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Grade Santos J, Mills MT, Calvert P, Worthington N, Phenton C, Modi S, Ashrafi R, Todd D, Waktare J, Mahida S, Gupta D, Luther V. Delineating postinfarct ventricular tachycardia substrate with dynamic voltage mapping in areas of omnipolar vector disarray. Heart Rhythm O2 2024; 5:224-233. [PMID: 38690145 PMCID: PMC11056467 DOI: 10.1016/j.hroo.2024.02.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/02/2024] Open
Abstract
Background Defining postinfarct ventricular arrhythmic substrate is challenging with voltage mapping alone, though it may be improved in combination with an activation map. Omnipolar technology on the EnSite X system displays activation as vectors that can be superimposed onto a voltage map. Objective The study sought to optimize voltage map settings during ventricular tachycardia (VT) ablation, adjusting them dynamically using omnipolar vectors. Methods Consecutive patients undergoing substrate mapping were retrospectively studied. We categorized omnipolar vectors as uniform when pointing in one direction, or in disarray when pointing in multiple directions. We superimposed vectors onto voltage maps colored purple in tissue >1.5 mV, and the voltage settings were adjusted so that uniform vectors appeared within purple voltages, a process termed dynamic voltage mapping (DVM). Vectors in disarray appeared within red-blue lower voltages. Results A total of 17 substrate maps were studied in 14 patients (mean age 63 ± 13 years; mean left ventricular ejection fraction 35 ± 6%, median 4 [interquartile range 2-8.5] recent VT episodes). The DVM mean voltage threshold that differentiated tissue supporting uniform vectors from disarray was 0.27 mV, ranging between patients from 0.18 to 0.50 mV, with good interobserver agreement (median difference: 0.00 mV). We found that VT isthmus components, as well as sites of latest activation, isochronal crowding, and excellent pace maps colocated with tissue along the DVM border zone surrounding areas of disarray. Conclusion DVM, guided by areas of omnipolar vector disarray, allows for individualized postinfarct ventricular substrate characterization. Tissue bordering areas of disarray may harbor greater arrhythmogenic potential.
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Affiliation(s)
- Joao Grade Santos
- Department of Cardiology, Liverpool Heart and Chest Hospital, Liverpool, United Kingdom
- Department of Cardiology, Hospital Garcia de Orta, Almada, Portugal
| | - Mark T. Mills
- Department of Cardiology, Liverpool Heart and Chest Hospital, Liverpool, United Kingdom
- Liverpool Centre for Cardiovascular Science, University of Liverpool, Liverpool, United Kingdom
| | - Peter Calvert
- Department of Cardiology, Liverpool Heart and Chest Hospital, Liverpool, United Kingdom
- Liverpool Centre for Cardiovascular Science, University of Liverpool, Liverpool, United Kingdom
| | | | | | - Simon Modi
- Department of Cardiology, Liverpool Heart and Chest Hospital, Liverpool, United Kingdom
| | - Reza Ashrafi
- Department of Cardiology, Liverpool Heart and Chest Hospital, Liverpool, United Kingdom
| | - Derick Todd
- Department of Cardiology, Liverpool Heart and Chest Hospital, Liverpool, United Kingdom
| | - Johan Waktare
- Department of Cardiology, Liverpool Heart and Chest Hospital, Liverpool, United Kingdom
| | - Saagar Mahida
- Department of Cardiology, Liverpool Heart and Chest Hospital, Liverpool, United Kingdom
- Department of Cardiology, Hospital Garcia de Orta, Almada, Portugal
| | - Dhiraj Gupta
- Department of Cardiology, Liverpool Heart and Chest Hospital, Liverpool, United Kingdom
- Liverpool Centre for Cardiovascular Science, University of Liverpool, Liverpool, United Kingdom
| | - Vishal Luther
- Department of Cardiology, Liverpool Heart and Chest Hospital, Liverpool, United Kingdom
- Liverpool Centre for Cardiovascular Science, University of Liverpool, Liverpool, United Kingdom
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Burg MR, Anderson RD, Massé S, Nanthakumar K. Cardiac mapping with irreverence to time: Replacing isochrones with omnipolar vectors. Heart Rhythm 2022; 19:1802-1803. [PMID: 35973658 DOI: 10.1016/j.hrthm.2022.08.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Accepted: 08/08/2022] [Indexed: 11/15/2022]
Affiliation(s)
- Melanie R Burg
- Hull Family Cardiac Fibrillation Management Laboratory, Division of Cardiology, University Health Network, Toronto General Hospital, Toronto, Ontario, Canada
| | - Robert D Anderson
- Hull Family Cardiac Fibrillation Management Laboratory, Division of Cardiology, University Health Network, Toronto General Hospital, Toronto, Ontario, Canada
| | - Stéphane Massé
- Hull Family Cardiac Fibrillation Management Laboratory, Division of Cardiology, University Health Network, Toronto General Hospital, Toronto, Ontario, Canada
| | - Kumaraswamy Nanthakumar
- Hull Family Cardiac Fibrillation Management Laboratory, Division of Cardiology, University Health Network, Toronto General Hospital, Toronto, Ontario, Canada.
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