum NRW, Ruhr-Universität Bochum, Bad Oeynhausen, Deutschland
| | - Tilman Maurer
- Klinik für Kardiologie, Asklepios Klinik St. Georg, Hamburg, Deutschland
| | - Till Althoff
- Med. Klinik m.S. Kardiologie u. Angiologie, Charité - Universitätsmedizin Medizin Berlin, Berlin, Deutschland
| | - Dong-In Shin
- Klinik für Kardiologie, Herzzentrum Niederrhein, HELIOS Klinikum Krefeld, Krefeld, Deutschland.,Center for Clinical Medicine Witten-Herdecke, University Faculty of Health, Wuppertal, Deutschland
| | - David Duncker
- Hannover Herzrhythmus Centrum, Klinik für Kardiologie und Angiologie, Medizinische Hochschule Hannover, Hannover, Deutschland
| | - Victoria Johnson
- Klinik für Innere Medizin, Universitätsklinikum Gießen, Gießen, Deutschland
| | - Heidi Estner
- Medizinische Klinik und Poliklinik I, LMU Klinikum der Universität München, München, Deutschland
| | - Andreas Rillig
- Universitäres Herzzentrum Hamburg, Universitätsklinikum Eppendorf, Hamburg, Deutschland
| | - Livio Bertagnolli
- Abteilung für Rhythmologie, Herzzentrum HELIOS Leipzig, Leipzig, Deutschland
| | - Leon Iden
- Klinik für Kardiologie, Herz- und Gefäßzentrum Bad Segeberg, Bad Segeberg, Deutschland
| | - Thomas Deneke
- Klinik für Kardiologie, Rhön-Klinikum, Campus Bad Neustadt, Bad Neustadt a. d. Saale, Deutschland
| | - Roland Tilz
- Sektion für Elektrophysiologie, Medizinische Klinik II, Universitäres Herzzentrum Lübeck, Universitätsklinikum Schleswig-Holstein (UKSH), Lübeck, Deutschland
| | - Andreas Metzner
- Universitäres Herzzentrum Hamburg, Universitätsklinikum Eppendorf, Hamburg, Deutschland
| | - Julian Chun
- Cardioangiologisches Centrum Bethanien - CCB, Frankfurt, Deutschland
| | - Daniel Steven
- Abteilung für Elektrophysiologie, Herzzentrum der Uniklinik Köln, Köln, Deutschland
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16
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Ciaccio EJ, Anter E, Coromilas J, Wan EY, Yarmohammadi H, Wit AL, Peters NS, Garan H. Structure and function of the ventricular tachycardia isthmus. Heart Rhythm 2022; 19:137-153. [PMID: 34371192 DOI: 10.1016/j.hrthm.2021.08.001] [Citation(s) in RCA: 31] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2021] [Revised: 07/22/2021] [Accepted: 08/01/2021] [Indexed: 12/24/2022]
Abstract
Catheter ablation of postinfarction reentrant ventricular tachycardia (VT) has received renewed interest owing to the increased availability of high-resolution electroanatomic mapping systems that can describe the VT circuits in greater detail, and the emergence and need to target noninvasive external beam radioablation. These recent advancements provide optimism for improving the clinical outcome of VT ablation in patients with postinfarction and potentially other scar-related VTs. The combination of analyses gleaned from studies in swine and canine models of postinfarction reentrant VT, and in human studies, suggests the existence of common electroanatomic properties for reentrant VT circuits. Characterizing these properties may be useful for increasing the specificity of substrate mapping techniques and for noninvasive identification to guide ablation. Herein, we describe properties of reentrant VT circuits that may assist in elucidating the mechanisms of onset and maintenance, as well as a means to localize and delineate optimal catheter ablation targets.
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Affiliation(s)
- Edward J Ciaccio
- Department of Medicine, Division of Cardiology, Columbia University College of Physicians and Surgeons, New York, New York; ElectroCardioMaths Programme, Imperial Centre for Cardiac Engineering, Imperial College London, London, United Kingdom.
| | - Elad Anter
- Department of Cardiovascular Medicine, Cardiac Electrophysiology, Cleveland Clinic, Cleveland, Ohio
| | - James Coromilas
- Department of Medicine, Division of Cardiovascular Disease and Hypertension, Rutgers University, New Brunswick, New Jersey
| | - Elaine Y Wan
- Department of Medicine, Division of Cardiology, Columbia University College of Physicians and Surgeons, New York, New York
| | - Hirad Yarmohammadi
- Department of Medicine, Division of Cardiology, Columbia University College of Physicians and Surgeons, New York, New York
| | - Andrew L Wit
- Department of Pharmacology, Columbia University College of Physicians and Surgeons, New York, New York
| | - Nicholas S Peters
- ElectroCardioMaths Programme, Imperial Centre for Cardiac Engineering, Imperial College London, London, United Kingdom
| | - Hasan Garan
- Department of Medicine, Division of Cardiology, Columbia University College of Physicians and Surgeons, New York, New York
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17
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Hattori M, Komatsu Y, Naeemah QJ, Hanaki Y, Ichihara N, Ota C, Machino T, Kuroki K, Yamasaki H, Igarashi M, Aonuma K, Nogami A, Ieda M. Rotational Activation Pattern During Functional Substrate Mapping: Novel Target for Catheter Ablation of Scar-Related Ventricular Tachycardia. Circ Arrhythm Electrophysiol 2021; 15:e010308. [PMID: 34937390 PMCID: PMC8772437 DOI: 10.1161/circep.121.010308] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Recent advancements in a 3-dimensional mapping system allow for the assessment of detailed conduction properties during sinus rhythm and thus the establishment of a strategy targeting functionally abnormal regions in scar-related ventricular tachycardia (VT). We hypothesized that a rotational activation pattern (RAP) observed in maps during baseline rhythm was associated with the critical location of VT. METHODS We retrospectively examined the pattern of wavefront propagation during sinus rhythm in patients with scar-related VT. The prevalence and features of the RAP on critical VT circuits were analyzed. RAP was defined as >90° of inward curvature directly above or at the edge of the slow conductive areas. RESULTS Forty-five VTs in 37 patients (66±15 years old, 89% male, 27% ischemic heart disease) were evaluated. High-density substrate mapping during sinus rhythm (median, 2524 points) was performed using the CARTO3 system before VT induction. Critical sites for reentry were identified by direct termination by radiofrequency catheter ablation in 21 VTs or by pace mapping in 12 VTs. Among them, RAP was present in 70% of the 33 VTs. Four VTs had no RAP at the critical sites during sinus rhythm, but it became visible in the mappings with different wavefront directions. Six VTs, in which intramural or epicardial isthmus was suspected, were rendered noninducible by radiofrequency catheter ablation to the endocardial surface without RAP. RAP had a sensitivity and specificity of 70% and 89%, respectively, for predicting the elements in the critical zone for VT. CONCLUSIONS The critical zone of VT appears to correspond to an area characterized by the RAP with slow conduction during sinus rhythm, which facilitates targeting areas specific for reentry. However, this may not be applicable to intramural VT substrates and might be affected by the direction of wavefront propagation to the scar during mapping.
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Affiliation(s)
- Masayuki Hattori
- Department of Cardiology, Faculty of Medicine, University of Tsukuba, Japan
| | - Yuki Komatsu
- Department of Cardiology, Faculty of Medicine, University of Tsukuba, Japan
| | - Qasim J Naeemah
- Department of Cardiology, Faculty of Medicine, University of Tsukuba, Japan
| | - Yuichi Hanaki
- Department of Cardiology, Faculty of Medicine, University of Tsukuba, Japan
| | - Noboru Ichihara
- Department of Cardiology, Faculty of Medicine, University of Tsukuba, Japan
| | - Chihiro Ota
- Department of Cardiology, Faculty of Medicine, University of Tsukuba, Japan
| | - Takeshi Machino
- Department of Cardiology, Faculty of Medicine, University of Tsukuba, Japan
| | - Kenji Kuroki
- Department of Cardiology, Faculty of Medicine, University of Tsukuba, Japan
| | - Hiro Yamasaki
- Department of Cardiology, Faculty of Medicine, University of Tsukuba, Japan
| | - Miyako Igarashi
- Department of Cardiology, Faculty of Medicine, University of Tsukuba, Japan
| | - Kazutaka Aonuma
- Department of Cardiology, Faculty of Medicine, University of Tsukuba, Japan
| | - Akihiko Nogami
- Department of Cardiology, Faculty of Medicine, University of Tsukuba, Japan
| | - Masaki Ieda
- Department of Cardiology, Faculty of Medicine, University of Tsukuba, Japan
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18
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Itoh T, Kimura M, Ishida Y, Tomita H. Multiple exit sites identification by pace mapping with a grid catheter: Which bipolar pairs are in the critical ventricular tachycardia isthmus? HeartRhythm Case Rep 2021; 7:776-779. [PMID: 34820279 PMCID: PMC8602121 DOI: 10.1016/j.hrcr.2021.08.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Affiliation(s)
- Taihei Itoh
- Department of Cardiology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Masaomi Kimura
- Department of Cardiology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Yuji Ishida
- Department of Cardiology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Hirofumi Tomita
- Department of Cardiology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
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19
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Three-dimensional electroanatomic mapping and radiofrequency catheter ablation of ventricular arrhythmia in a dog without structural heart disease. J Vet Cardiol 2021; 39:14-21. [PMID: 34923431 DOI: 10.1016/j.jvc.2021.11.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2021] [Revised: 11/08/2021] [Accepted: 11/09/2021] [Indexed: 11/22/2022]
Abstract
A 1.5-year-old, female-spayed mix-breed dog was presented with recurrent episodes of shaking and excessive panting attributed to drug-refractory ventricular arrhythmia (VA) characterized predominantly by incessant periods of ventricular bigeminy. The VA had a narrow QRS morphology, suggestive of an origin near the His bundle or fascicular system. Diagnostic evaluation found no structural heart disease or underlying etiology. Three-dimensional electroanatomic mapping and radiofrequency catheter ablation were pursued. Voltage mapping demonstrated normal bi-ventricular voltage (≥1.5 mV) without any fractionated or multicomponent electrograms, indicating the absence of ventricular myocardial scar. Pace mapping identified an endocardial origin of the VA at the basal anterior septum of the left ventricle, distal to the His bundle and near the left bundle branch. Two ablation lesions were delivered to this site, and a left bundle branch block was temporarily induced. The dog recovered uneventfully. One month later, the owners reported a remarkable improvement in clinical signs, and follow-up 48-h Holter monitor found complete resolution of VA.
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20
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Whitaker J, Neji R, Kim S, Connolly A, Aubriot T, Calvo JJ, Karim R, Roney CH, Murfin B, Richardson C, Morgan S, Ismail TF, Harrison J, de Vos J, Aalders MCG, Williams SE, Mukherjee R, O'Neill L, Chubb H, Tschabrunn C, Anter E, Camporota L, Niederer S, Roujol S, Bishop MJ, Wright M, Silberbauer J, Razavi R, O'Neill M. Late Gadolinium Enhancement Cardiovascular Magnetic Resonance Assessment of Substrate for Ventricular Tachycardia With Hemodynamic Compromise. Front Cardiovasc Med 2021; 8:744779. [PMID: 34765656 PMCID: PMC8576410 DOI: 10.3389/fcvm.2021.744779] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Accepted: 09/20/2021] [Indexed: 11/13/2022] Open
Abstract
Background: The majority of data regarding tissue substrate for post myocardial infarction (MI) VT has been collected during hemodynamically tolerated VT, which may be distinct from the substrate responsible for VT with hemodynamic compromise (VT-HC). This study aimed to characterize tissue at diastolic locations of VT-HC in a porcine model. Methods: Late Gadolinium Enhancement (LGE) cardiovascular magnetic resonance (CMR) imaging was performed in eight pigs with healed antero-septal infarcts. Seven pigs underwent electrophysiology study with venous arterial-extra corporeal membrane oxygenation (VA-ECMO) support. Tissue thickness, scar and heterogeneous tissue (HT) transmurality were calculated at the location of the diastolic electrograms of mapped VT-HC. Results: Diastolic locations had median scar transmurality of 33.1% and a median HT transmurality 7.6%. Diastolic activation was found within areas of non-transmural scar in 80.1% of cases. Tissue activated during the diastolic component of VT circuits was thinner than healthy tissue (median thickness: 5.5 mm vs. 8.2 mm healthy tissue, p < 0.0001) and closer to HT (median distance diastolic tissue: 2.8 mm vs. 11.4 mm healthy tissue, p < 0.0001). Non-scarred regions with diastolic activation were closer to steep gradients in thickness than non-scarred locations with normal EGMs (diastolic locations distance = 1.19 mm vs. 9.67 mm for non-diastolic locations, p < 0.0001). Sites activated late in diastole were closest to steep gradients in tissue thickness. Conclusions: Non-transmural scar, mildly decreased tissue thickness, and steep gradients in tissue thickness represent the structural characteristics of the diastolic component of reentrant circuits in VT-HC in this porcine model and could form the basis for imaging criteria to define ablation targets in future trials.
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Affiliation(s)
- John Whitaker
- School of Biomedical Engineering and Imaging Sciences, King's College, London, United Kingdom
| | - Radhouene Neji
- School of Biomedical Engineering and Imaging Sciences, King's College, London, United Kingdom.,Siemens Healthcare, Frimley, United Kingdom
| | - Steven Kim
- Abbott Medical, St Paul, MN, United States
| | - Adam Connolly
- School of Biomedical Engineering and Imaging Sciences, King's College, London, United Kingdom
| | | | - Justo Juliá Calvo
- Brighton and Sussex University Hospitals NHS Trust, Brighton, United Kingdom
| | - Rashed Karim
- School of Biomedical Engineering and Imaging Sciences, King's College, London, United Kingdom
| | - Caroline H Roney
- School of Biomedical Engineering and Imaging Sciences, King's College, London, United Kingdom
| | - Brendan Murfin
- Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
| | - Carla Richardson
- Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
| | - Stephen Morgan
- Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
| | - Tevfik F Ismail
- School of Biomedical Engineering and Imaging Sciences, King's College, London, United Kingdom.,Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
| | - James Harrison
- School of Biomedical Engineering and Imaging Sciences, King's College, London, United Kingdom
| | - Judith de Vos
- Department of Biomedical Engineering and Physics, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
| | - Maurice C G Aalders
- Department of Biomedical Engineering and Physics, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
| | - Steven E Williams
- School of Biomedical Engineering and Imaging Sciences, King's College, London, United Kingdom.,Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, United Kingdom
| | - Rahul Mukherjee
- School of Biomedical Engineering and Imaging Sciences, King's College, London, United Kingdom
| | - Louisa O'Neill
- School of Biomedical Engineering and Imaging Sciences, King's College, London, United Kingdom
| | - Henry Chubb
- School of Biomedical Engineering and Imaging Sciences, King's College, London, United Kingdom
| | - Cory Tschabrunn
- Division of Cardiovascular Medicine, University of Pennsylvania, Philadelphia, PA, United States
| | - Elad Anter
- Cleveland Clinic, Cleveland, OH, United States
| | - Luigi Camporota
- Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
| | - Steven Niederer
- School of Biomedical Engineering and Imaging Sciences, King's College, London, United Kingdom
| | - Sébastien Roujol
- School of Biomedical Engineering and Imaging Sciences, King's College, London, United Kingdom
| | - Martin J Bishop
- School of Biomedical Engineering and Imaging Sciences, King's College, London, United Kingdom
| | - Matthew Wright
- Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
| | - John Silberbauer
- Brighton and Sussex University Hospitals NHS Trust, Brighton, United Kingdom
| | - Reza Razavi
- School of Biomedical Engineering and Imaging Sciences, King's College, London, United Kingdom
| | - Mark O'Neill
- School of Biomedical Engineering and Imaging Sciences, King's College, London, United Kingdom
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21
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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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22
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Hanaki Y, Komatsu Y, Nogami A, Kowase S, Kurosaki K, Sekiguchi Y, Aonuma K, Ieda M. Combined endo- and epicardial pace-mapping to localize ventricular tachycardia isthmus in ischaemic and non-ischaemic cardiomyopathy. Europace 2021; 24:587-597. [PMID: 34543395 DOI: 10.1093/europace/euab245] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Accepted: 09/03/2021] [Indexed: 11/12/2022] Open
Abstract
AIMS A high-density pace-mapping can depict an abrupt transition in paced QRS morphology from a poor to excellent match, unmasking the critical component of ventricular tachycardia (VT) isthmus from the entrance to exit. We sought to assess pace-mapping at multiple sites within the endo- and epicardial scars to identify the VT isthmus in patients with ischaemic (ICM) and non-ischaemic cardiomyopathy (NICM). METHODS AND RESULTS Colour-coded maps correlating to the percentage matches between 12-lead electrocardiograms during VT and pace-mapping [referred to as correlation score maps (CSMs)] were analysed. We studied 115 CSMs (80 endo- and 35 epicardial CSMs) in 37 patients (17 ICM, 20 NICM). The CSM with an abrupt change (AC) in pacemap score (AC-type) on the endocardium was more frequently observed in ICM than in NICM [11/39 (28%) vs. 1/41 (2%); P = 0.001]. Among 35 CSMs that were analysed by the combined endo- and epicardial mapping, 10 (29%) CSMs exhibited non-AC-type on the endocardium; however, AC-type was present on the opposite epicardium. Although 24 (69%) CSMs did not show AC-type on both the endocardium and epicardium, 16 of them had either an excellent (>90%) or poor (<0%) correlation score on either side, associated with isthmus exit or entrance, respectively. However, the remaining eight CSMs had neither excellent nor poor scores. CONCLUSION The CSM may provide electrophysiological information to localize the endo- and epicardial VT isthmus. The absence of AC-type CSM on the endocardium, which is frequently observed in NICM, appears to indicate the sub-epicardial or intramural course of the critical isthmus.
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Affiliation(s)
- Yuichi Hanaki
- Department of Cardiology, Faculty of Medicine, University of Tsukuba, 1-1-1 Tennodai, Tsukuba 305-8575, Japan
| | - Yuki Komatsu
- Department of Cardiology, Faculty of Medicine, University of Tsukuba, 1-1-1 Tennodai, Tsukuba 305-8575, Japan
| | - Akihiko Nogami
- Department of Cardiology, Faculty of Medicine, University of Tsukuba, 1-1-1 Tennodai, Tsukuba 305-8575, Japan
| | - Shinya Kowase
- Department of Heart Rhythm management, Yokohama Rosai Hospital, Yokohama, Japan
| | - Kenji Kurosaki
- Department of Heart Rhythm management, Yokohama Rosai Hospital, Yokohama, Japan
| | - Yukio Sekiguchi
- Department of Cardiology, Faculty of Medicine, University of Tsukuba, 1-1-1 Tennodai, Tsukuba 305-8575, Japan
| | - Kazutaka Aonuma
- Department of Cardiology, Faculty of Medicine, University of Tsukuba, 1-1-1 Tennodai, Tsukuba 305-8575, Japan
| | - Masaki Ieda
- Department of Cardiology, Faculty of Medicine, University of Tsukuba, 1-1-1 Tennodai, Tsukuba 305-8575, Japan
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23
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Muser D, Santangeli P. Why does catheter ablation of premature ventricular contractions in arrhythmogenic right ventricular cardiomyopathy fail? J Cardiovasc Electrophysiol 2021; 32:1675-1677. [PMID: 33783894 DOI: 10.1111/jce.15022] [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] [Received: 03/11/2021] [Accepted: 03/16/2021] [Indexed: 11/28/2022]
Affiliation(s)
- Daniele Muser
- Cardiac Electrophysiology, Cardiovascular Medicine Division, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Pasquale Santangeli
- Cardiac Electrophysiology, Cardiovascular Medicine Division, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
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24
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Conte E, Mushtaq S, Carbucicchio C, Piperno G, Catto V, Mancini ME, Formenti A, Annoni A, Guglielmo M, Baggiano A, Muscogiuri G, Belmonte M, Cattani F, Pontone G, Jereczek-Fossa BA, Orecchia R, Tondo C, Andreini D. State of the art paper: Cardiovascular CT for planning ventricular tachycardia ablation procedures. J Cardiovasc Comput Tomogr 2021; 15:394-402. [PMID: 33563533 DOI: 10.1016/j.jcct.2021.01.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Revised: 12/22/2020] [Accepted: 01/21/2021] [Indexed: 10/22/2022]
Abstract
In the last 20 years coronary computed tomography angiography (CCTA) gained a pivotal role in the evaluation of patients with suspected coronary artery disease (CAD) as finally recognized by the ESC guidelines on stable CAD. Technological advances have progressively improved the temporal resolution of CT scanners, contemporary reducing acquisition time, radiation dose and contrast volume needed for the whole heart volume acquisition, further expanding the role of cardiac CT beyond coronary anatomy evaluation. Aim of the present review is to discuss use and benefit of cardiac CT for the planning and preparation of VT ablation.
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Affiliation(s)
| | | | | | - Gaia Piperno
- Division of Radiotherapy IEO, European Institute of Oncology, IRCCS, Milan, Italy
| | | | | | | | | | | | | | | | | | - Federica Cattani
- Unit of Medical Physics, IEO European Institute of Oncology, IRCCS, Milan, Italy
| | | | - Barbara Alicja Jereczek-Fossa
- Unit of Medical Physics, IEO European Institute of Oncology, IRCCS, Milan, Italy; Department of Oncology and Hemato-oncology, University of Milan, Milan, Italy
| | - Roberto Orecchia
- Scientific Directorate, IEO European Institute of Oncology, IRCCS, Milan, Italy
| | - Claudio Tondo
- Centro Cardiologico Monzino, IRCCS, Milan, Italy; Department of Clinical Sciences and Community Health, Cardiovascular Section, University of Milan, Milan, Italy
| | - Daniele Andreini
- Centro Cardiologico Monzino, IRCCS, Milan, Italy; Department of Clinical Sciences and Community Health, Cardiovascular Section, University of Milan, Milan, Italy.
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25
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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: 232] [Impact Index Per Article: 58.0] [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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26
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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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27
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Monaci S, Strocchi M, Rodero C, Gillette K, Whitaker J, Rajani R, Rinaldi CA, O'Neill M, Plank G, King A, Bishop MJ. In-silico pace-mapping using a detailed whole torso model and implanted electronic device electrograms for more efficient ablation planning. Comput Biol Med 2020; 125:104005. [PMID: 32971325 DOI: 10.1016/j.compbiomed.2020.104005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Revised: 09/07/2020] [Accepted: 09/07/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Pace-mapping is a commonly used electrophysiological (EP) procedure which aims to identify exit sites of ventricular tachycardia (VT) by matching ventricular activation patterns (assessed by QRS morphology) at specific pacing locations with activation during VT. However, long procedure durations and the need for VT induction render this technique non-optimal. To demonstrate the potential of in-silico pace-mapping, using stored electrogram (EGM) recordings of clinical VT from implanted devices to guide pre-procedural ablation planning. METHOD Six scar-related VT episodes were simulated in a 3D torso model reconstructed from computed tomography (CT) imaging data, including three different infarct anatomies mapped from infarcted porcine imaging data. In-silico pace-mapping was performed to localise VT exit sites and isthmuses by using 12-lead electrocardiogram (ECG) signals and different combinations of EGM sensing vectors from implanted devices, through the creation of conventional correlation maps and reference-less maps. RESULTS Our in-silico platform was successful in identifying VT exit sites for a variety of different VT morphologies from both ECG correlation maps and corresponding EGM maps, with the latter dependent upon the number of sensing vectors used. We also showed the added utility of both ECG and EGM reference-less pace-mapping for the identification of slow-conducting isthmuses, uncovering the optimal algorithm parameters. Finally, EGM-based pace-mapping was shown to be more dependent upon the mapped surface (epicardial/endocardial), relative to the VT origin. CONCLUSIONS In-silico pace-mapping can be used along with EGMs from implanted devices to localise VT ablation targets in pre-procedural planning.
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Affiliation(s)
| | | | | | | | | | - Ronak Rajani
- King's College London, London, United Kingdom; Guy's and St Thomas' Hospital, London, United Kingdom
| | - Christopher A Rinaldi
- King's College London, London, United Kingdom; Guy's and St Thomas' Hospital, London, United Kingdom
| | | | | | - Andrew King
- King's College London, London, United Kingdom
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28
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Kim Y, Chen S, Ernst S, Guzman CE, Han S, Kalarus Z, Labadet C, Lin Y, Lo L, Nogami A, Saad EB, Sapp J, Sticherling C, Tilz R, Tung R, Kim YG, Stiles MK. 2019 APHRS expert consensus statement on three-dimensional mapping systems for tachycardia developed in collaboration with HRS, EHRA, and LAHRS. J Arrhythm 2020; 36:215-270. [PMID: 32256872 PMCID: PMC7132207 DOI: 10.1002/joa3.12308] [Citation(s) in RCA: 64] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2020] [Accepted: 01/20/2020] [Indexed: 12/24/2022] Open
Affiliation(s)
- Young‐Hoon Kim
- Department of Internal MedicineArrhythmia CenterKorea University Medicine Anam HospitalSeoulRepublic of Korea
| | - Shih‐Ann Chen
- Division of CardiologyDepartment of MedicineTaipei Veterans General HospitalTaipeiROC
| | - Sabine Ernst
- Department of CardiologyRoyal Brompton and Harefield HospitalImperial College LondonLondonUK
| | | | - Seongwook Han
- Division of CardiologyDepartment of Internal MedicineKeimyung University School of MedicineDaeguRepublic of Korea
| | - Zbigniew Kalarus
- Department of CardiologyMedical University of SilesiaKatowicePoland
| | - Carlos Labadet
- Cardiology DepartmentArrhythmias and Electrophysiology ServiceClinica y Maternidad Suizo ArgentinaBuenos AiresArgentina
| | - Yenn‐Jian Lin
- Division of CardiologyDepartment of MedicineTaipei Veterans General HospitalTaipeiROC
| | - Li‐Wei Lo
- Division of CardiologyDepartment of MedicineTaipei Veterans General HospitalTaipeiROC
| | - Akihiko Nogami
- Department of CardiologyFaculty of MedicineUniversity of TsukubaTsukubaJapan
| | - Eduardo B. Saad
- Center for Atrial FibrillationHospital Pro‐CardiacoRio de JaneiroBrazil
| | - John Sapp
- Division of CardiologyDepartment of MedicineQEII Health Sciences CentreDalhousie UniversityHalifaxNSCanada
| | | | - Roland Tilz
- Medical Clinic II (Department of Cardiology, Angiology and Intensive Care Medicine)University Hospital Schleswig‐Holstein (UKSH) – Campus LuebeckLuebeckGermany
| | - Roderick Tung
- Center for Arrhythmia CarePritzker School of MedicineUniversity of Chicago MedicineChicagoILUSA
| | - Yun Gi Kim
- Department of Internal MedicineArrhythmia CenterKorea University Medicine Anam HospitalSeoulRepublic of Korea
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29
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Graham AJ, Orini M, Zacur E, Dhillon G, Daw H, Srinivasan NT, Martin C, Lane J, Mansell JS, Cambridge A, Garcia J, Pugliese F, Segal O, Ahsan S, Lowe M, Finlay M, Earley MJ, Chow A, Sporton S, Dhinoja M, Hunter RJ, Schilling RJ, Lambiase PD. Evaluation of ECG Imaging to Map Hemodynamically Stable and Unstable Ventricular Arrhythmias. Circ Arrhythm Electrophysiol 2020; 13:e007377. [PMID: 31934784 DOI: 10.1161/circep.119.007377] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND ECG imaging (ECGI) has been used to guide treatment of ventricular ectopy and arrhythmias. However, the accuracy of ECGI in localizing the origin of arrhythmias during catheter ablation of ventricular tachycardia (VT) in structurally abnormal hearts remains to be fully validated. METHODS During catheter ablation of VT, simultaneous mapping was performed using electroanatomical mapping (CARTO, Biosense-Webster) and ECGI (CardioInsight, Medtronic) in 18 patients. Sites of entrainment, pace-mapping, and termination during ablation were used to define the VT site of origin (SoO). Distance between SoO and the site of earliest activation on ECGI were measured using co-registered geometries from both systems. The accuracy of ECGI versus a 12-lead surface ECG algorithm was compared. RESULTS A total of 29 VTs were available for comparison. Distance between SoO and sites of earliest activation in ECGI was 22.6, 13.9 to 36.2 mm (median, first to third quartile). ECGI mapped VT sites of origin onto the correct AHA segment with higher accuracy than a validated 12-lead ECG algorithm (83.3% versus 38.9%; P=0.015). CONCLUSIONS This simultaneous assessment demonstrates that CardioInsight localizes VT circuits with sufficient accuracy to provide a region of interest for targeting mapping for ablation. Resolution is not sufficient to guide discrete radiofrequency lesion delivery via catheter ablation without concomitant use of an electroanatomical mapping system but may be sufficient for segmental ablation with radiotherapy.
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Affiliation(s)
- Adam J Graham
- Barts Heart Centre, Barts Health NHS Trust, London, United Kingdom (A.J.G., M.O., G.D., H.D., N.T.S., C.M., J.L., J.S.M., A.C., J.G., F.P., O.S., S.A., M.L., M.F., M.J.E., A.C., S.S., M.D., R.J.H., R.J.S., P.D.L.)
| | - Michele Orini
- Barts Heart Centre, Barts Health NHS Trust, London, United Kingdom (A.J.G., M.O., G.D., H.D., N.T.S., C.M., J.L., J.S.M., A.C., J.G., F.P., O.S., S.A., M.L., M.F., M.J.E., A.C., S.S., M.D., R.J.H., R.J.S., P.D.L.).,Institute of Cardiovascular Science, University College London, United Kingdom (M.O., P.D.L.)
| | - Ernesto Zacur
- Institute of Biomedical Engineering, University of Oxford, United Kingdom (E.Z.)
| | - Gurpreet Dhillon
- Barts Heart Centre, Barts Health NHS Trust, London, United Kingdom (A.J.G., M.O., G.D., H.D., N.T.S., C.M., J.L., J.S.M., A.C., J.G., F.P., O.S., S.A., M.L., M.F., M.J.E., A.C., S.S., M.D., R.J.H., R.J.S., P.D.L.)
| | - Holly Daw
- Barts Heart Centre, Barts Health NHS Trust, London, United Kingdom (A.J.G., M.O., G.D., H.D., N.T.S., C.M., J.L., J.S.M., A.C., J.G., F.P., O.S., S.A., M.L., M.F., M.J.E., A.C., S.S., M.D., R.J.H., R.J.S., P.D.L.)
| | - Neil T Srinivasan
- Barts Heart Centre, Barts Health NHS Trust, London, United Kingdom (A.J.G., M.O., G.D., H.D., N.T.S., C.M., J.L., J.S.M., A.C., J.G., F.P., O.S., S.A., M.L., M.F., M.J.E., A.C., S.S., M.D., R.J.H., R.J.S., P.D.L.)
| | - Claire Martin
- Barts Heart Centre, Barts Health NHS Trust, London, United Kingdom (A.J.G., M.O., G.D., H.D., N.T.S., C.M., J.L., J.S.M., A.C., J.G., F.P., O.S., S.A., M.L., M.F., M.J.E., A.C., S.S., M.D., R.J.H., R.J.S., P.D.L.)
| | - Jem Lane
- Barts Heart Centre, Barts Health NHS Trust, London, United Kingdom (A.J.G., M.O., G.D., H.D., N.T.S., C.M., J.L., J.S.M., A.C., J.G., F.P., O.S., S.A., M.L., M.F., M.J.E., A.C., S.S., M.D., R.J.H., R.J.S., P.D.L.)
| | - Josephine S Mansell
- Barts Heart Centre, Barts Health NHS Trust, London, United Kingdom (A.J.G., M.O., G.D., H.D., N.T.S., C.M., J.L., J.S.M., A.C., J.G., F.P., O.S., S.A., M.L., M.F., M.J.E., A.C., S.S., M.D., R.J.H., R.J.S., P.D.L.)
| | - Alex Cambridge
- Barts Heart Centre, Barts Health NHS Trust, London, United Kingdom (A.J.G., M.O., G.D., H.D., N.T.S., C.M., J.L., J.S.M., A.C., J.G., F.P., O.S., S.A., M.L., M.F., M.J.E., A.C., S.S., M.D., R.J.H., R.J.S., P.D.L.)
| | - Jason Garcia
- Barts Heart Centre, Barts Health NHS Trust, London, United Kingdom (A.J.G., M.O., G.D., H.D., N.T.S., C.M., J.L., J.S.M., A.C., J.G., F.P., O.S., S.A., M.L., M.F., M.J.E., A.C., S.S., M.D., R.J.H., R.J.S., P.D.L.)
| | - Francesca Pugliese
- Barts Heart Centre, Barts Health NHS Trust, London, United Kingdom (A.J.G., M.O., G.D., H.D., N.T.S., C.M., J.L., J.S.M., A.C., J.G., F.P., O.S., S.A., M.L., M.F., M.J.E., A.C., S.S., M.D., R.J.H., R.J.S., P.D.L.)
| | - Oliver Segal
- Barts Heart Centre, Barts Health NHS Trust, London, United Kingdom (A.J.G., M.O., G.D., H.D., N.T.S., C.M., J.L., J.S.M., A.C., J.G., F.P., O.S., S.A., M.L., M.F., M.J.E., A.C., S.S., M.D., R.J.H., R.J.S., P.D.L.)
| | - Syed Ahsan
- Barts Heart Centre, Barts Health NHS Trust, London, United Kingdom (A.J.G., M.O., G.D., H.D., N.T.S., C.M., J.L., J.S.M., A.C., J.G., F.P., O.S., S.A., M.L., M.F., M.J.E., A.C., S.S., M.D., R.J.H., R.J.S., P.D.L.)
| | - Martin Lowe
- Barts Heart Centre, Barts Health NHS Trust, London, United Kingdom (A.J.G., M.O., G.D., H.D., N.T.S., C.M., J.L., J.S.M., A.C., J.G., F.P., O.S., S.A., M.L., M.F., M.J.E., A.C., S.S., M.D., R.J.H., R.J.S., P.D.L.)
| | - Malcolm Finlay
- Barts Heart Centre, Barts Health NHS Trust, London, United Kingdom (A.J.G., M.O., G.D., H.D., N.T.S., C.M., J.L., J.S.M., A.C., J.G., F.P., O.S., S.A., M.L., M.F., M.J.E., A.C., S.S., M.D., R.J.H., R.J.S., P.D.L.)
| | - Mark J Earley
- Barts Heart Centre, Barts Health NHS Trust, London, United Kingdom (A.J.G., M.O., G.D., H.D., N.T.S., C.M., J.L., J.S.M., A.C., J.G., F.P., O.S., S.A., M.L., M.F., M.J.E., A.C., S.S., M.D., R.J.H., R.J.S., P.D.L.)
| | - Anthony Chow
- Barts Heart Centre, Barts Health NHS Trust, London, United Kingdom (A.J.G., M.O., G.D., H.D., N.T.S., C.M., J.L., J.S.M., A.C., J.G., F.P., O.S., S.A., M.L., M.F., M.J.E., A.C., S.S., M.D., R.J.H., R.J.S., P.D.L.)
| | - Simon Sporton
- Barts Heart Centre, Barts Health NHS Trust, London, United Kingdom (A.J.G., M.O., G.D., H.D., N.T.S., C.M., J.L., J.S.M., A.C., J.G., F.P., O.S., S.A., M.L., M.F., M.J.E., A.C., S.S., M.D., R.J.H., R.J.S., P.D.L.)
| | - Mehul Dhinoja
- Barts Heart Centre, Barts Health NHS Trust, London, United Kingdom (A.J.G., M.O., G.D., H.D., N.T.S., C.M., J.L., J.S.M., A.C., J.G., F.P., O.S., S.A., M.L., M.F., M.J.E., A.C., S.S., M.D., R.J.H., R.J.S., P.D.L.)
| | - Ross J Hunter
- Barts Heart Centre, Barts Health NHS Trust, London, United Kingdom (A.J.G., M.O., G.D., H.D., N.T.S., C.M., J.L., J.S.M., A.C., J.G., F.P., O.S., S.A., M.L., M.F., M.J.E., A.C., S.S., M.D., R.J.H., R.J.S., P.D.L.)
| | - Richard J Schilling
- Barts Heart Centre, Barts Health NHS Trust, London, United Kingdom (A.J.G., M.O., G.D., H.D., N.T.S., C.M., J.L., J.S.M., A.C., J.G., F.P., O.S., S.A., M.L., M.F., M.J.E., A.C., S.S., M.D., R.J.H., R.J.S., P.D.L.)
| | - Pier D Lambiase
- Barts Heart Centre, Barts Health NHS Trust, London, United Kingdom (A.J.G., M.O., G.D., H.D., N.T.S., C.M., J.L., J.S.M., A.C., J.G., F.P., O.S., S.A., M.L., M.F., M.J.E., A.C., S.S., M.D., R.J.H., R.J.S., P.D.L.).,Institute of Cardiovascular Science, University College London, United Kingdom (M.O., P.D.L.)
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Ueda A, Soejima K, Nakahara S, Fukuda R, Fukamizu S, Kawamura I, Miwa Y, Mohri T, Katsume Y. Conduction slowing area during sinus rhythm harbors ventricular tachycardia isthmus. J Cardiovasc Electrophysiol 2020; 31:440-449. [PMID: 31916643 DOI: 10.1111/jce.14339] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2019] [Revised: 12/19/2019] [Accepted: 01/03/2020] [Indexed: 11/28/2022]
Abstract
INTRODUCTION The voltage map during sinus rhythm (SR) is a cornerstone of substrate mapping (SM) in scar-related ventricular tachycardia (VT) and frequently used with pace mapping (PM). Where to conduct PM is unclear in cases of an extensive or unidentified substrate. Conduction properties are another aspect incorporated by SM, and conduction slowing has gained interest as being related to successful ablation, although its mechanism has not been elucidated. We aimed to investigate the relationship between SR conduction properties and VT isthmuses. METHODS Nineteen patients (mean age, 62 years) who underwent VT ablation with voltage mapping and PM were reviewed. Isochronal late activation maps (ILAMs) with eight zones were reconstructed and sequentially named from one to eight according to the SR propagation. Good PM sites were superimposed on ILAMs, and the isthmus was defined using different pacing latencies. ILAM properties harboring isthmuses were investigated. RESULTS Twenty-eight ILAMs (13 epicardium, 1 right ventricular [RV], and 14 left ventricular [LV] endocardium) were reviewed. Eighteen isthmuses of 24 target VTs were identified, in which the proximal ends were in a later zone than the distal ends (zone 6 vs 4; P < .001), suggesting a reverse isthmus vector to the SR. The conduction velocity of the zone involving the distal isthmus was significantly lower than that of the SR preceding zone (0.40 vs 1.30 m/s; P < .001). SR conduction velocity decelerated by 69.5% (range 59.7%-74.5%) before propagating into the isthmus area. CONCLUSION Conduction slowing area during SR were related with the exit portion of the VT isthmuses.
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Affiliation(s)
- Akiko Ueda
- Division of Advanced Arrhythmia Management, Kyorin University Hospital, Mitaka, Tokyo, Japan
| | - Kyoko Soejima
- Department of Cardiovascular Medicine, Kyorin University Hospital, Mitaka, Tokyo, Japan
| | - Shiro Nakahara
- Department of Cardiology, Dokkyo Medical University Saitama Medical Center, Koshigaya, Saitama, Japan
| | - Reiko Fukuda
- Department of Cardiology, Dokkyo Medical University Saitama Medical Center, Koshigaya, Saitama, Japan
| | - Seiji Fukamizu
- Department of Cardiology, Tokyo Metropolitan Hiroo Hospital, Shibuya-ku, Tokyo, Japan
| | - Iwanari Kawamura
- Department of Cardiology, Tokyo Metropolitan Hiroo Hospital, Shibuya-ku, Tokyo, Japan
| | - Yosuke Miwa
- Department of Cardiovascular Medicine, Kyorin University Hospital, Mitaka, Tokyo, Japan
| | - Takato Mohri
- Department of Cardiovascular Medicine, Kyorin University Hospital, Mitaka, Tokyo, Japan
| | - Yumi Katsume
- Department of Cardiovascular Medicine, Kyorin University Hospital, Mitaka, Tokyo, Japan
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31
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Ventricular Tachycardia Ablation. JACC Clin Electrophysiol 2019; 5:1363-1383. [DOI: 10.1016/j.jacep.2019.09.015] [Citation(s) in RCA: 43] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2019] [Revised: 09/23/2019] [Accepted: 09/26/2019] [Indexed: 11/23/2022]
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Kuroda S, Mizukami A, Hayashi T, Yoshioka K, Suzuki M, Matsumura A. Verapamil-sensitive ventricular tachycardia demonstrating multiform QRS morphology in a patient with ischemic cardiomyopathy. HeartRhythm Case Rep 2019; 5:573-577. [PMID: 31890579 PMCID: PMC6926198 DOI: 10.1016/j.hrcr.2019.08.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2019] [Revised: 08/06/2019] [Accepted: 08/27/2019] [Indexed: 11/27/2022] Open
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Kara M, Korkmaz A, Ozeke O, Cay S, Ozcan F, Karimli E, Simsek E, Topaloglu S, Aras D. Wide QRS tachycardia with alternating QRS morphologies: What is the mechanism? PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2019; 43:146-148. [PMID: 31774186 DOI: 10.1111/pace.13847] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/13/2019] [Revised: 11/21/2019] [Accepted: 11/25/2019] [Indexed: 11/28/2022]
Affiliation(s)
- Meryem Kara
- Department of Cardiology, Health Sciences University, Ankara City Hospital, Ankara, Turkey
| | - Ahmet Korkmaz
- Department of Cardiology, Ege University, İzmir, Turkey
| | - Ozcan Ozeke
- Department of Cardiology, Health Sciences University, Ankara City Hospital, Ankara, Turkey
| | - Serkan Cay
- Department of Cardiology, Health Sciences University, Ankara City Hospital, Ankara, Turkey
| | - Firat Ozcan
- Department of Cardiology, Health Sciences University, Ankara City Hospital, Ankara, Turkey
| | - Emin Karimli
- Department of Cardiology, Health Sciences University, Ankara City Hospital, Ankara, Turkey
| | - Evrim Simsek
- Department of Cardiology, Health Sciences University, Ankara City Hospital, Ankara, Turkey.,Department of Cardiology, Ege University, İzmir, Turkey
| | - Serkan Topaloglu
- Department of Cardiology, Health Sciences University, Ankara City Hospital, Ankara, Turkey
| | - Dursun Aras
- Department of Cardiology, Health Sciences University, Ankara City Hospital, Ankara, Turkey
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Aziz Z, Shatz D, Raiman M, Upadhyay GA, Beaser AD, Besser SA, Shatz NA, Fu Z, Jiang R, Nishimura T, Liao H, Nayak HM, Tung R. Targeted Ablation of Ventricular Tachycardia Guided by Wavefront Discontinuities During Sinus Rhythm. Circulation 2019; 140:1383-1397. [DOI: 10.1161/circulationaha.119.042423] [Citation(s) in RCA: 79] [Impact Index Per Article: 15.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background:
Accurate and expedited identification of scar regions most prone to reentry is needed to guide ventricular tachycardia (VT) ablation. We aimed to prospectively assess outcomes of VT ablation guided primarily by the targeting of deceleration zones (DZ) identified by propagational analysis of ventricular activation during sinus rhythm.
Methods:
Patients with scar-related VT were prospectively enrolled in the University of Chicago VT Ablation Registry between 2016 and 2018. Isochronal late activation maps annotated to the latest local electrogram deflection were created with high-density multielectrode mapping catheters. Targeted ablation of DZ (>3 isochrones within 1cm radius) was performed, prioritizing later activated regions with maximal isochronal crowding. When possible, activation mapping of VT was performed, and successful ablation sites were compared with DZ locations for mechanistic correlation. Patients were prospectively followed for VT recurrence and mortality.
Results:
One hundred twenty patients (median age 65 years [59-71], 15% female, 50% nonischemic, median ejection fraction 31%) underwent 144 ablation procedures for scar-related VT. 57% of patients had previous ablation and epicardial access was employed in 59% of cases. High-density mapping during baseline rhythm was performed (2518 points [1615-3752] endocardial, 5049±2580 points epicardial) and identified an average of 2±1 DZ, which colocalized to successful termination sites in 95% of cases. The median total radiofrequency application duration was 29 min (21-38 min) to target DZ, representing ablation of 18% of the low-voltage area. At 12±10 months, 70% freedom from VT recurrence (80% in ischemic cardiomyopathy and 63% in nonischemic cardiomyopathy) was achieved. The overall survival rate was 87%.
Conclusions:
A novel voltage-independent high-density mapping display can identify the functional substrate for VT during sinus rhythm and guide targeted ablation, obviating the need for extensive radiofrequency delivery. Regions with isochronal crowding during the baseline rhythm were predictive of VT termination sites, providing mechanistic evidence that deceleration zones are highly arrhythmogenic, functioning as niduses for reentry.
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Affiliation(s)
- Zaid Aziz
- Center for Arrhythmia Care, Pritzker School of Medicine, Department of Medicine, Division of Cardiology, University of Chicago, IL (Z.A., D.S., M.R., G.A.U., A.B., S.A.B., Z.F., R.J., T.N., H.L, H.M.N., R.T.)
| | - Dalise Shatz
- Center for Arrhythmia Care, Pritzker School of Medicine, Department of Medicine, Division of Cardiology, University of Chicago, IL (Z.A., D.S., M.R., G.A.U., A.B., S.A.B., Z.F., R.J., T.N., H.L, H.M.N., R.T.)
| | - Michael Raiman
- Center for Arrhythmia Care, Pritzker School of Medicine, Department of Medicine, Division of Cardiology, University of Chicago, IL (Z.A., D.S., M.R., G.A.U., A.B., S.A.B., Z.F., R.J., T.N., H.L, H.M.N., R.T.)
- Abbott, Abbott Park, IL (M.R., N.A.S.)
| | - Gaurav A Upadhyay
- Center for Arrhythmia Care, Pritzker School of Medicine, Department of Medicine, Division of Cardiology, University of Chicago, IL (Z.A., D.S., M.R., G.A.U., A.B., S.A.B., Z.F., R.J., T.N., H.L, H.M.N., R.T.)
| | - Andrew D. Beaser
- Center for Arrhythmia Care, Pritzker School of Medicine, Department of Medicine, Division of Cardiology, University of Chicago, IL (Z.A., D.S., M.R., G.A.U., A.B., S.A.B., Z.F., R.J., T.N., H.L, H.M.N., R.T.)
| | - Stephanie A. Besser
- Center for Arrhythmia Care, Pritzker School of Medicine, Department of Medicine, Division of Cardiology, University of Chicago, IL (Z.A., D.S., M.R., G.A.U., A.B., S.A.B., Z.F., R.J., T.N., H.L, H.M.N., R.T.)
| | | | - Zihuan Fu
- Center for Arrhythmia Care, Pritzker School of Medicine, Department of Medicine, Division of Cardiology, University of Chicago, IL (Z.A., D.S., M.R., G.A.U., A.B., S.A.B., Z.F., R.J., T.N., H.L, H.M.N., R.T.)
| | - Ruhong Jiang
- Center for Arrhythmia Care, Pritzker School of Medicine, Department of Medicine, Division of Cardiology, University of Chicago, IL (Z.A., D.S., M.R., G.A.U., A.B., S.A.B., Z.F., R.J., T.N., H.L, H.M.N., R.T.)
| | - Takuro Nishimura
- Center for Arrhythmia Care, Pritzker School of Medicine, Department of Medicine, Division of Cardiology, University of Chicago, IL (Z.A., D.S., M.R., G.A.U., A.B., S.A.B., Z.F., R.J., T.N., H.L, H.M.N., R.T.)
| | - Hongtao Liao
- Center for Arrhythmia Care, Pritzker School of Medicine, Department of Medicine, Division of Cardiology, University of Chicago, IL (Z.A., D.S., M.R., G.A.U., A.B., S.A.B., Z.F., R.J., T.N., H.L, H.M.N., R.T.)
| | - Hemal M. Nayak
- Center for Arrhythmia Care, Pritzker School of Medicine, Department of Medicine, Division of Cardiology, University of Chicago, IL (Z.A., D.S., M.R., G.A.U., A.B., S.A.B., Z.F., R.J., T.N., H.L, H.M.N., R.T.)
| | - Roderick Tung
- Center for Arrhythmia Care, Pritzker School of Medicine, Department of Medicine, Division of Cardiology, University of Chicago, IL (Z.A., D.S., M.R., G.A.U., A.B., S.A.B., Z.F., R.J., T.N., H.L, H.M.N., R.T.)
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Lopez EM, Malhotra R. Ventricular Tachycardia in Structural Heart Disease. J Innov Card Rhythm Manag 2019; 10:3762-3773. [PMID: 32477742 PMCID: PMC7252751 DOI: 10.19102/icrm.2019.100801] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2018] [Accepted: 11/26/2018] [Indexed: 02/07/2023] Open
Abstract
Patients with structural heart disease (SHD) are at risk of ventricular tachycardia (VT), which can be difficult to manage clinically. Many treatment options are currently available, but no single approach can be applied with 100% perfect results; often, a combination of therapies is required to achieve good control of ventricular arrhythmias. Coronary artery disease with previous myocardial infarction (MI) is the most common form of SHD presenting with VT, with scar-mediated reentry being the predominant mechanism. Other cardiomyopathies such as arrhythmogenic right ventricular cardiomyopathy, sarcoidosis, Chagas disease, and repaired congenital heart disease can also present in conjunction with ventricular arrhythmias. A thorough analysis of the patient’s history, 12-lead electrocardiogram, and imaging findings are essential for understanding the mechanism and guiding localization of the site of origin of the arrhythmia and the presence of underlying heart disease, which will improve outcomes following catheter ablation if such is indicated. Separately, antiarrhythmic drugs have not been shown to decrease mortality in this patient population but can help to reduce the VT burden and subsequently the need for implantable cardioverter-defibrillator therapy. Unfortunately, most antiarrhythmic agents are negative inotropes, with the possibility of worsening heart failure. This review aims to discuss the current options available for the management of VT in SHD.
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Affiliation(s)
- Eliany Mejia Lopez
- Cardiac Electrophysiology Department, Cardiovascular Division, Department of Medicine, University of Virginia Health System, Charlottesville, VA, USA
| | - Rohit Malhotra
- Cardiac Electrophysiology Department, Cardiovascular Division, Department of Medicine, University of Virginia Health System, Charlottesville, VA, USA
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Qian P, Tedrow U. Scar Anisotropy: What Can Varying Wavefronts of Ventricular Activation Tell Us About the Physiology of Reentry Circuits? Circ Arrhythm Electrophysiol 2019; 12:e007457. [PMID: 31122053 DOI: 10.1161/circep.119.007457] [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: 11/16/2022]
Affiliation(s)
- Pierre Qian
- Cardiovascular Division, Brigham and Women's Hospital, Boston, MA
| | - Usha Tedrow
- Cardiovascular Division, Brigham and Women's Hospital, Boston, MA
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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: 186] [Impact Index Per Article: 37.2] [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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Affiliation(s)
- Kalyanam Shivkumar
- From the University of California, Los Angeles (UCLA), Cardiac Arrhythmia Center and Electrophysiology Programs, David Geffen School of Medicine at UCLA, Los Angeles
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Hwang M, Kim J, Lim B, Song JS, Joung B, Shim EB, Pak HN. Multiple factors influence the morphology of the bipolar electrogram: An in silico modeling study. PLoS Comput Biol 2019; 15:e1006765. [PMID: 30951529 PMCID: PMC6469793 DOI: 10.1371/journal.pcbi.1006765] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2018] [Revised: 04/17/2019] [Accepted: 01/07/2019] [Indexed: 12/04/2022] Open
Abstract
Although bipolar electrograms (Bi-egms) are commonly used for catheter mapping and ablation of cardiac arrhythmias, the accuracy and reproducibility of Bi-egms have not been evaluated. We aimed to clarify the influence of the catheter orientation (CO), catheter contact angle (CA), local conduction velocity (CV), scar size, and catheter type on the Bi-egm morphology using an in silico 3-dimensional realistic model of atrial fibrillation. We constructed a 3-dimensional, realistic, in silico left atrial model with activation wave propagation including bipolar catheter models. Bi-egms were obtained by computing the extracellular potentials from the distal and proximal electrodes. The amplitude and width were measured on virtual Bi-egms obtained under different conditions created by changing the CO according to the wave direction, catheter-atrial wall CA, local CV, size of the non-conductive area, and catheter type. Bipolar voltages were also compared between virtual and clinically acquired Bi-egms. Bi-egm amplitudes were lower for a perpendicular than parallel CO relative to the wave direction (p<0.001), lower for a 90° than 0° CA (p<0.001), and lower for a CV of 0.13m/s than 0.48m/s (p<0.001). Larger sized non-conductive areas were associated with a decreased bipolar amplitude (p<0.001) and increased bipolar width (p<0.001). Among three commercially available catheters (Orion, Pentaray, and Thermocool), those with more narrowly spaced and smaller electrodes produced higher voltages on the virtual Bi-egms (p<0.001). Multiple factors including the CO, CA, CV, and catheter design significantly influence the Bi-egm morphology. Universal voltage cut-off values may not be appropriate for bipolar voltage-guided substrate mapping. Cardiac arrhythmias are rhythm disorders of the heart leading to abnormal heart function. For the diagnosis and treatment of the arrhythmias, clinicians insert catheters into the heart and examine the electrical signal propagation in the heart. Among different type of catheters, bipolar catheters have two electrodes at the tip of the catheter with the signal being the difference between the two electrodes, which provides sharper signal than unipolar catheter. However, bipolar electrogram is dependent on many factors including catheter design and orientation, and consequently, knowledge of the determinants of the bipolar electrogram is needed for proper interpretation of the signal. In this study, we examined the effects of many factors on bipolar electrogram using computer simulation. Computer simulation is very useful in this type of study because, in clinical settings, it is not feasible to control each factor precisely. We quantitatively demonstrated the effects of catheter design and orientation, and cardiac wave propagation speed on bipolar electrogram.
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Affiliation(s)
- Minki Hwang
- Division of Cardiology, Yonsei University Health System, Seoul, Republic of Korea
| | - Jaehyuk Kim
- Division of Cardiology, Yonsei University Health System, Seoul, Republic of Korea
| | - Byounghyun Lim
- Division of Cardiology, Yonsei University Health System, Seoul, Republic of Korea
| | - Jun-Seop Song
- Division of Cardiology, Yonsei University Health System, Seoul, Republic of Korea
| | - Boyoung Joung
- Division of Cardiology, Yonsei University Health System, Seoul, Republic of Korea
| | - Eun Bo Shim
- Department of Mechanical and Biomedical Engineering, Kangwon National University, Chuncheon, Kangwon-do, Republic of Korea
| | - Hui-Nam Pak
- Division of Cardiology, Yonsei University Health System, Seoul, Republic of Korea
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Campos FO, Orini M, Taggart P, Hanson B, Lambiase PD, Porter B, Rinaldi CA, Gill J, Bishop MJ. Characterizing the clinical implementation of a novel activation-repolarization metric to identify targets for catheter ablation of ventricular tachycardias using computational models. Comput Biol Med 2019; 108:263-275. [PMID: 31009930 PMCID: PMC6538827 DOI: 10.1016/j.compbiomed.2019.03.018] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2018] [Revised: 03/08/2019] [Accepted: 03/19/2019] [Indexed: 11/24/2022]
Abstract
Identification of targets for catheter ablation of ventricular tachycardias (VTs) remains a significant challenge. VTs are often driven by re-entrant circuits resulting from a complex interaction between the front (activation) and tail (repolarization) of the electrical wavefront. Most mapping techniques do not take into account the tissue repolarization which may hinder the detection of ablation targets. The re-entry vulnerability index (RVI), a recently proposed mapping procedure, incorporates both activation and repolarization times to uncover VT circuits. The method showed potential in a series of experiments, but it still requires further development to enable its incorporation into a clinical protocol. Here, in-silico experiments were conducted to thoroughly assess RVI maps constructed under clinically-relevant mapping conditions. Within idealized as well as anatomically realistic infarct models, we show that parameters of the algorithm such as the search radius can significantly alter the specificity and sensitivity of the RVI maps. When constructed on sparse grids obtained following various placements of clinical recording catheters, RVI maps can identify vulnerable regions as long as two electrodes were placed on both sides of the line of block. Moreover, maps computed during pacing without inducing VT can reveal areas of abnormal repolarization and slow conduction but not directly vulnerability. In conclusion, the RVI algorithm can detect re-entrant circuits during VT from low resolution mapping grids resembling the clinical setting. Furthermore, RVI maps may provide information about the underlying tissue electrophysiology to guide catheter ablation without the need of inducing potentially harmful VT during the clinical procedure. Finally, the ability of the RVI maps to identify vulnerable regions with specificity in high resolution computer models could potentially improve the prediction of optimal ablation targets of simulation-based strategies. Safe and accurate detection of targets for catheter ablation remains a challenge. We conducted a thorough assessment of the Re-entry Vulnerability Index (RVI). Parameters of the algorithm can alter the specificity and sensitivity of RVI maps. When constructed on sparse grids RVI maps could still detect arrhythmogenic sites. In absence of arrhythmia, RVI maps revealed abnormal sites, but not vulnerability.
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Affiliation(s)
- Fernando O Campos
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, United Kingdom
| | - Michele Orini
- The Heart Hospital, University College London, London, United Kingdom; Institute of Cardiovascular Science, University College London, London, United Kingdom
| | - Peter Taggart
- The Heart Hospital, University College London, London, United Kingdom; Institute of Cardiovascular Science, University College London, London, United Kingdom
| | - Ben Hanson
- Department of Mechanical Engineering, University College London, London, United Kingdom
| | - Pier D Lambiase
- Institute of Cardiovascular Science, University College London, London, United Kingdom; Electrophysiology Department, Barts Heart Centre, St Bartholomew's Hospital, London, United Kingdom
| | - Bradley Porter
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, United Kingdom; Department of Cardiology, Guys and St Thomas' NHS Trust, London, United Kingdom
| | | | - Jaswinder Gill
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, United Kingdom; Department of Cardiology, Guys and St Thomas' NHS Trust, London, United Kingdom
| | - Martin J Bishop
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, United Kingdom. https://kclpure.kcl.ac.uk/portal/martin.bishop.html
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Pan-Asia United States PrEvention of Sudden Cardiac Death Catheter Ablation Trial (PAUSE-SCD): rationale and study design. J Interv Card Electrophysiol 2019; 57:271-278. [PMID: 30891654 DOI: 10.1007/s10840-019-00535-w] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2018] [Accepted: 03/06/2019] [Indexed: 02/05/2023]
Abstract
BACKGROUND The role of catheter ablation as an adjunct and alternative to ICD implantation is not known in patients at risk for recurrent ventricular tachycardia (VT) and sudden cardiac death (SCD) across Asia. Patients with nonischemic etiologies of cardiomyopathy, which are highly prevalent in Asia, have not been previously enrolled in randomized trials of VT ablation. OBJECTIVE To evaluate whether preemptive catheter ablation in patients with monomorphic VT and an indication for ICD implantation results in improved clinical outcomes compared to ICD implantation with standard medical therapy alone. To examine the natural history of ablation outcomes in the absence of background ICD therapy in patients that refuse randomization. METHODS The PAUSE-SCD study (NCT02848781) is a prospective, multi-center, randomized controlled trial enrolling patients with structural heart disease (EF < 50%) with an indication for ICD implantation. Patients are randomized in a 1:1 fashion to two treatment arms: ICD with ablation and ICD with standard medical therapy alone. A prospective registry cohort was designed to follow the outcomes of patients who refuse ICD and randomization but elect to receive catheter ablation as primary therapy. The primary endpoint is defined as a composite of recurrent VT, cardiovascular rehospitalization, and death. Pre-specified secondary endpoints include each of the individual components of the primary endpoint in addition to comparison between randomized and registry patients. CONCLUSION The PAUSE-SCD study is a prospective, multi-center, randomized, and controlled trial examining the impact of preemptive catheter ablation on cardiovascular outcomes in patients with an indication for ICD at risk for recurrent VT and SCD. It represents the first multi-center VT ablation study in Asia, with a design intended to provide insights into the role of both ICD and ablation therapy in a predominantly nonischemic population.
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42
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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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43
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Bhaskaran A, Nayyar S, Porta‐Sánchez A, Haldar S, Bokhari M, Massé S, Liang T, Zehra N, Farid T, Downar E, Nanthakumar K. Exit sites on the epicardium rarely subtend critical diastolic path of ischemic VT on the endocardium: Implications for noninvasive ablation. J Cardiovasc Electrophysiol 2019; 30:520-527. [DOI: 10.1111/jce.13843] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2018] [Revised: 12/04/2018] [Accepted: 12/24/2019] [Indexed: 11/28/2022]
Affiliation(s)
- Abhishek Bhaskaran
- Division of CardiologyPeter Munk Cardiac Centre, Toronto General Hospital, University Health NetworkToronto Ontario Canada
| | - Sachin Nayyar
- Division of CardiologyPeter Munk Cardiac Centre, Toronto General Hospital, University Health NetworkToronto Ontario Canada
| | - Andreu Porta‐Sánchez
- Division of CardiologyPeter Munk Cardiac Centre, Toronto General Hospital, University Health NetworkToronto Ontario Canada
| | - Shouvik Haldar
- Division of CardiologyPeter Munk Cardiac Centre, Toronto General Hospital, University Health NetworkToronto Ontario Canada
| | - Mahmoud Bokhari
- Division of CardiologyPeter Munk Cardiac Centre, Toronto General Hospital, University Health NetworkToronto Ontario Canada
| | - Stéphane Massé
- Division of CardiologyPeter Munk Cardiac Centre, Toronto General Hospital, University Health NetworkToronto Ontario Canada
| | - Timothy Liang
- Division of CardiologyPeter Munk Cardiac Centre, Toronto General Hospital, University Health NetworkToronto Ontario Canada
| | - Nawazish Zehra
- Division of CardiologyPeter Munk Cardiac Centre, Toronto General Hospital, University Health NetworkToronto Ontario Canada
| | - Talha Farid
- Division of CardiologyPeter Munk Cardiac Centre, Toronto General Hospital, University Health NetworkToronto Ontario Canada
| | - Eugene Downar
- Division of CardiologyPeter Munk Cardiac Centre, Toronto General Hospital, University Health NetworkToronto Ontario Canada
| | - Kumaraswamy Nanthakumar
- Division of CardiologyPeter Munk Cardiac Centre, Toronto General Hospital, University Health NetworkToronto Ontario Canada
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44
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Walton RD, Pashaei A, Martinez ME, Constantin M, Duchateau J, Bear L, Cros C, Pascarel-Auclerc C, Guo Y, Benoist D, Dubes V, Faye NR, Chaigne S, Dupuis S, Détaille D, Pourtau L, Pasdois P, Brette F, Rogier J, Labrousse L, Hocini M, Vigmond EJ, Haïssaguerre M, Bernus O. Compartmentalized Structure of the Moderator Band Provides a Unique Substrate for Macroreentrant Ventricular Tachycardia. Circ Arrhythm Electrophysiol 2018; 11:e005913. [PMID: 30354313 PMCID: PMC7661046 DOI: 10.1161/circep.117.005913] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Supplemental Digital Content is available in the text.
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Affiliation(s)
- Richard D Walton
- Université de Bordeaux, Centre de recherche Cardio-Thoracique de Bordeaux, U1045, France (R.D.W., A.P., M.E.M, M.C., J.D., L.B., C.C., C.P-A., Y.G., D.B., V.D., N.R.F., S.C., S.D., D.D., L.P., P.P., F.B., J.R., L.L., M.H., M.H., O.B.).,INSERM, Centre de recherche Cardio-Thoracique de Bordeaux, U1045, France (R.D.W.,A.P., M.E.M, M.C., J.D., L.B., C.C., C.P-A., Y.G., D.B., V.D., N.R.F., S.C., S.D., D.D., L.P., P.P., F.B., J.R., L.L., M.H., M.H., O.B.).,IHU Liryc, Electrophysiology and Heart Modeling Institute, Fondation Bordeaux Université, Pessac-Bordeaux, France (R.D.W., A.P., M.E.M, M.C., J.D., L.B., C.C., C.P-A., Y.G., D.B., V.D., N.R.F., S.C., S.D., D.D., L.P., P.P., F.B., J.R., L.L., M.H., E.J.V., M.H., O.B.)
| | - Ali Pashaei
- Université de Bordeaux, Centre de recherche Cardio-Thoracique de Bordeaux, U1045, France (R.D.W., A.P., M.E.M, M.C., J.D., L.B., C.C., C.P-A., Y.G., D.B., V.D., N.R.F., S.C., S.D., D.D., L.P., P.P., F.B., J.R., L.L., M.H., M.H., O.B.).,INSERM, Centre de recherche Cardio-Thoracique de Bordeaux, U1045, France (R.D.W.,A.P., M.E.M, M.C., J.D., L.B., C.C., C.P-A., Y.G., D.B., V.D., N.R.F., S.C., S.D., D.D., L.P., P.P., F.B., J.R., L.L., M.H., M.H., O.B.).,IHU Liryc, Electrophysiology and Heart Modeling Institute, Fondation Bordeaux Université, Pessac-Bordeaux, France (R.D.W., A.P., M.E.M, M.C., J.D., L.B., C.C., C.P-A., Y.G., D.B., V.D., N.R.F., S.C., S.D., D.D., L.P., P.P., F.B., J.R., L.L., M.H., E.J.V., M.H., O.B.)
| | - Marine E Martinez
- Université de Bordeaux, Centre de recherche Cardio-Thoracique de Bordeaux, U1045, France (R.D.W., A.P., M.E.M, M.C., J.D., L.B., C.C., C.P-A., Y.G., D.B., V.D., N.R.F., S.C., S.D., D.D., L.P., P.P., F.B., J.R., L.L., M.H., M.H., O.B.).,INSERM, Centre de recherche Cardio-Thoracique de Bordeaux, U1045, France (R.D.W.,A.P., M.E.M, M.C., J.D., L.B., C.C., C.P-A., Y.G., D.B., V.D., N.R.F., S.C., S.D., D.D., L.P., P.P., F.B., J.R., L.L., M.H., M.H., O.B.).,IHU Liryc, Electrophysiology and Heart Modeling Institute, Fondation Bordeaux Université, Pessac-Bordeaux, France (R.D.W., A.P., M.E.M, M.C., J.D., L.B., C.C., C.P-A., Y.G., D.B., V.D., N.R.F., S.C., S.D., D.D., L.P., P.P., F.B., J.R., L.L., M.H., E.J.V., M.H., O.B.)
| | - Marion Constantin
- Université de Bordeaux, Centre de recherche Cardio-Thoracique de Bordeaux, U1045, France (R.D.W., A.P., M.E.M, M.C., J.D., L.B., C.C., C.P-A., Y.G., D.B., V.D., N.R.F., S.C., S.D., D.D., L.P., P.P., F.B., J.R., L.L., M.H., M.H., O.B.).,INSERM, Centre de recherche Cardio-Thoracique de Bordeaux, U1045, France (R.D.W.,A.P., M.E.M, M.C., J.D., L.B., C.C., C.P-A., Y.G., D.B., V.D., N.R.F., S.C., S.D., D.D., L.P., P.P., F.B., J.R., L.L., M.H., M.H., O.B.).,IHU Liryc, Electrophysiology and Heart Modeling Institute, Fondation Bordeaux Université, Pessac-Bordeaux, France (R.D.W., A.P., M.E.M, M.C., J.D., L.B., C.C., C.P-A., Y.G., D.B., V.D., N.R.F., S.C., S.D., D.D., L.P., P.P., F.B., J.R., L.L., M.H., E.J.V., M.H., O.B.)
| | - Josselin Duchateau
- Université de Bordeaux, Centre de recherche Cardio-Thoracique de Bordeaux, U1045, France (R.D.W., A.P., M.E.M, M.C., J.D., L.B., C.C., C.P-A., Y.G., D.B., V.D., N.R.F., S.C., S.D., D.D., L.P., P.P., F.B., J.R., L.L., M.H., M.H., O.B.).,INSERM, Centre de recherche Cardio-Thoracique de Bordeaux, U1045, France (R.D.W.,A.P., M.E.M, M.C., J.D., L.B., C.C., C.P-A., Y.G., D.B., V.D., N.R.F., S.C., S.D., D.D., L.P., P.P., F.B., J.R., L.L., M.H., M.H., O.B.).,IHU Liryc, Electrophysiology and Heart Modeling Institute, Fondation Bordeaux Université, Pessac-Bordeaux, France (R.D.W., A.P., M.E.M, M.C., J.D., L.B., C.C., C.P-A., Y.G., D.B., V.D., N.R.F., S.C., S.D., D.D., L.P., P.P., F.B., J.R., L.L., M.H., E.J.V., M.H., O.B.).,Bordeaux University Hospital (CHU), Electrophysiology and Ablation Unit, F-33600 Pessac, France (J.D., J.R., L.L., M.H., M.H.)
| | - Laura Bear
- Université de Bordeaux, Centre de recherche Cardio-Thoracique de Bordeaux, U1045, France (R.D.W., A.P., M.E.M, M.C., J.D., L.B., C.C., C.P-A., Y.G., D.B., V.D., N.R.F., S.C., S.D., D.D., L.P., P.P., F.B., J.R., L.L., M.H., M.H., O.B.).,INSERM, Centre de recherche Cardio-Thoracique de Bordeaux, U1045, France (R.D.W.,A.P., M.E.M, M.C., J.D., L.B., C.C., C.P-A., Y.G., D.B., V.D., N.R.F., S.C., S.D., D.D., L.P., P.P., F.B., J.R., L.L., M.H., M.H., O.B.).,IHU Liryc, Electrophysiology and Heart Modeling Institute, Fondation Bordeaux Université, Pessac-Bordeaux, France (R.D.W., A.P., M.E.M, M.C., J.D., L.B., C.C., C.P-A., Y.G., D.B., V.D., N.R.F., S.C., S.D., D.D., L.P., P.P., F.B., J.R., L.L., M.H., E.J.V., M.H., O.B.)
| | - Caroline Cros
- Université de Bordeaux, Centre de recherche Cardio-Thoracique de Bordeaux, U1045, France (R.D.W., A.P., M.E.M, M.C., J.D., L.B., C.C., C.P-A., Y.G., D.B., V.D., N.R.F., S.C., S.D., D.D., L.P., P.P., F.B., J.R., L.L., M.H., M.H., O.B.).,INSERM, Centre de recherche Cardio-Thoracique de Bordeaux, U1045, France (R.D.W.,A.P., M.E.M, M.C., J.D., L.B., C.C., C.P-A., Y.G., D.B., V.D., N.R.F., S.C., S.D., D.D., L.P., P.P., F.B., J.R., L.L., M.H., M.H., O.B.).,IHU Liryc, Electrophysiology and Heart Modeling Institute, Fondation Bordeaux Université, Pessac-Bordeaux, France (R.D.W., A.P., M.E.M, M.C., J.D., L.B., C.C., C.P-A., Y.G., D.B., V.D., N.R.F., S.C., S.D., D.D., L.P., P.P., F.B., J.R., L.L., M.H., E.J.V., M.H., O.B.)
| | - Caroline Pascarel-Auclerc
- Université de Bordeaux, Centre de recherche Cardio-Thoracique de Bordeaux, U1045, France (R.D.W., A.P., M.E.M, M.C., J.D., L.B., C.C., C.P-A., Y.G., D.B., V.D., N.R.F., S.C., S.D., D.D., L.P., P.P., F.B., J.R., L.L., M.H., M.H., O.B.).,INSERM, Centre de recherche Cardio-Thoracique de Bordeaux, U1045, France (R.D.W.,A.P., M.E.M, M.C., J.D., L.B., C.C., C.P-A., Y.G., D.B., V.D., N.R.F., S.C., S.D., D.D., L.P., P.P., F.B., J.R., L.L., M.H., M.H., O.B.).,IHU Liryc, Electrophysiology and Heart Modeling Institute, Fondation Bordeaux Université, Pessac-Bordeaux, France (R.D.W., A.P., M.E.M, M.C., J.D., L.B., C.C., C.P-A., Y.G., D.B., V.D., N.R.F., S.C., S.D., D.D., L.P., P.P., F.B., J.R., L.L., M.H., E.J.V., M.H., O.B.)
| | - Yunbo Guo
- Université de Bordeaux, Centre de recherche Cardio-Thoracique de Bordeaux, U1045, France (R.D.W., A.P., M.E.M, M.C., J.D., L.B., C.C., C.P-A., Y.G., D.B., V.D., N.R.F., S.C., S.D., D.D., L.P., P.P., F.B., J.R., L.L., M.H., M.H., O.B.).,INSERM, Centre de recherche Cardio-Thoracique de Bordeaux, U1045, France (R.D.W.,A.P., M.E.M, M.C., J.D., L.B., C.C., C.P-A., Y.G., D.B., V.D., N.R.F., S.C., S.D., D.D., L.P., P.P., F.B., J.R., L.L., M.H., M.H., O.B.).,IHU Liryc, Electrophysiology and Heart Modeling Institute, Fondation Bordeaux Université, Pessac-Bordeaux, France (R.D.W., A.P., M.E.M, M.C., J.D., L.B., C.C., C.P-A., Y.G., D.B., V.D., N.R.F., S.C., S.D., D.D., L.P., P.P., F.B., J.R., L.L., M.H., E.J.V., M.H., O.B.)
| | - David Benoist
- Université de Bordeaux, Centre de recherche Cardio-Thoracique de Bordeaux, U1045, France (R.D.W., A.P., M.E.M, M.C., J.D., L.B., C.C., C.P-A., Y.G., D.B., V.D., N.R.F., S.C., S.D., D.D., L.P., P.P., F.B., J.R., L.L., M.H., M.H., O.B.).,INSERM, Centre de recherche Cardio-Thoracique de Bordeaux, U1045, France (R.D.W.,A.P., M.E.M, M.C., J.D., L.B., C.C., C.P-A., Y.G., D.B., V.D., N.R.F., S.C., S.D., D.D., L.P., P.P., F.B., J.R., L.L., M.H., M.H., O.B.).,IHU Liryc, Electrophysiology and Heart Modeling Institute, Fondation Bordeaux Université, Pessac-Bordeaux, France (R.D.W., A.P., M.E.M, M.C., J.D., L.B., C.C., C.P-A., Y.G., D.B., V.D., N.R.F., S.C., S.D., D.D., L.P., P.P., F.B., J.R., L.L., M.H., E.J.V., M.H., O.B.)
| | - Virginie Dubes
- Université de Bordeaux, Centre de recherche Cardio-Thoracique de Bordeaux, U1045, France (R.D.W., A.P., M.E.M, M.C., J.D., L.B., C.C., C.P-A., Y.G., D.B., V.D., N.R.F., S.C., S.D., D.D., L.P., P.P., F.B., J.R., L.L., M.H., M.H., O.B.).,INSERM, Centre de recherche Cardio-Thoracique de Bordeaux, U1045, France (R.D.W.,A.P., M.E.M, M.C., J.D., L.B., C.C., C.P-A., Y.G., D.B., V.D., N.R.F., S.C., S.D., D.D., L.P., P.P., F.B., J.R., L.L., M.H., M.H., O.B.).,IHU Liryc, Electrophysiology and Heart Modeling Institute, Fondation Bordeaux Université, Pessac-Bordeaux, France (R.D.W., A.P., M.E.M, M.C., J.D., L.B., C.C., C.P-A., Y.G., D.B., V.D., N.R.F., S.C., S.D., D.D., L.P., P.P., F.B., J.R., L.L., M.H., E.J.V., M.H., O.B.)
| | - Ndeye Rokhaya Faye
- Université de Bordeaux, Centre de recherche Cardio-Thoracique de Bordeaux, U1045, France (R.D.W., A.P., M.E.M, M.C., J.D., L.B., C.C., C.P-A., Y.G., D.B., V.D., N.R.F., S.C., S.D., D.D., L.P., P.P., F.B., J.R., L.L., M.H., M.H., O.B.).,INSERM, Centre de recherche Cardio-Thoracique de Bordeaux, U1045, France (R.D.W.,A.P., M.E.M, M.C., J.D., L.B., C.C., C.P-A., Y.G., D.B., V.D., N.R.F., S.C., S.D., D.D., L.P., P.P., F.B., J.R., L.L., M.H., M.H., O.B.).,IHU Liryc, Electrophysiology and Heart Modeling Institute, Fondation Bordeaux Université, Pessac-Bordeaux, France (R.D.W., A.P., M.E.M, M.C., J.D., L.B., C.C., C.P-A., Y.G., D.B., V.D., N.R.F., S.C., S.D., D.D., L.P., P.P., F.B., J.R., L.L., M.H., E.J.V., M.H., O.B.)
| | - Sebastien Chaigne
- Université de Bordeaux, Centre de recherche Cardio-Thoracique de Bordeaux, U1045, France (R.D.W., A.P., M.E.M, M.C., J.D., L.B., C.C., C.P-A., Y.G., D.B., V.D., N.R.F., S.C., S.D., D.D., L.P., P.P., F.B., J.R., L.L., M.H., M.H., O.B.).,INSERM, Centre de recherche Cardio-Thoracique de Bordeaux, U1045, France (R.D.W.,A.P., M.E.M, M.C., J.D., L.B., C.C., C.P-A., Y.G., D.B., V.D., N.R.F., S.C., S.D., D.D., L.P., P.P., F.B., J.R., L.L., M.H., M.H., O.B.).,IHU Liryc, Electrophysiology and Heart Modeling Institute, Fondation Bordeaux Université, Pessac-Bordeaux, France (R.D.W., A.P., M.E.M, M.C., J.D., L.B., C.C., C.P-A., Y.G., D.B., V.D., N.R.F., S.C., S.D., D.D., L.P., P.P., F.B., J.R., L.L., M.H., E.J.V., M.H., O.B.)
| | - Sebastien Dupuis
- Université de Bordeaux, Centre de recherche Cardio-Thoracique de Bordeaux, U1045, France (R.D.W., A.P., M.E.M, M.C., J.D., L.B., C.C., C.P-A., Y.G., D.B., V.D., N.R.F., S.C., S.D., D.D., L.P., P.P., F.B., J.R., L.L., M.H., M.H., O.B.).,INSERM, Centre de recherche Cardio-Thoracique de Bordeaux, U1045, France (R.D.W.,A.P., M.E.M, M.C., J.D., L.B., C.C., C.P-A., Y.G., D.B., V.D., N.R.F., S.C., S.D., D.D., L.P., P.P., F.B., J.R., L.L., M.H., M.H., O.B.).,IHU Liryc, Electrophysiology and Heart Modeling Institute, Fondation Bordeaux Université, Pessac-Bordeaux, France (R.D.W., A.P., M.E.M, M.C., J.D., L.B., C.C., C.P-A., Y.G., D.B., V.D., N.R.F., S.C., S.D., D.D., L.P., P.P., F.B., J.R., L.L., M.H., E.J.V., M.H., O.B.)
| | - Dominique Détaille
- Université de Bordeaux, Centre de recherche Cardio-Thoracique de Bordeaux, U1045, France (R.D.W., A.P., M.E.M, M.C., J.D., L.B., C.C., C.P-A., Y.G., D.B., V.D., N.R.F., S.C., S.D., D.D., L.P., P.P., F.B., J.R., L.L., M.H., M.H., O.B.).,INSERM, Centre de recherche Cardio-Thoracique de Bordeaux, U1045, France (R.D.W.,A.P., M.E.M, M.C., J.D., L.B., C.C., C.P-A., Y.G., D.B., V.D., N.R.F., S.C., S.D., D.D., L.P., P.P., F.B., J.R., L.L., M.H., M.H., O.B.).,IHU Liryc, Electrophysiology and Heart Modeling Institute, Fondation Bordeaux Université, Pessac-Bordeaux, France (R.D.W., A.P., M.E.M, M.C., J.D., L.B., C.C., C.P-A., Y.G., D.B., V.D., N.R.F., S.C., S.D., D.D., L.P., P.P., F.B., J.R., L.L., M.H., E.J.V., M.H., O.B.)
| | - Line Pourtau
- Université de Bordeaux, Centre de recherche Cardio-Thoracique de Bordeaux, U1045, France (R.D.W., A.P., M.E.M, M.C., J.D., L.B., C.C., C.P-A., Y.G., D.B., V.D., N.R.F., S.C., S.D., D.D., L.P., P.P., F.B., J.R., L.L., M.H., M.H., O.B.).,INSERM, Centre de recherche Cardio-Thoracique de Bordeaux, U1045, France (R.D.W.,A.P., M.E.M, M.C., J.D., L.B., C.C., C.P-A., Y.G., D.B., V.D., N.R.F., S.C., S.D., D.D., L.P., P.P., F.B., J.R., L.L., M.H., M.H., O.B.).,IHU Liryc, Electrophysiology and Heart Modeling Institute, Fondation Bordeaux Université, Pessac-Bordeaux, France (R.D.W., A.P., M.E.M, M.C., J.D., L.B., C.C., C.P-A., Y.G., D.B., V.D., N.R.F., S.C., S.D., D.D., L.P., P.P., F.B., J.R., L.L., M.H., E.J.V., M.H., O.B.)
| | - Philippe Pasdois
- Université de Bordeaux, Centre de recherche Cardio-Thoracique de Bordeaux, U1045, France (R.D.W., A.P., M.E.M, M.C., J.D., L.B., C.C., C.P-A., Y.G., D.B., V.D., N.R.F., S.C., S.D., D.D., L.P., P.P., F.B., J.R., L.L., M.H., M.H., O.B.).,INSERM, Centre de recherche Cardio-Thoracique de Bordeaux, U1045, France (R.D.W.,A.P., M.E.M, M.C., J.D., L.B., C.C., C.P-A., Y.G., D.B., V.D., N.R.F., S.C., S.D., D.D., L.P., P.P., F.B., J.R., L.L., M.H., M.H., O.B.).,IHU Liryc, Electrophysiology and Heart Modeling Institute, Fondation Bordeaux Université, Pessac-Bordeaux, France (R.D.W., A.P., M.E.M, M.C., J.D., L.B., C.C., C.P-A., Y.G., D.B., V.D., N.R.F., S.C., S.D., D.D., L.P., P.P., F.B., J.R., L.L., M.H., E.J.V., M.H., O.B.)
| | - Fabien Brette
- Université de Bordeaux, Centre de recherche Cardio-Thoracique de Bordeaux, U1045, France (R.D.W., A.P., M.E.M, M.C., J.D., L.B., C.C., C.P-A., Y.G., D.B., V.D., N.R.F., S.C., S.D., D.D., L.P., P.P., F.B., J.R., L.L., M.H., M.H., O.B.).,INSERM, Centre de recherche Cardio-Thoracique de Bordeaux, U1045, France (R.D.W.,A.P., M.E.M, M.C., J.D., L.B., C.C., C.P-A., Y.G., D.B., V.D., N.R.F., S.C., S.D., D.D., L.P., P.P., F.B., J.R., L.L., M.H., M.H., O.B.).,IHU Liryc, Electrophysiology and Heart Modeling Institute, Fondation Bordeaux Université, Pessac-Bordeaux, France (R.D.W., A.P., M.E.M, M.C., J.D., L.B., C.C., C.P-A., Y.G., D.B., V.D., N.R.F., S.C., S.D., D.D., L.P., P.P., F.B., J.R., L.L., M.H., E.J.V., M.H., O.B.)
| | - Julien Rogier
- Université de Bordeaux, Centre de recherche Cardio-Thoracique de Bordeaux, U1045, France (R.D.W., A.P., M.E.M, M.C., J.D., L.B., C.C., C.P-A., Y.G., D.B., V.D., N.R.F., S.C., S.D., D.D., L.P., P.P., F.B., J.R., L.L., M.H., M.H., O.B.).,INSERM, Centre de recherche Cardio-Thoracique de Bordeaux, U1045, France (R.D.W.,A.P., M.E.M, M.C., J.D., L.B., C.C., C.P-A., Y.G., D.B., V.D., N.R.F., S.C., S.D., D.D., L.P., P.P., F.B., J.R., L.L., M.H., M.H., O.B.).,IHU Liryc, Electrophysiology and Heart Modeling Institute, Fondation Bordeaux Université, Pessac-Bordeaux, France (R.D.W., A.P., M.E.M, M.C., J.D., L.B., C.C., C.P-A., Y.G., D.B., V.D., N.R.F., S.C., S.D., D.D., L.P., P.P., F.B., J.R., L.L., M.H., E.J.V., M.H., O.B.).,Bordeaux University Hospital (CHU), Electrophysiology and Ablation Unit, F-33600 Pessac, France (J.D., J.R., L.L., M.H., M.H.)
| | - Louis Labrousse
- Université de Bordeaux, Centre de recherche Cardio-Thoracique de Bordeaux, U1045, France (R.D.W., A.P., M.E.M, M.C., J.D., L.B., C.C., C.P-A., Y.G., D.B., V.D., N.R.F., S.C., S.D., D.D., L.P., P.P., F.B., J.R., L.L., M.H., M.H., O.B.).,INSERM, Centre de recherche Cardio-Thoracique de Bordeaux, U1045, France (R.D.W.,A.P., M.E.M, M.C., J.D., L.B., C.C., C.P-A., Y.G., D.B., V.D., N.R.F., S.C., S.D., D.D., L.P., P.P., F.B., J.R., L.L., M.H., M.H., O.B.).,IHU Liryc, Electrophysiology and Heart Modeling Institute, Fondation Bordeaux Université, Pessac-Bordeaux, France (R.D.W., A.P., M.E.M, M.C., J.D., L.B., C.C., C.P-A., Y.G., D.B., V.D., N.R.F., S.C., S.D., D.D., L.P., P.P., F.B., J.R., L.L., M.H., E.J.V., M.H., O.B.).,Bordeaux University Hospital (CHU), Electrophysiology and Ablation Unit, F-33600 Pessac, France (J.D., J.R., L.L., M.H., M.H.)
| | - Mélèze Hocini
- Université de Bordeaux, Centre de recherche Cardio-Thoracique de Bordeaux, U1045, France (R.D.W., A.P., M.E.M, M.C., J.D., L.B., C.C., C.P-A., Y.G., D.B., V.D., N.R.F., S.C., S.D., D.D., L.P., P.P., F.B., J.R., L.L., M.H., M.H., O.B.).,INSERM, Centre de recherche Cardio-Thoracique de Bordeaux, U1045, France (R.D.W.,A.P., M.E.M, M.C., J.D., L.B., C.C., C.P-A., Y.G., D.B., V.D., N.R.F., S.C., S.D., D.D., L.P., P.P., F.B., J.R., L.L., M.H., M.H., O.B.).,IHU Liryc, Electrophysiology and Heart Modeling Institute, Fondation Bordeaux Université, Pessac-Bordeaux, France (R.D.W., A.P., M.E.M, M.C., J.D., L.B., C.C., C.P-A., Y.G., D.B., V.D., N.R.F., S.C., S.D., D.D., L.P., P.P., F.B., J.R., L.L., M.H., E.J.V., M.H., O.B.).,Bordeaux University Hospital (CHU), Electrophysiology and Ablation Unit, F-33600 Pessac, France (J.D., J.R., L.L., M.H., M.H.)
| | - Edward J Vigmond
- Université de Bordeaux, Bordeaux Mathematics Institute UMR5251, France (E.J.V.).,Department of Electrical and Computer Engineering, University of Calgary, AB, Canada (E.J.V.)
| | - Michel Haïssaguerre
- Université de Bordeaux, Centre de recherche Cardio-Thoracique de Bordeaux, U1045, France (R.D.W., A.P., M.E.M, M.C., J.D., L.B., C.C., C.P-A., Y.G., D.B., V.D., N.R.F., S.C., S.D., D.D., L.P., P.P., F.B., J.R., L.L., M.H., M.H., O.B.).,INSERM, Centre de recherche Cardio-Thoracique de Bordeaux, U1045, France (R.D.W.,A.P., M.E.M, M.C., J.D., L.B., C.C., C.P-A., Y.G., D.B., V.D., N.R.F., S.C., S.D., D.D., L.P., P.P., F.B., J.R., L.L., M.H., M.H., O.B.).,IHU Liryc, Electrophysiology and Heart Modeling Institute, Fondation Bordeaux Université, Pessac-Bordeaux, France (R.D.W., A.P., M.E.M, M.C., J.D., L.B., C.C., C.P-A., Y.G., D.B., V.D., N.R.F., S.C., S.D., D.D., L.P., P.P., F.B., J.R., L.L., M.H., E.J.V., M.H., O.B.).,Bordeaux University Hospital (CHU), Electrophysiology and Ablation Unit, F-33600 Pessac, France (J.D., J.R., L.L., M.H., M.H.)
| | - Olivier Bernus
- Université de Bordeaux, Centre de recherche Cardio-Thoracique de Bordeaux, U1045, France (R.D.W., A.P., M.E.M, M.C., J.D., L.B., C.C., C.P-A., Y.G., D.B., V.D., N.R.F., S.C., S.D., D.D., L.P., P.P., F.B., J.R., L.L., M.H., M.H., O.B.).,INSERM, Centre de recherche Cardio-Thoracique de Bordeaux, U1045, France (R.D.W.,A.P., M.E.M, M.C., J.D., L.B., C.C., C.P-A., Y.G., D.B., V.D., N.R.F., S.C., S.D., D.D., L.P., P.P., F.B., J.R., L.L., M.H., M.H., O.B.).,IHU Liryc, Electrophysiology and Heart Modeling Institute, Fondation Bordeaux Université, Pessac-Bordeaux, France (R.D.W., A.P., M.E.M, M.C., J.D., L.B., C.C., C.P-A., Y.G., D.B., V.D., N.R.F., S.C., S.D., D.D., L.P., P.P., F.B., J.R., L.L., M.H., E.J.V., M.H., O.B.)
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Shimada H, Nishizaki M, Yamawake N, Suzuki M, Sakurada H, Hiraoka M. A case of scar-related ventricular tachycardia demonstrating termination with nonglobal capture at the site of concealed entrainment with dual slow conduction pathways. HeartRhythm Case Rep 2018; 4:459-463. [PMID: 30364584 PMCID: PMC6197363 DOI: 10.1016/j.hrcr.2018.07.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Lin CH, Lo LW, Lin YJ, Chang SL, Hu YF, Tuan TC, Huang HK, Chiang CH, Allamsetty S, Liao JN, Chung FP, Chang YT, Lin CY, Te ALD, Yamada S, Walia R, Hung Y, Chen SA. Ventricular arrhythmias originating from the cardiac crux and the basal inferior segment of the interventricular septum in the patients with structural heart diseases: characteristics, mapping, and electrophysiological properties. J Interv Card Electrophysiol 2018; 52:225-236. [PMID: 29572717 DOI: 10.1007/s10840-018-0350-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2017] [Accepted: 03/01/2018] [Indexed: 11/29/2022]
Abstract
PURPOSE There are few reports describing ventricular arrhythmias (VAs) from the crux and the corresponding endocardial site, i.e., the basal inferior segment of the interventricular septum (IVS). We aimed to investigate a distinct clinical group of VAs arising from the endocardium at this area in patients with structural heart diseases (SHD). METHODS We included 17 patients with SHD and clinically documented VAs. Thirteen patients underwent endocardial mapping only. Three patients underwent both epicardial and endocardial approaches and one had only epicardial mapping. Eighteen VAs were identified, 14 focal and 4 reentrant VAs, confirmed by entrainment. RESULTS There were 2 VAs from the crux, 5 VAs from the corresponding endocardial site in the right ventricle (RV), and 11 from the site in the left ventricle (LV). Compared with the VAs from RV endocardium, VAs from LV endocardium had a higher R wave in V3 than V2 (V2R/V3R ratio, 1.83 ± 0.84 vs. 0.86 ± 0.38, P = 0.008) and a higher V3 transition ratio percentage (2.16 ± 2.07 vs. 0.58 ± 0.62, P = 0.008). Combining all 16 patients with endocardial mapping, there were also lower bipolar voltages (1.21 ± 1.05 vs. 3.10 ± 2.65 mv, P < 0.0001), lower unipolar voltages (4.05 ± 1.92 vs. 5.75 ± 2.90 mv, P < 0.0001), and longer local electrocardiogram (EGM) lateness (157.6 ± 47.9 vs.140.3 ± 52.5 ms, P = 0.0001) in the dominant chambers. CONCLUSIONS In VAs from the crux and the corresponding endocardial site, the complete ECG V2R/V3R ratio and V3 transition ratio percentage could differentiate the VAs from the RV or LV endocardium. The lower unipolar, bipolar voltage mapping, and longer EGM lateness are helpful to identify the abnormal substrate in the endocardium in these patients.
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Affiliation(s)
- Chung-Hsing Lin
- Division of Cardiology, Department of Medicine, Heart Rhythm Center, Taipei Veterans General Hospital, Taipei, Taiwan.,Division of Cardiology, Department of Medicine, Taipei Medical University, Shuang Ho Hospital, Taipei, Taiwan
| | - Li-Wei Lo
- Division of Cardiology, Department of Medicine, Heart Rhythm Center, Taipei Veterans General Hospital, Taipei, Taiwan.,Faculty of Medicine, Institute of Clinical Medicine, and Cardiovascular Research Institute, National Yang-Ming University, Taipei, Taiwan
| | - Yenn-Jiang Lin
- Division of Cardiology, Department of Medicine, Heart Rhythm Center, Taipei Veterans General Hospital, Taipei, Taiwan.,Faculty of Medicine, Institute of Clinical Medicine, and Cardiovascular Research Institute, National Yang-Ming University, Taipei, Taiwan
| | - Shih-Lin Chang
- Division of Cardiology, Department of Medicine, Heart Rhythm Center, Taipei Veterans General Hospital, Taipei, Taiwan.,Faculty of Medicine, Institute of Clinical Medicine, and Cardiovascular Research Institute, National Yang-Ming University, Taipei, Taiwan
| | - Yu-Feng Hu
- Division of Cardiology, Department of Medicine, Heart Rhythm Center, Taipei Veterans General Hospital, Taipei, Taiwan.,Faculty of Medicine, Institute of Clinical Medicine, and Cardiovascular Research Institute, National Yang-Ming University, Taipei, Taiwan
| | - Ta-Chuan Tuan
- Division of Cardiology, Department of Medicine, Heart Rhythm Center, Taipei Veterans General Hospital, Taipei, Taiwan.,Faculty of Medicine, Institute of Clinical Medicine, and Cardiovascular Research Institute, National Yang-Ming University, Taipei, Taiwan
| | - Hung-Kai Huang
- Division of Cardiology, Department of Medicine, Heart Rhythm Center, Taipei Veterans General Hospital, Taipei, Taiwan.,Division of Cardiology, Department of Medicine, Changhua Christian Hospital, Changhua, Taiwan
| | - Cheng-Hung Chiang
- Division of Cardiology, Department of Medicine, Heart Rhythm Center, Taipei Veterans General Hospital, Taipei, Taiwan.,Division of Cardiology, Department of Internal Medicine, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
| | - Suresh Allamsetty
- Division of Cardiology, Department of Medicine, Heart Rhythm Center, Taipei Veterans General Hospital, Taipei, Taiwan.,Apollo Hospital, Visakhapatnam, Andhra Pradesh, India
| | - Jo-Nan Liao
- Division of Cardiology, Department of Medicine, Heart Rhythm Center, 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, Department of Medicine, Heart Rhythm Center, Taipei Veterans General Hospital, Taipei, Taiwan.,Faculty of Medicine, Institute of Clinical Medicine, and Cardiovascular Research Institute, National Yang-Ming University, Taipei, Taiwan
| | - Yao-Ting Chang
- Division of Cardiology, Department of Medicine, Heart Rhythm Center, Taipei Veterans General Hospital, Taipei, Taiwan.,Faculty of Medicine, Institute of Clinical Medicine, and Cardiovascular Research Institute, National Yang-Ming University, Taipei, Taiwan
| | - Chin-Yu Lin
- Division of Cardiology, Department of Medicine, Heart Rhythm Center, Taipei Veterans General Hospital, Taipei, Taiwan.,Faculty of Medicine, Institute of Clinical Medicine, and Cardiovascular Research Institute, National Yang-Ming University, Taipei, Taiwan
| | - Abigail Louise D Te
- Division of Cardiology, Department of Medicine, Heart Rhythm Center, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Shinya Yamada
- Division of Cardiology, Department of Medicine, Heart Rhythm Center, Taipei Veterans General Hospital, Taipei, Taiwan.,Department of Cardiovascular Medicine, Fukushima Medical University, Fukushima, Japan
| | - Rohit Walia
- Division of Cardiology, Department of Medicine, Heart Rhythm Center, Taipei Veterans General Hospital, Taipei, Taiwan.,Bhagat Phool Singh Government Medical College, Sonipat, Haryana, India
| | - Yuan Hung
- Division of Cardiology, Department of Medicine, Heart Rhythm Center, Taipei Veterans General Hospital, Taipei, Taiwan.,Division of Cardiology, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Shih-Ann Chen
- Division of Cardiology, Department of Medicine, Heart Rhythm Center, 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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Right ventricular lead proarrhythmia: A novel intervention for an under-recognized phenomenon. HeartRhythm Case Rep 2018; 4:50-53. [PMID: 29876287 PMCID: PMC5988465 DOI: 10.1016/j.hrcr.2017.10.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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Incidence and significance of adhesions encountered during epicardial mapping and ablation of ventricular tachycardia in patients with no history of prior cardiac surgery or pericarditis. Heart Rhythm 2018; 15:65-74. [DOI: 10.1016/j.hrthm.2017.09.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2017] [Indexed: 11/21/2022]
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Sapp JL, Deyell MW. Ventricular Tachycardia Ablation: Should We Be Impelled to Do More? JACC Clin Electrophysiol 2017; 3:1544-1546. [PMID: 29759836 DOI: 10.1016/j.jacep.2017.08.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2017] [Accepted: 08/03/2017] [Indexed: 10/18/2022]
Affiliation(s)
- John L Sapp
- Division of Cardiology, Department of Medicine, QEII Health Sciences Centre and Dalhousie University, Halifax, Nova Scotia, Canada.
| | - Marc W Deyell
- Heart Rhythm Services, Division of Cardiology, Department of Medicine, University of British Columbia, Vancouver, Canada
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