1
|
Gagyi RB, Hoogendijk M, Yap SC, Szili-Torok T. Treatment of brief episodes of highly symptomatic supraventricular and ventricular arrhythmias: a methodological review. Expert Rev Med Devices 2021; 18:1155-1163. [PMID: 34854768 DOI: 10.1080/17434440.2021.2012449] [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: 10/19/2022]
Abstract
INTRODUCTION Patients with brief arrhythmias are a challenging group to treat effectively with catheter ablation. Current standard approaches for the localization and treatment of brief arrhythmias suffer from several limitations, including the lack of spatiotemporal stability and adequate resolution. Recently, novel methods became available that open new perspectives and can be implemented both on the atrial and ventricular level to approach the diagnosis and treatment of these arrhythmias. AREAS COVERED In this paper, we demonstrate in each section a novel mapping modality that has a potential to approach arrhythmias considered unmappable in the past. After describing the method, we focused on the most important features of each system that makes mapping of short arrhythmias feasible. At the end of each section, we gave a short overview about necessary developments to improve the utility of these systems in the near future. EXPERT OPINION Treating brief episodes of tachycardias remains a challenge and can cause significant frustration for electrophysiologists. Although the broadening of the indication is clearly visible, currently available sequential mapping techniques often fail to map short-lived arrhythmias. New beneficial technological features permit the mapping of these previously considered unmappable arrhythmias, and offer a new perspective in their management.
Collapse
Affiliation(s)
- Rita B Gagyi
- Department of Cardiology, Electrophysiology, Erasmus Mc, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Mark Hoogendijk
- Department of Cardiology, Electrophysiology, Erasmus Mc, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Sing-Chien Yap
- Department of Cardiology, Electrophysiology, Erasmus Mc, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Tamas Szili-Torok
- Department of Cardiology, Electrophysiology, Erasmus Mc, University Medical Center Rotterdam, Rotterdam, The Netherlands
| |
Collapse
|
2
|
Chen X, Sun L, Chen Q, Kojodjojo P, Chen H, Ju W, Zhu W, Zhu Y, Zhao P, Zhang F, Chen M. Contact‐ versus noncontact‐guided ablation of the right ventricular outflow tract arrhythmias: A propensity score matched analysis. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2020; 43:822-827. [PMID: 32363589 DOI: 10.1111/pace.13935] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/06/2019] [Revised: 04/18/2020] [Accepted: 04/28/2020] [Indexed: 11/30/2022]
Affiliation(s)
- Xinguang Chen
- Section of Pacing and Electrophysiology, Division of Cardiology Jiangsu Province Hospital and the First Affiliated Hospital with Nanjing Medical University Nanjing China
| | - Ling Sun
- Section of Pacing and Electrophysiology, Division of Cardiology Jiangsu Province Hospital and the First Affiliated Hospital with Nanjing Medical University Nanjing China
| | - Qiushi Chen
- Section of Pacing and Electrophysiology, Division of Cardiology Jiangsu Province Hospital and the First Affiliated Hospital with Nanjing Medical University Nanjing China
| | | | - Hongwu Chen
- Section of Pacing and Electrophysiology, Division of Cardiology Jiangsu Province Hospital and the First Affiliated Hospital with Nanjing Medical University Nanjing China
| | - Weizhu Ju
- Section of Pacing and Electrophysiology, Division of Cardiology Jiangsu Province Hospital and the First Affiliated Hospital with Nanjing Medical University Nanjing China
| | - Wenwu Zhu
- Section of Pacing and Electrophysiology, Division of Cardiology Jiangsu Province Hospital and the First Affiliated Hospital with Nanjing Medical University Nanjing China
| | - Yeqian Zhu
- Section of Pacing and Electrophysiology, Division of Cardiology Jiangsu Province Hospital and the First Affiliated Hospital with Nanjing Medical University Nanjing China
| | - Pengcheng Zhao
- Section of Pacing and Electrophysiology, Division of Cardiology Jiangsu Province Hospital and the First Affiliated Hospital with Nanjing Medical University Nanjing China
| | - Fengxiang Zhang
- Section of Pacing and Electrophysiology, Division of Cardiology Jiangsu Province Hospital and the First Affiliated Hospital with Nanjing Medical University Nanjing China
- Qinghai Province Hospital
| | - Minglong Chen
- Section of Pacing and Electrophysiology, Division of Cardiology Jiangsu Province Hospital and the First Affiliated Hospital with Nanjing Medical University Nanjing China
| |
Collapse
|
3
|
de Vries LJ, Hendriks AA, Yap SC, Theuns DAMJ, van Domburg RT, Szili-Torok T. Procedural and long-term outcome after catheter ablation of idiopathic outflow tract ventricular arrhythmias: comparing manual, contact force, and magnetic navigated ablation. Europace 2019; 20:ii22-ii27. [PMID: 29722857 DOI: 10.1093/europace/euy004] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2017] [Accepted: 01/08/2018] [Indexed: 11/14/2022] Open
Abstract
Aims Currently, comparative data on procedural and long-term clinical outcome of outflow tract (OT) idiopathic ventricular arrhythmia (IVA) ablation with manual (MAN), contact force (CF), and magnetic navigation system (MNS) ablation are lacking. The aim of this study was to compare the procedural and long-term clinical outcome of MAN, CF, and MNS ablation of OT IVAs. Methods and results Seventy-three patients (31 MAN, 17 CF, and 25 MNS patients; consecutive per group) with OT IVA, who underwent catheter ablation in our centre were analysed. Procedural success rates (success at the end of the procedure), procedural data and long-term follow-up data were compared. Baseline patient demographics were comparable. Procedural success rates were similar (MAN 81%, 71% CF, and MNS 92%; P = 0.20). Median fluoroscopy time was shorter in the MNS group: MAN 29 (16-38), CF 37 (21-46), and MNS 13 (10-20) min (P = 0.002 for MNS vs. CF and MAN). The overall complication rate was: MAN 10%, CF 0%, and MNS 0% (P = 0.12). Median follow-up was: MAN 2184 (1672-2802), CF 1721 (1404-1913), and MNS 3031 (2524-3286) days (P <0.001). Recurrences occurred in MAN 46%, CF 50%, and MNS 46% (P = 0.97). Repeat procedures were performed in MAN 20%, CF 40%, and MNS 33% (P = 0.32). Conclusion Procedural and long-term clinical outcome of OT IVA ablation are equal for MAN, CF, and MNS. MNS has a favourable procedural safety profile due to the shorter fluoroscopy time compared with MAN and CF.
Collapse
Affiliation(s)
- Lennart J de Vries
- Division of Electrophysiology, Department of Cardiology, Erasmus Medical Center, 's-Gravendijkwal 230, 3000 CA, Zuid-Holland, Rotterdam, The Netherlands
| | - Astrid A Hendriks
- Division of Electrophysiology, Department of Cardiology, Erasmus Medical Center, 's-Gravendijkwal 230, 3000 CA, Zuid-Holland, Rotterdam, The Netherlands
| | - Sing C Yap
- Division of Electrophysiology, Department of Cardiology, Erasmus Medical Center, 's-Gravendijkwal 230, 3000 CA, Zuid-Holland, Rotterdam, The Netherlands
| | - Dominic A M J Theuns
- Division of Electrophysiology, Department of Cardiology, Erasmus Medical Center, 's-Gravendijkwal 230, 3000 CA, Zuid-Holland, Rotterdam, The Netherlands
| | - Ron T van Domburg
- Department of Clinical Epidemiology, Erasmus Medical Center, 's-Gravendijkwal 230, 3000 CA, Zuid-Holland, Rotterdam, The Netherlands
| | - Tamas Szili-Torok
- Division of Electrophysiology, Department of Cardiology, Erasmus Medical Center, 's-Gravendijkwal 230, 3000 CA, Zuid-Holland, Rotterdam, The Netherlands
| |
Collapse
|
4
|
Wieczorek M. Non-contact mapping in cardiac electrophysiology. Herzschrittmacherther Elektrophysiol 2018; 29:264-270. [PMID: 29992405 DOI: 10.1007/s00399-018-0575-x] [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: 05/23/2018] [Accepted: 05/25/2018] [Indexed: 11/29/2022]
Abstract
Catheter ablation of atrial and ventricular arrhythmias is now considered a standard technology for selected patients. In some patients, however, cure of the arrhythmia is hampered by the complexity of the arrhythmia or the way the arrhythmia presents in the electrophysiological laboratory: some focal atrial and ventricular arrhythmias are difficult to induce using electrical stimulation or medical provocation. Precise mapping of these arrhythmias is challenging or even impossible by contact mapping, while other arrhythmias are poorly tolerated and need early termination.In these scenarios, use of non-contact mapping technology can be an alternative to conventional mapping, since isopotential maps may require no more than one ectopic beat identical with the clinical focal arrhythmia to reconstruct its endocardial origin. This review article presents the technology of non-contact cardiac mapping, as well as various arrhythmias that have been successfully treated using this technology in the past. The possibilities and limitations of using non-contact cardiac mapping under various conditions are also presented.
Collapse
Affiliation(s)
- Marcus Wieczorek
- Department of Cardiology and Electrophysiology, St. Agnes-Hospital Bocholt, Witten/Herdecke University, School of Medicine, Barloer Weg 125, 46397, Bocholt, Germany.
| |
Collapse
|
5
|
Miyazawa K, Ueda M, Kondo Y, Hayashi T, Nakano M, Ishimura M, Nakano M, Kobayashi Y. Rapid mapping and differentiation in ventricular outflow tract arrhythmia using non-contact mapping. J Interv Card Electrophysiol 2017; 49:41-49. [DOI: 10.1007/s10840-017-0250-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2016] [Accepted: 03/29/2017] [Indexed: 11/24/2022]
|
6
|
Hoshiyama T, Yamabe H, Koyama J, Kanazawa H, Ito M, Ogawa H. Usefulness of non-contact mapping for catheter ablation of ventricular tachycardias originating at the right ventricular outflow tract. J Arrhythm 2014. [DOI: 10.1016/j.joa.2014.03.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
|
7
|
Schleifer JW, Mookadam F, Srivathsan K. Recent developments in the ablation of ventricular arrhythmias. Future Cardiol 2013; 9:799-808. [PMID: 24180538 DOI: 10.2217/fca.13.79] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Catheter ablation for the management of recurrent ventricular arrhythmias (VAs) is an emerging technology, with good efficacy in selected patients. It is an effective treatment for recurrent VA and can terminate VA during electrical storm. Recent innovations enhance the accuracy of ventricular mapping, allowing for substrate modification while the patient remains in sinus rhythm, thus facilitating the treatment of different types of VA. Epicardial ablation is now a feasible option for treating VA and increases the likelihood of success in certain types of VA. Percutaneous hemodynamic support facilitates successful ablation during poorly tolerated VA. This article reviews recent advances in catheter ablation techniques for VA and approaches to the management of specific types of VA, with a view toward future developments.
Collapse
Affiliation(s)
- John William Schleifer
- Mayo Clinic Arizona, Division of Cardiovascular Diseases, Mayo Clinic Hospital, 5777 East Mayo Boulevard, Phoenix, AZ 85054, USA
| | | | | |
Collapse
|
8
|
Zhang F, Yang B, Chen H, Ju W, Kojodjojo P, Cao K, Chen M. Noncontact mapping to guide ablation of right ventricular outflow tract arrhythmias. Heart Rhythm 2013; 10:1895-902. [PMID: 24055941 DOI: 10.1016/j.hrthm.2013.09.052] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2013] [Indexed: 10/26/2022]
Abstract
BACKGROUND There is limited data on outcomes after noncontact mapping (NCM)-guided right ventricular outflow tract (RVOT) ventricular arrhythmia (VA) ablation. OBJECTIVES To assess outcomes of NCM-guided RVOT VA ablation in a large cohort with extended follow-up, to determine optimal ablation site, and to analyze limitations of conventional mapping techniques. METHODS In consecutive patients undergoing RVOT VA ablation, 2 sites of early activation--earliest activation (EA) and breakout (BO) sites--were identified on NCM maps. Pace mapping and activation mapping were performed at both sites. The area of depolarized myocardium during the first 10 ms of spontaneous VA and pacing was measured. The initial site of ablation was randomized to either EA or BO sites, with crossover to the alternate site if ablation was not successful. RESULTS In 136 patients, prematurity of local activation and pace maps were similar at EA and BO sites. More myocardium was depolarized 10 ms after pacing than during spontaneous VA (12.9 ± 7.8 cm(2) vs 5.3 ± 3.9 cm(2); P < .01). Clinical success was more likely achieved when initial ablation was directed toward the EA site (P < .05). A wider EA-BO separation was associated with acute procedural failure (P < .01). With a follow-up of 36.2 ± 17.5 months, the success rate after a single procedure without antiarrhythmic agents was 86.8%. CONCLUSIONS NCM-guided RVOT VA ablation is highly effective, and clinical success is best achieved by ablating the EA site. Broad regions of early activation are associated with worsened clinical outcomes. Spatial resolution of activation and pace mapping is limited by rapid electrical propagation in the RVOT.
Collapse
Affiliation(s)
- Fengxiang Zhang
- Section of Pacing and Electrophysiology, Division of Cardiology, First Affiliated Hospital with Nanjing Medical University, Nanjing, People's Republic of China
| | | | | | | | | | | | | |
Collapse
|
9
|
Lü CM, Zhang ZX, Li L, Tang JM, Feng HX. Study on the relationship between myocardial ischemia assessed by 24-hour ambulatory electrocardiogram and ventricular premature beat originating from different positions in older adults. Eur Geriatr Med 2012. [DOI: 10.1016/j.eurger.2012.03.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
|
10
|
Abstract
The evolution of 3-dimensional (D) mapping systems has contributed to improved procedures for ablation of complex tachyarrhythmia in terms of providing detailed anatomical information along with the ability to integrate with pre-acquired computed tomography/magnetic resonance imaging/intracardiac echocardiography images, reducing the radiation exposure, and producing activation and substrate maps. 3-D mapping systems are categorized as magnetic based vs. impedance based according to the catheter location technology, and are also classified as contact based vs. non-contact based according to the data collection technology. Contact-based mapping systems are used widely, in which a series of electrograms is taken sequentially in contact with the heart, thus requiring a relatively stable and sustained arrhythmia to create an activation map. Non-contact mapping systems, however, allow a beat-to-beat analysis of the activation even in non-sustained, polymorphic, or hemodynamically intolerant tachycardia. In this article, the clinical utility of 3-D mapping systems is discussed based on the literature and on experience, with particular emphasis on the non-contact mapping system.
Collapse
|
11
|
Affiliation(s)
- Hiroshi Tada
- Cardiovascular Division, Institute of Clinical Medicine, Graduate School of Comprehensive Human Sciences, University of Tsukuba
- Cardiovascular Division, Institute of Clinical Medicine, Graduate School of Comprehensive Human Sciences, University of Tsukuba
| |
Collapse
|
12
|
Nagashima K, Watanabe I, Okumura Y, Sonoda K, Kofune M, Mano H, Ohkubo K, Nakai T, Kunimoto S, Kasamaki Y, Hirayama A. Epicardial ablation with irrigated electrodes: – effect of bipolar vs. unipolar ablation on lesion formation –. Circ J 2011; 76:322-7. [PMID: 22166835 DOI: 10.1253/circj.cj-11-0984] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Ablation of ventricular tachycardia originating from the left ventricular (LV) epicardium is often limited by the radiofrequency power delivery. We compared the effect of bipolar vs. unipolar epicardial ablation on lesion size. METHODS AND RESULTS Eleven excised pig hearts were superfused with saline (2 L/min). Unipolar ablation (25 or 30 W for 120 s) was performed between the LV epicardial saline-irrigated electrode and an indifferent electrode (n = 33 lesions). Bipolar ablation (25 or 30 W for 120 s) was performed between a 4-mm saline-irrigated-tip (20 ml/min) electrode on the LV epicardium and an opposing 10-mm non-irrigated-tip electrode on the LV endocardium (n = 38 lesions). Wall thickness did not differ between experiments (15.4 ± 2.4 vs. 15.3 ± 2.1 mm). Impedance was lower at the beginning and end of unipolar ablation than at the beginning and end of bipolar ablation (163.2 ± 20.3Ω and 109.9 ± 16.0Ω vs. 194.6 ± 23.3Ω and 127.1 ± 16.4Ω, respectively) (P<0.001). Epicardial lesion width did not differ between unipolar and bipolar ablation (10.1 ± 2.7 vs. 10.2 ± 2.4 mm), but lesion depth was greater with bipolar ablation (10.6 ± 2.7 vs. 7.5 ± 1.0 mm) (P<0.001). Unipolar ablation produced no transmural lesion, but bipolar ablation produced 15 (46%) (P<0.001). Steam pop occurred in 11 (29%) and 3 (9%) cases, respectively (P = 0.036). CONCLUSIONS Bipolar ablation of the LV free wall is highly effective at creating an appropriately deep epicardial lesion.
Collapse
Affiliation(s)
- Koichi Nagashima
- Division of Cardiology, Department of Medicine, Nihon University School of Medicine, Tokyo, Japan
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
13
|
Nagamoto Y, Tsuchiya T, Miyamoto K, Yamaguchi T, Takahashi N. Atrial Tachycardia During Ongoing Atrial Fibrillation Ablation - EnSite Array Analysis -. Circ J 2011; 75:1080-9. [DOI: 10.1253/circj.cj-10-0742] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
| | | | | | | | - Naohiko Takahashi
- First Department of Internal Medicine, Faculty of Medicine, Oita University
| |
Collapse
|
14
|
Tanaka Y, Tada H, Ito S, Naito S, Higuchi K, Kumagai K, Hachiya H, Hirao K, Oshima S, Taniguchi K, Aonuma K, Isobe M. Gender and Age Differences in Candidates for Radiofrequency Catheter Ablation of Idiopathic Ventricular Arrhythmias. Circ J 2011; 75:1585-91. [DOI: 10.1253/circj.cj-10-0941] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Yasuaki Tanaka
- Department of Cardiovascular Medicine, Tokyo Medical and Dental University
| | - Hiroshi Tada
- Cardiovascular Division, Institute of Clinical Medicine, Graduate School of Comprehensive Human Sciences, University of Tsukuba
| | - Sachiko Ito
- Division of Cardiology, Gunma Prefectural Cardiovascular Center
| | - Shigeto Naito
- Division of Cardiology, Gunma Prefectural Cardiovascular Center
| | - Koji Higuchi
- Department of Cardiovascular Medicine, Tokyo Medical and Dental University
| | - Koji Kumagai
- Division of Cardiology, Gunma Prefectural Cardiovascular Center
| | - Hitoshi Hachiya
- Department of Cardiovascular Medicine, Tokyo Medical and Dental University
| | - Kenzo Hirao
- Department of Cardiovascular Medicine, Tokyo Medical and Dental University
| | - Shigeru Oshima
- Division of Cardiology, Gunma Prefectural Cardiovascular Center
| | | | - Kazutaka Aonuma
- Cardiovascular Division, Institute of Clinical Medicine, Graduate School of Comprehensive Human Sciences, University of Tsukuba
| | - Mitsuaki Isobe
- Department of Cardiovascular Medicine, Tokyo Medical and Dental University
| |
Collapse
|
15
|
Nagashima K, Watanabe I, Okumura Y, Ohkubo K, Kofune M, Ohya T, Kasamaki Y, Hirayama A. Lesion Formation by Ventricular Septal Ablation With Irrigated Electrodes - Comparison of Bipolar and Sequential Unipolar Ablation -. Circ J 2011; 75:565-70. [DOI: 10.1253/circj.cj-10-0870] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Koichi Nagashima
- Division of Cardiology, Department of Medicine, Nihon University School of Medicine
| | - Ichiro Watanabe
- Division of Cardiology, Department of Medicine, Nihon University School of Medicine
| | - Yasuo Okumura
- Division of Cardiology, Department of Medicine, Nihon University School of Medicine
| | - Kimie Ohkubo
- Division of Cardiology, Department of Medicine, Nihon University School of Medicine
| | - Masayoshi Kofune
- Division of Cardiology, Department of Medicine, Nihon University School of Medicine
| | - Toshiyuki Ohya
- Division of Cardiology, Department of Medicine, Nihon University School of Medicine
| | - Yuji Kasamaki
- Division of Cardiology, Department of Medicine, Nihon University School of Medicine
| | - Atsushi Hirayama
- Division of Cardiology, Department of Medicine, Nihon University School of Medicine
| |
Collapse
|
16
|
Fukuhara J, Sumitomo N, Nakamura T, Ichikawa R, Matsumura M, Abe O, Miyashita M, Taniguchi K, Kanamaru H, Ayusawa M, Karasawa K, Mugishima H. Electrophysiological Characteristics of Idiopathic Ventricular Tachycardia in Children. Circ J 2011; 75:672-6. [DOI: 10.1253/circj.cj-10-0339] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Junji Fukuhara
- Department of Pediatrics and Child Health, Nihon University, School of Medicine
| | - Naokata Sumitomo
- Department of Pediatrics and Child Health, Nihon University, School of Medicine
| | - Takahiro Nakamura
- Department of Pediatrics and Child Health, Nihon University, School of Medicine
| | - Rie Ichikawa
- Department of Pediatrics and Child Health, Nihon University, School of Medicine
| | - Masaharu Matsumura
- Department of Pediatrics and Child Health, Nihon University, School of Medicine
| | - Osamu Abe
- Department of Pediatrics and Child Health, Nihon University, School of Medicine
| | - Michio Miyashita
- Department of Pediatrics and Child Health, Nihon University, School of Medicine
| | - Kazuo Taniguchi
- Department of Pediatrics and Child Health, Nihon University, School of Medicine
| | - Hiroshi Kanamaru
- Department of Pediatrics and Child Health, Nihon University, School of Medicine
| | - Mamoru Ayusawa
- Department of Pediatrics and Child Health, Nihon University, School of Medicine
| | - Kensuke Karasawa
- Department of Pediatrics and Child Health, Nihon University, School of Medicine
| | - Hideo Mugishima
- Department of Pediatrics and Child Health, Nihon University, School of Medicine
| |
Collapse
|
17
|
Okumura Y, Watanabe I, Nakai T, Ohkubo K, Kofune T, Ashino S, Kofune M, Nagashima K, Hiro T, Hirata A, Nikaido M, Hirayama A. A quantitative and qualitative analysis of the virtual unipolar electrograms from non-contact mapping of right or left-sided outflow tract premature ventricular contractions/ventricular tachycardia origins. J Interv Card Electrophysiol 2010; 30:17-25. [PMID: 21161574 DOI: 10.1007/s10840-010-9522-4] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2010] [Accepted: 10/05/2010] [Indexed: 11/29/2022]
Abstract
OBJECTIVE This study was conducted to examine the virtual unipolar electrogram configuration of right/left outflow tract (OT) premature ventricular contraction (PVC)/ventricular tachycardia (VT) origins obtained from a non-contact mapping system (NCMS). METHODS The subjects consisted of 30 patients with OT-PVCs/VT who underwent NCMS-guided ablation. We evaluated the virtual unipolar electrograms of the origin on 3D right ventricular (RV)-OT isochronal maps. RESULTS Successful ablation was achieved from the RV in 20 patients (RVOT group), and it failed in 10 (non-RVOT group: including left-sided/pulmonary artery/deep RVOT foci). On the virtual unipolar electrograms, the earliest activation (EA) preceded the QRS onset by 11.2 ± 2.6 ms in the RVOT group and by 7.4 ± 10.5 ms in the non-RVOT group (P = 0.138). The negative slope of the electrogram at the EA site (EA slope(5)), quantified by the virtual unipolar voltage amplitude 5 ms after the EA onset, was significantly steeper in the RVOT group than in the non-RVOT group (0.66 ± 0.52 mV vs. 0.14 ± 0.17 mV, P = 0.005). Cutoff values for the EA-to-QRS onset time and EA slope(5) of ≥ 8 ms and >0.3 mV, respectively, completely differentiated the RVOT group from the non-RVOT group. A lesser EA slope(5) was associated with a greater radiofrequency energy delivery required to terminate RVOT-PVCs/VT. CONCLUSIONS These demonstrate the importance of the virtual unipolar electrograms from OT-PVC/VT origins obtained with the NCMS. The virtual EA predicts both successful and potentially difficult ablation sites from the RV side.
Collapse
Affiliation(s)
- Yasuo Okumura
- Division of Cardiology, Department of Medicine, Nihon University School of Medicine, 30-1 Ohyaguchi-kami machi, Itabashi-ku, Tokyo 173-8610, Japan.
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|