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Choi JH, Kwon CH. Timing of critical isthmus from end of P wave and usefulness of activation mapping with window of interest from end to end of P wave in reentrant atrial tachycardia. Heart Vessels 2024; 39:319-327. [PMID: 38015232 DOI: 10.1007/s00380-023-02335-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Accepted: 11/01/2023] [Indexed: 11/29/2023]
Abstract
In activation mapping of reentrant atrial tachycardia (AT), there was no reference for window of interest (WOI). We examined the timing of a successful termination site from end of the P wave and attempted to determine whether the critical isthmus can be identified using activation mapping when WOI was set as end to end of the P wave. Forty patients with 54 reentrant AT who underwent 3D electroanatomic mapping and radiofrequency catheter ablation were evaluated retrospectively. The critical isthmus was defined as a successful termination site. We evaluate critical isthmus timing from end of the P wave and percentage of critical isthmus timing from end of the P wave to tachycardia cycle length. In 54 reentrant AT, Macro-reentry was identified in 46 (85.2%) and micro-reentry was identified in eight (14.8%). The timing of the critical isthmus site from end of the P wave was - 4.0 ± 31.1 ms (Macro-reentry vs. Micro-reentry; - 8.9 ± 29.4 ms vs. 24.0 ± 26.7 ms; P = 0.005). The percentage of critical isthmus timing from end of the P wave/tachycardia cycle length was - 1.4 ± 10.5% (Macro-reentry vs. Micro-reentry; - 3.1 ± 9.8% vs. 8.3 ± 9.3%, P = 0.004) The critical isthmus of reentrant AT is located within 10% backward and forward from end of the P wave to tachycardia cycle length. Setting the WOI from end to end of the P wave is useful for identification of the critical isthmus through activation mapping.
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Affiliation(s)
- Ji-Hoon Choi
- Division of Cardiology, Department of Internal Medicine, Konkuk University Medical Center, Konkuk University School of Medicine, 120-1 Neungdong-Ro, Gwangjin-Gu, Seoul, 05030, Korea
| | - Chang Hee Kwon
- Division of Cardiology, Department of Internal Medicine, Konkuk University Medical Center, Konkuk University School of Medicine, 120-1 Neungdong-Ro, Gwangjin-Gu, Seoul, 05030, Korea.
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Khawajakhail R, Khan RU, Gondal MUR, Toru HK, Malik M, Iqbal A, Malik J, Faraz M, Awais M. Advancements in gene therapy approaches for atrial fibrillation: Targeted delivery, mechanistic insights and future prospects. Curr Probl Cardiol 2024; 49:102431. [PMID: 38309546 DOI: 10.1016/j.cpcardiol.2024.102431] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2024] [Accepted: 01/29/2024] [Indexed: 02/05/2024]
Abstract
Atrial fibrillation (AF) remains a complex and challenging arrhythmia to treat, necessitating innovative therapeutic strategies. This review explores the evolving landscape of gene therapy for AF, focusing on targeted delivery methods, mechanistic insights, and future prospects. Direct myocardial injection, reversible electroporation, and gene painting techniques are discussed as effective means of delivering therapeutic genes, emphasizing their potential to modulate both structural and electrical aspects of the AF substrate. The importance of identifying precise targets for gene therapy, particularly in the context of AF-associated genetic, structural, and electrical abnormalities, is highlighted. Current studies employing animal models, such as mice and large animals, provide valuable insights into the efficacy and limitations of gene therapy approaches. The significance of imaging methods for detecting atrial fibrosis and guiding targeted gene delivery is underscored. Activation mapping techniques offer a nuanced understanding of AF-specific mechanisms, enabling tailored gene therapy interventions. Future prospects include the integration of advanced imaging, activation mapping, and percutaneous catheter-based techniques to refine transendocardial gene delivery, with potential applications in both ventricular and atrial contexts. As gene therapy for AF progresses, bridging the translational gap between preclinical models and clinical applications is imperative for the successful implementation of these promising approaches.
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Affiliation(s)
| | | | | | - Hamza Khan Toru
- Department of Medicine, King's Mill Hospital, Nottinghamshire, United Kingdom
| | - Maria Malik
- Department of Cardiovascular Medicine, Cardiovascular Analytics Group, Islamabad, Pakistan
| | - Arham Iqbal
- Department of Medicine, Dow International Medical College, Karachi, Pakistan
| | - Jahanzeb Malik
- Department of Cardiovascular Medicine, Cardiovascular Analytics Group, Islamabad, Pakistan
| | - Maria Faraz
- Department of Cardiovascular Medicine, Cardiovascular Analytics Group, Islamabad, Pakistan
| | - Muhammad Awais
- Department of Cardiology, Islamic International Medical College, Rawalpindi, Pakistan.
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Sakamoto K, Takase S, Ikeda Y, Sakamoto I. Biventricular activation of right bundle branch block pattern ventricular tachycardia originating from the right ventricle in Ebstein's anomaly. HeartRhythm Case Rep 2024; 10:109-111. [PMID: 38264116 PMCID: PMC10801088 DOI: 10.1016/j.hrcr.2023.10.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2024] Open
Affiliation(s)
- Kazuo Sakamoto
- Department of Cardiovascular Medicine, Kyushu University Hospital, Fukuoka, Japan
| | - Susumu Takase
- Department of Cardiovascular Medicine, Kyushu University Hospital, Fukuoka, Japan
| | - Yuki Ikeda
- Department of Cardiovascular Medicine, Kyushu University Hospital, Fukuoka, Japan
| | - Ichiro Sakamoto
- Department of Cardiovascular Medicine, Kyushu University Hospital, Fukuoka, Japan
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Yang J, Li M, Jiang C, Tang R, Sang C, Wang W, Zhao X, Li C, Li S, Guo X, Jia C, Ning M, Feng L, Wen D, Zhu H, Jiang Y, Liu T, Liu F, Long D, Dong J, Ma C. Electrophysiological characteristics and ablation of ventricular arrhythmias originating from the intramural basal inferior septum. Europace 2023; 26:euae001. [PMID: 38180948 PMCID: PMC10799636 DOI: 10.1093/europace/euae001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2023] [Accepted: 12/28/2023] [Indexed: 01/07/2024] Open
Abstract
AIMS The electrocardiographic and electrophysiological characteristics of ventricular arrhythmia (VA) arising from the intramural basal inferior septum (BIS) have not been specifically addressed to date. The aim of the current study was to characterize intramural BIS-VA and distinguish it from those with endocardial origins besides clarifying the anatomical configurations of the pyramidal space. METHODS AND RESULTS Fifty-five consecutive patients undergoing catheter ablation of VAs from BIS were identified and divided into three groups: the left ventricular (LV)-BIS group (n = 28), right ventricular (RV)-BIS group (n = 8), and intramural group (Intra, n = 19). Compared with the LV-BIS and RV-BIS groups, patients in the Intra group presented with no adequate earliest activation time at the two-sided BIS and epicardial coronary system [right: 7.79 ± 2.38 vs. left: 7.16 ± 2.59 vs. the middle cardiac vein (MCV): 6.26 ± 1.73 ms, P = 0.173] and poor-matched pacing-produced QRS at each site. Under the intracardiac echocardiography view, the pyramidal base was the broadest part of the septum and served as the division of the two-sided BIS. Focal ablation yielded promising acute-term and long-term procedural success in the LV-BIS and RV-BIS groups. But for the Intra group, VAs disappeared only after stepwise ablation successively targeted early preferential exit. After follow-up, three patients in the Intra group had recurrent VA, and all of them were treated well by a redo procedure or drug therapy. CONCLUSION Intramural VAs were relatively common in the BIS region in our series. Intra-procedural mapping was important to distinguish the intramural VAs from other VAs by comparing the local activation time and pacing mapping. Procedural success could be achieved by stepwise ablation on the counterpart sides of the BIS and within the MCV.
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Affiliation(s)
- Jie Yang
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, National Clinical Research Center for Cardiovascular Diseases, No. 2, Anzhen Road, Chaoyang District, Beijing 100029, China
| | - Mengmeng Li
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, National Clinical Research Center for Cardiovascular Diseases, No. 2, Anzhen Road, Chaoyang District, Beijing 100029, China
| | - Chenxi Jiang
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, National Clinical Research Center for Cardiovascular Diseases, No. 2, Anzhen Road, Chaoyang District, Beijing 100029, China
| | - Ribo Tang
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, National Clinical Research Center for Cardiovascular Diseases, No. 2, Anzhen Road, Chaoyang District, Beijing 100029, China
| | - Caihua Sang
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, National Clinical Research Center for Cardiovascular Diseases, No. 2, Anzhen Road, Chaoyang District, Beijing 100029, China
| | - Wei Wang
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, National Clinical Research Center for Cardiovascular Diseases, No. 2, Anzhen Road, Chaoyang District, Beijing 100029, China
| | - Xin Zhao
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, National Clinical Research Center for Cardiovascular Diseases, No. 2, Anzhen Road, Chaoyang District, Beijing 100029, China
| | - Changyi Li
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, National Clinical Research Center for Cardiovascular Diseases, No. 2, Anzhen Road, Chaoyang District, Beijing 100029, China
| | - Songnan Li
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, National Clinical Research Center for Cardiovascular Diseases, No. 2, Anzhen Road, Chaoyang District, Beijing 100029, China
| | - Xueyuan Guo
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, National Clinical Research Center for Cardiovascular Diseases, No. 2, Anzhen Road, Chaoyang District, Beijing 100029, China
| | - Changqi Jia
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, National Clinical Research Center for Cardiovascular Diseases, No. 2, Anzhen Road, Chaoyang District, Beijing 100029, China
| | - Man Ning
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, National Clinical Research Center for Cardiovascular Diseases, No. 2, Anzhen Road, Chaoyang District, Beijing 100029, China
| | - Li Feng
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, National Clinical Research Center for Cardiovascular Diseases, No. 2, Anzhen Road, Chaoyang District, Beijing 100029, China
| | - Dan Wen
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, National Clinical Research Center for Cardiovascular Diseases, No. 2, Anzhen Road, Chaoyang District, Beijing 100029, China
| | - Hui Zhu
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, National Clinical Research Center for Cardiovascular Diseases, No. 2, Anzhen Road, Chaoyang District, Beijing 100029, China
| | - Yuexin Jiang
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, National Clinical Research Center for Cardiovascular Diseases, No. 2, Anzhen Road, Chaoyang District, Beijing 100029, China
| | - Tong Liu
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, National Clinical Research Center for Cardiovascular Diseases, No. 2, Anzhen Road, Chaoyang District, Beijing 100029, China
| | - Fang Liu
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, National Clinical Research Center for Cardiovascular Diseases, No. 2, Anzhen Road, Chaoyang District, Beijing 100029, China
| | - Deyong Long
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, National Clinical Research Center for Cardiovascular Diseases, No. 2, Anzhen Road, Chaoyang District, Beijing 100029, China
| | - Jianzeng Dong
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, National Clinical Research Center for Cardiovascular Diseases, No. 2, Anzhen Road, Chaoyang District, Beijing 100029, China
| | - Changsheng Ma
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, National Clinical Research Center for Cardiovascular Diseases, No. 2, Anzhen Road, Chaoyang District, Beijing 100029, China
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Hellemans A, Duytschaever M, Van Steenkiste G, van Loon G, Bosmans T, Mampaey G, Smets P. Successful high-resolution three-dimensional electroanatomical mapping and radiofrequency catheter ablation of a posteroseptal accessory pathway in a dog using CARTO 3. J Vet Cardiol 2023; 51:207-213. [PMID: 38198978 DOI: 10.1016/j.jvc.2023.12.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Revised: 12/14/2023] [Accepted: 12/18/2023] [Indexed: 01/12/2024]
Abstract
A one-year-and-seven-month-old, 28 kg, male castrated crossbreed dog was presented for supraventricular tachycardia causing recurrent episodes of anorexia and lethargy. Sotalol (2.2 mg/kg q12 h) reduced the frequency of symptomatic episodes but did not provide full relief. Three-dimensional electroanatomical mapping was performed at the Ghent University Small Animal Teaching hospital using the CARTO 3. Right atrial activation mapping identified the earliest atrial activation right posteroseptal, near the tricuspid annulus. Fast retrograde ventriculoatrial conduction during tachycardia and extrastimulus testing confirmed the presence of a concealed right posteroseptal accessory pathway. Six radiofrequency catheter ablation applications were delivered, and tachycardia remained uninducible. The dog recovered well from the procedure. Sotalol was stopped three weeks later, and no more clinical signs were noted by the owner. Repeated 24-hour electrocardiography monitoring on day one and at 1, 3, and 12 months after the procedure showed no recurrence of tachycardia.
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Affiliation(s)
- A Hellemans
- Small Animal Department, Faculty of Veterinary Medicine, Ghent University, Salisburylaan 133, 9820 Merelbeke, Belgium.
| | - M Duytschaever
- Department of Cardiology, AZ Sint-Jan Brugge, Ruddershove 10, 8000 Brugge, Belgium
| | - G Van Steenkiste
- Equine Cardioteam Ghent, Department of Internal Medicine, Reproduction and Population Medicine, Faculty of Veterinary Medicine, Ghent University, Salisburylaan 133, 9820 Merelbeke, Belgium
| | - G van Loon
- Equine Cardioteam Ghent, Department of Internal Medicine, Reproduction and Population Medicine, Faculty of Veterinary Medicine, Ghent University, Salisburylaan 133, 9820 Merelbeke, Belgium
| | - T Bosmans
- Small Animal Department, Faculty of Veterinary Medicine, Ghent University, Salisburylaan 133, 9820 Merelbeke, Belgium
| | - G Mampaey
- Small Animal Department, Faculty of Veterinary Medicine, Ghent University, Salisburylaan 133, 9820 Merelbeke, Belgium
| | - P Smets
- Small Animal Department, Faculty of Veterinary Medicine, Ghent University, Salisburylaan 133, 9820 Merelbeke, Belgium
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Ahlers M, Darden D, Hoffmayer K, Feld GK, Krummen DE, Ho G. A perfect storm of ventricular fibrillation: Infarct, posterior fascicle, and the moderator band. HeartRhythm Case Rep 2023; 9:943-947. [PMID: 38204826 PMCID: PMC10774567 DOI: 10.1016/j.hrcr.2023.10.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2024] Open
Affiliation(s)
- Michael Ahlers
- Division of Cardiology, Section of Cardiac Electrophysiology, University of California San Diego, La Jolla, California
| | - Douglas Darden
- Division of Cardiology, Section of Cardiac Electrophysiology, University of California San Diego, La Jolla, California
| | - Kurt Hoffmayer
- Division of Cardiology, Section of Cardiac Electrophysiology, University of California San Diego, La Jolla, California
| | - Gregory K. Feld
- Division of Cardiology, Section of Cardiac Electrophysiology, University of California San Diego, La Jolla, California
| | - David E. Krummen
- Division of Cardiology, Section of Cardiac Electrophysiology, University of California San Diego, La Jolla, California
| | - Gordon Ho
- Division of Cardiology, Section of Cardiac Electrophysiology, University of California San Diego, La Jolla, California
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Raymond-Paquin A, Pillai A, Myadam R, Mankad P, Lovejoy S, Koneru JN, Ellenbogen KA. Atypical atrial flutter catheter ablation in the era of high-density mapping. J Interv Card Electrophysiol 2023; 66:1807-1815. [PMID: 36645578 DOI: 10.1007/s10840-023-01475-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Accepted: 01/10/2023] [Indexed: 01/17/2023]
Abstract
BACKGROUND Mapping and ablating atypical atrial flutters (AAFLs) have evolved greatly with advances in high-density 3D mapping systems over the last years. METHODS The objectives are to evaluate the feasibility of AAFL catheter ablation based on high-density mapping and minimizing entrainment and to better characterize AAFL circuits. Consecutive patients who underwent AAFL ablation using the EnSite Precision™ system and HD Grid™ mapping catheter (Abbott, Chicago, IL) between 06/2018 and 1/2022 were included. Mitral isthmus-dependent and roof-dependent AAFLs were classified as conventional circuits. All other AAFL circuits were classified as non-conventional circuits and were defined based on the location of the critical isthmus. RESULTS Sixty-two patients underwent AAFL ablation (mean age 68±11 years). A total of 95 AAFLs were mapped and 92 (97%) were successfully ablated. Fifty-three (85%) patients had a previous AF/AFL ablation. Forty-four (46%) AAFL circuits were classified as conventional and 51 (54%) as non-conventional. Conventional AAFL circuits had longer critical isthmuses (19.0±9.0 vs 10.8±6.3mm, p<0.001), a lower prevalence of slow conduction at the critical isthmus (59% vs 86%, p=0.005), and a longer radiofrequency time to AAFL termination (117±119 vs 51±66 s, p=0.002). Entrainment was attempted in 19 (20%) flutters and its use declined significantly over the study period. Procedural success rates remained high whether entrainment was used or not. Freedom of any atrial tachycardia was 65% over a follow-up of 13.8±9.0 months. CONCLUSIONS AAFL catheter ablation can be achieved with high procedural success rate using a contemporary strategy based on high-density mapping alone. Non-conventional circuits are frequent and present unique electrophysiological characteristics.
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Affiliation(s)
- Alexandre Raymond-Paquin
- Division of Cardiology, Pauley Heart Center, Virginia Commonwealth University, Richmond, VA, USA.
- Department of Medicine, Montreal Heart Institute, Université de Montréal, 5000, Bélanger Street, Montreal, Quebec, H1T 1C8, Canada.
| | - Ajay Pillai
- Division of Cardiology, Pauley Heart Center, Virginia Commonwealth University, Richmond, VA, USA
| | - Rahul Myadam
- Division of Cardiology, Pauley Heart Center, Virginia Commonwealth University, Richmond, VA, USA
| | - Pranav Mankad
- Division of Cardiology, Pauley Heart Center, Virginia Commonwealth University, Richmond, VA, USA
| | | | - Jayanthi N Koneru
- Division of Cardiology, Pauley Heart Center, Virginia Commonwealth University, Richmond, VA, USA
| | - Kenneth A Ellenbogen
- Division of Cardiology, Pauley Heart Center, Virginia Commonwealth University, Richmond, VA, USA
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Hu W, Wu X, Ou Z, Zhou L, Chen W, Qiu Z. Comparing different activation patterns in a physiological pacing case: Insights from high-resolution mapping. HeartRhythm Case Rep 2023; 9:790-793. [PMID: 38023671 PMCID: PMC10667112 DOI: 10.1016/j.hrcr.2023.08.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2023] Open
Affiliation(s)
- Wei Hu
- Tong Ren Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Xianhao Wu
- Tong Ren Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Ziming Ou
- Tong Ren Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Lihong Zhou
- Tong Ren Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Wanlan Chen
- Tong Ren Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- The First People’s Hospital of Foshan, Guangdong, China
| | - Zhaohui Qiu
- Tong Ren Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
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Ciaccio EJ, Coromilas J, Wan EY, Yarmohammadi H, Saluja DS, Peters NS, Garan H, Biviano AB. Correlation relationships of the reentrant ventricular tachycardia circuit. Comput Methods Programs Biomed 2023; 241:107764. [PMID: 37597351 DOI: 10.1016/j.cmpb.2023.107764] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Revised: 07/01/2023] [Accepted: 08/12/2023] [Indexed: 08/21/2023]
Abstract
INTRODUCTION A quantitative analysis of the components of reentrant ventricular tachycardia (VT) circuitry could improve understanding of its onset and perpetuation. METHOD In 19 canine experiments, the left anterior descending coronary artery was ligated to generate a subepicardial infarct. The border zone resided at the epicardial surface of the anterior left ventricle and was mapped 3-5 days postinfarction with a 196-312 bipolar multielectrode array. Monomorphic VT was inducible by extrastimulation. Activation maps revealed an epicardial double-loop reentrant circuit and isthmus, causing VT. Several circuit parameters were analyzed: the coupling interval for VT induction, VT cycle length, the lateral isthmus boundary (LIB) lengths, and isthmus width and angle. RESULTS The extrastimulus interval for VT induction and the VT cycle length were strongly correlated (p < 0.001). Both the extrastimulus interval and VT cycle length were correlated to the shortest LIB (p < 0.005). A derivation was developed to suggest that when conduction block at the shorter LIB is functional, the VT cycle length may depend on the local refractory period and the delay from wavefront pivot around the LIB. Isthmus width and angle were uncorrelated to other parameters. CONCLUSIONS The shorter LIB is correlated to VT cycle length, hence its circuit loop may drive reentrant VT. The extrastimulation interval, VT cycle length, and shorter LIB are intertwined, and may depend upon the local refractory period. Isthmus width and angle are less correlated, perhaps being more related to electrical discontinuity caused by alterations in infarct shape at depth.
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Affiliation(s)
- Edward J Ciaccio
- Department of Medicine - Division of Cardiology, Columbia University College of Physicians and Surgeons, New York, NY, USA; ElectroCardioMaths Programme, Imperial Centre for Cardiac Engineering, Imperial College London, London, UK.
| | - James Coromilas
- Department of Medicine - Division of Cardiovascular Disease and Hypertension, Rutgers University, New Brunswick, NJ, USA
| | - Elaine Y Wan
- Department of Medicine - Division of Cardiology, Columbia University College of Physicians and Surgeons, New York, NY, USA
| | - Hirad Yarmohammadi
- Department of Medicine - Division of Cardiology, Columbia University College of Physicians and Surgeons, New York, NY, USA
| | - Deepak S Saluja
- Department of Medicine - Division of Cardiology, Columbia University College of Physicians and Surgeons, New York, NY, USA
| | - Nicholas S Peters
- ElectroCardioMaths Programme, Imperial Centre for Cardiac Engineering, Imperial College London, London, UK
| | - Hasan Garan
- Department of Medicine - Division of Cardiology, Columbia University College of Physicians and Surgeons, New York, NY, USA
| | - Angelo B Biviano
- Department of Medicine - Division of Cardiology, Columbia University College of Physicians and Surgeons, New York, NY, USA
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Tonko JB, Sporton S, Sawhney V, Dhinoja M. Mapping the unmappable-Rapid high-density contact mapping in hemodynamically unstable ventricular tachycardia using a novel star-shaped multipolar catheter. HeartRhythm Case Rep 2023; 9:749-754. [PMID: 38047195 PMCID: PMC10691944 DOI: 10.1016/j.hrcr.2023.07.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2023] Open
Affiliation(s)
- Johanna B. Tonko
- St Bartholomew’s Hospital, London, United Kingdom
- Institute for Cardiovascular Science, University College London, London, United Kingdom
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Zhao Y, Gao Y, Zu Z, Li M, Schilling KG, Anderson AW, Ding Z, Gore JC. Detection of functional activity in brain white matter using fiber architecture informed synchrony mapping. Neuroimage 2022; 258:119399. [PMID: 35724855 PMCID: PMC9388229 DOI: 10.1016/j.neuroimage.2022.119399] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Revised: 06/13/2022] [Accepted: 06/17/2022] [Indexed: 01/12/2023] Open
Abstract
A general linear model is widely used for analyzing fMRI data, in which the blood oxygenation-level dependent (BOLD) signals in gray matter (GM) evoked in response to neural stimulation are modeled by convolving the time course of the expected neural activity with a canonical hemodynamic response function (HRF) obtained a priori. The maps of brain activity produced reflect the magnitude of local BOLD responses. However, detecting BOLD signals in white matter (WM) is more challenging as the BOLD signals are weaker and the HRF is different, and may vary more across the brain. Here we propose a model-free approach to detect changes in BOLD signals in WM by measuring task-evoked increases of BOLD signal synchrony in WM fibers. The proposed approach relies on a simple assumption that, in response to a functional task, BOLD signals in relevant fibers are modulated by stimulus-evoked neural activity and thereby show greater synchrony than when measured in a resting state, even if their magnitudes do not change substantially. This approach is implemented in two technical stages. First, for each voxel a fiber-architecture-informed spatial window is created with orientation distribution functions constructed from diffusion imaging data. This provides the basis for defining neighborhoods in WM that share similar local fiber architectures. Second, a modified principal component analysis (PCA) is used to estimate the synchrony of BOLD signals in each spatial window. The proposed approach is validated using a 3T fMRI dataset from the Human Connectome Project (HCP) at a group level. The results demonstrate that neural activity can be reliably detected as increases in fMRI signal synchrony within WM fibers that are engaged in a task with high sensitivities and reproducibility.
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Affiliation(s)
- Yu Zhao
- Vanderbilt University Institute of Imaging Science, United States; Department of Radiology and Radiological Sciences, Vanderbilt University Medical Center, United States.
| | - Yurui Gao
- Vanderbilt University Institute of Imaging Science, United States,Department of Biomedical Engineering, Vanderbilt University, United States
| | - Zhongliang Zu
- Vanderbilt University Institute of Imaging Science, United States,Department of Radiology and Radiological Sciences, Vanderbilt University Medical Center, United States
| | - Muwei Li
- Vanderbilt University Institute of Imaging Science, United States,Department of Radiology and Radiological Sciences, Vanderbilt University Medical Center, United States
| | - Kurt G. Schilling
- Vanderbilt University Institute of Imaging Science, United States,Department of Biomedical Engineering, Vanderbilt University, United States
| | - Adam W. Anderson
- Vanderbilt University Institute of Imaging Science, United States,Department of Radiology and Radiological Sciences, Vanderbilt University Medical Center, United States,Department of Biomedical Engineering, Vanderbilt University, United States
| | - Zhaohua Ding
- Vanderbilt University Institute of Imaging Science, United States; Department of Biomedical Engineering, Vanderbilt University, United States; Department of Electrical and Computer Engineering, Vanderbilt University, United States.
| | - John C. Gore
- Vanderbilt University Institute of Imaging Science, United States,Department of Radiology and Radiological Sciences, Vanderbilt University Medical Center, United States,Department of Biomedical Engineering, Vanderbilt University, United States,Department of Molecular Physiology and Biophysics, Vanderbilt University, United States,Department of Physics and Astronomy, Vanderbilt University, United States
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Nies M, Schleberger R, Dinshaw L, Klatt N, Muenkler P, Jungen C, Rottner L, Lemoine MD, Reißmann B, Rillig A, Metzner A, Kirchhof P, Meyer C. Spatial correction improves accuracy of catheter positioning during ablation of premature ventricular contractions: differences between ventricular outflow tracts and other localizations. BMC Cardiovasc Disord 2022; 22:312. [PMID: 35831801 PMCID: PMC9281105 DOI: 10.1186/s12872-022-02741-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Accepted: 06/21/2022] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Hybrid activation mapping is a novel tool to correct for spatial displacement of the mapping catheter due to asymmetrical contraction of myocardium during premature ventricular contractions (PVC). The aim of this study is to describe and improve our understanding of spatial displacement during PVC mapping as well as options for correction using hybrid activation mapping. METHODS AND RESULTS We analyzed 5798 hybrid mapping points in 40 acquired hybrid maps of 22 consecutive patients (age 63 ± 16 years, 45% female) treated for premature ventricular contractions (PVCs). Median PVC-coupling interval was 552 ms (IQR 83 ms). Spatial displacement was determined by measuring the dislocation of the catheter tip during PVC compared to the preceding sinus beat. Mean spatial displacement was 3.8 ± 1.5 mm for all maps. The displacement was 1.3 ± 0.4 mm larger for PVCs with non-outflow-tract origin compared to PVCs originating from the ventricular outflow tracts (RVOT/LVOT; p = 0.045). Demographic parameters, PVC-coupling-interval and chamber of origin had no significant influence on the extent of spatial displacement. CONCLUSION Ectopic activation of the ventricular myocardium during PVCs results in spatial displacement of mapping points that is significantly larger for PVCs with non-outflow-tract origin. The correction for spatial displacement may improve accuracy of radiofrequency current (RFC)-application in catheter ablation of PVCs.
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Affiliation(s)
- M. Nies
- grid.13648.380000 0001 2180 3484Department of Cardiology, University Heart and Vascular Center, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246 Hamburg, Germany ,grid.452396.f0000 0004 5937 5237DZHK (German Center for Cardiovascular Research), Partner Site Hamburg/Lübeck/Kiel, Berlin, Germany
| | - R. Schleberger
- grid.13648.380000 0001 2180 3484Department of Cardiology, University Heart and Vascular Center, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246 Hamburg, Germany
| | - L. Dinshaw
- grid.13648.380000 0001 2180 3484Department of Cardiology, University Heart and Vascular Center, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246 Hamburg, Germany
| | - N. Klatt
- grid.13648.380000 0001 2180 3484Department of Cardiology, University Heart and Vascular Center, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246 Hamburg, Germany ,grid.452396.f0000 0004 5937 5237DZHK (German Center for Cardiovascular Research), Partner Site Hamburg/Lübeck/Kiel, Berlin, Germany ,grid.492071.90000 0004 0580 7196Department of Cardiology, Schön Klinik Neustadt in Holstein, Am Kiebitzberg 10, 23730 Neustadt in Holstein, Germany
| | - P. Muenkler
- grid.13648.380000 0001 2180 3484Department of Cardiology, University Heart and Vascular Center, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246 Hamburg, Germany ,grid.452396.f0000 0004 5937 5237DZHK (German Center for Cardiovascular Research), Partner Site Hamburg/Lübeck/Kiel, Berlin, Germany
| | - C. Jungen
- grid.13648.380000 0001 2180 3484Department of Cardiology, University Heart and Vascular Center, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246 Hamburg, Germany ,grid.452396.f0000 0004 5937 5237DZHK (German Center for Cardiovascular Research), Partner Site Hamburg/Lübeck/Kiel, Berlin, Germany ,grid.10419.3d0000000089452978Department of Cardiology, Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, The Netherlands
| | - L. Rottner
- grid.13648.380000 0001 2180 3484Department of Cardiology, University Heart and Vascular Center, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246 Hamburg, Germany
| | - M. D. Lemoine
- grid.13648.380000 0001 2180 3484Department of Cardiology, University Heart and Vascular Center, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246 Hamburg, Germany ,grid.452396.f0000 0004 5937 5237DZHK (German Center for Cardiovascular Research), Partner Site Hamburg/Lübeck/Kiel, Berlin, Germany
| | - B. Reißmann
- grid.13648.380000 0001 2180 3484Department of Cardiology, University Heart and Vascular Center, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246 Hamburg, Germany
| | - A. Rillig
- grid.13648.380000 0001 2180 3484Department of Cardiology, University Heart and Vascular Center, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246 Hamburg, Germany
| | - A. Metzner
- grid.13648.380000 0001 2180 3484Department of Cardiology, University Heart and Vascular Center, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246 Hamburg, Germany
| | - P. Kirchhof
- grid.13648.380000 0001 2180 3484Department of Cardiology, University Heart and Vascular Center, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246 Hamburg, Germany ,grid.452396.f0000 0004 5937 5237DZHK (German Center for Cardiovascular Research), Partner Site Hamburg/Lübeck/Kiel, Berlin, Germany ,grid.6572.60000 0004 1936 7486Institute of Cardiovascular Sciences, University of Birmingham, Birmingham, UK
| | - C. Meyer
- grid.13648.380000 0001 2180 3484Department of Cardiology, University Heart and Vascular Center, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246 Hamburg, Germany ,Division of Cardiology, EVK Düsseldorf, cNEP, Cardiac Neuro- and Electrophysiology Research Consortium, Kirchfeldstraße 40, 40217 Düsseldorf, Germany ,grid.411327.20000 0001 2176 9917cNEP, Cardiac Neuro- and Electrophysiology Research Consortium, Institute for Neural and Sensory Physiology, Heinrich Heine University Düsseldorf, Medical Faculty, Düsseldorf, Germany
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13
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Nishizaki K, Itoh T, Kimura M, Tomita H. Mosaic activation pattern demonstrated by high-resolution mapping during double atrial tachycardia. J Interv Card Electrophysiol 2022; 64:269-270. [PMID: 35247113 DOI: 10.1007/s10840-022-01170-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Accepted: 02/24/2022] [Indexed: 11/30/2022]
Affiliation(s)
- Kimitaka Nishizaki
- Department of Cardiology, Hirosaki University Graduate School of Medicine, 5 Zaifu-cho, Hirosaki, Aomori, 036-8562, Japan
| | - Taihei Itoh
- Department of Advanced Management of Cardiac Arrhythmia, Hirosaki University Graduate School of Medicine, Hirosaki, Japan.
| | - Masaomi Kimura
- Department of Advanced Management of Cardiac Arrhythmia, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Hirofumi Tomita
- Department of Cardiology, Hirosaki University Graduate School of Medicine, 5 Zaifu-cho, Hirosaki, Aomori, 036-8562, Japan
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14
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Vlachos K, Efremidis M, Derval N, Martin CA, Takigawa M, Bazoukis G, Frontera A, Gkalapis C, Duchateau J, Nakashima T, Letsas KP, Mililis P, Pambrun T, Bourier F, André C, Krisai P, Ramirez FD, Kamakura T, Takagi T, Nakatani Y, Kitamura T, Cheniti G, Sacher F, Hocini M, Haïssaguerre M, Jaïs P. Use of high-density activation and voltage mapping in combination with entrainment to delineate gap-related atrial tachycardias post atrial fibrillation ablation. Europace 2021; 23:1052-1062. [PMID: 33564832 DOI: 10.1093/europace/euaa394] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Accepted: 12/03/2020] [Indexed: 11/13/2022] Open
Abstract
AIMS An incomplete understanding of the mechanism of atrial tachycardia (AT) is a major determinant of ablation failure. We systematically evaluated the mechanisms of AT using ultra-high-resolution mapping in a large cohort of patients. METHODS AND RESULTS We included 107 consecutive patients (mean age: 65.7 ± 9.2 years, males: 81 patients) with documented endocardial gap-related AT after left atrial ablation for persistent atrial fibrillation (AF). We analysed the mechanism of 134 AT (94 macro-re-entries and 40 localized re-entries) using high-resolution activation mapping in combination with high-density voltage and entrainment mapping. Voltage in the conducting channels may be extremely low, even <0.1 mV (0.14 ± 0.095 mV, 51 of 134 AT, 41%), and almost always <0.5 mV (0.03-0.5 mV, 133 of 134 AT, 99.3%). The use of multipolar Orion, HDGrid, and Pentaray catheters improved our accuracy in delineating ultra-low-voltage areas critical for maintenance of the circuit of endocardial gap-related AT. Conventional ablation catheters often do not detect any signal (noise level) even using adequate contact force, and only multipolar catheters of small electrodes and shorter interelectrode space can detect clear fractionated low-amplitude and high frequency signals, critical for re-entry maintenance. We performed a diagnosis in 112 out of 134 AT (83.6%) using only activation mapping and in 134 out of 134 AT (100%) using the combination of activation and entrainment mapping. CONCLUSION High-resolution activation mapping in combination with high-density voltage and entrainment mapping is the ideal strategy to delineate the critical part of the circuit in endocardial gap-related re-entrant AT after AF ablation.
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Affiliation(s)
- Konstantinos Vlachos
- Electrophysiology and Ablation Unit, Hôpital Cardiologique du Haut Lévêque, Avenue de Magellan, 33604 Pessac Cedex, France
| | - Michael Efremidis
- Second Department of Cardiology, Laboratory of Cardiac Electrophysiology, 'Evangelismos' General Hospital of Athens, Athens, Greece
| | - Nicolas Derval
- Electrophysiology and Ablation Unit, Hôpital Cardiologique du Haut Lévêque, Avenue de Magellan, 33604 Pessac Cedex, France
| | - Claire A Martin
- Electrophysiology and Ablation Unit, Hôpital Cardiologique du Haut Lévêque, Avenue de Magellan, 33604 Pessac Cedex, France.,Department of Electrophysiology-Cardiology, Royal Papworth Hospital NHS Foundation Trust, Cambridge, UK
| | - Masateru Takigawa
- Electrophysiology and Ablation Unit, Hôpital Cardiologique du Haut Lévêque, Avenue de Magellan, 33604 Pessac Cedex, France
| | - George Bazoukis
- Second Department of Cardiology, Laboratory of Cardiac Electrophysiology, 'Evangelismos' General Hospital of Athens, Athens, Greece
| | - Antonio Frontera
- Electrophysiology and Ablation Unit, Hôpital Cardiologique du Haut Lévêque, Avenue de Magellan, 33604 Pessac Cedex, France
| | - Charis Gkalapis
- Department of Electrophysiology-Cardiology, Klinikum Vest, Recklinghausen, Germany.,Department of Cardiology, Akademisches Lehrkrankenhaus, Ruhr-Universität Bochum, Bochum, Germany
| | - Josselin Duchateau
- Electrophysiology and Ablation Unit, Hôpital Cardiologique du Haut Lévêque, Avenue de Magellan, 33604 Pessac Cedex, France
| | - Takashi Nakashima
- Electrophysiology and Ablation Unit, Hôpital Cardiologique du Haut Lévêque, Avenue de Magellan, 33604 Pessac Cedex, France
| | - Konstantinos P Letsas
- Second Department of Cardiology, Laboratory of Cardiac Electrophysiology, 'Evangelismos' General Hospital of Athens, Athens, Greece
| | - Panagiotis Mililis
- Second Department of Cardiology, Laboratory of Cardiac Electrophysiology, 'Evangelismos' General Hospital of Athens, Athens, Greece
| | - Thomas Pambrun
- Electrophysiology and Ablation Unit, Hôpital Cardiologique du Haut Lévêque, Avenue de Magellan, 33604 Pessac Cedex, France
| | - Felix Bourier
- Electrophysiology and Ablation Unit, Hôpital Cardiologique du Haut Lévêque, Avenue de Magellan, 33604 Pessac Cedex, France
| | - Clémentine André
- Electrophysiology and Ablation Unit, Hôpital Cardiologique du Haut Lévêque, Avenue de Magellan, 33604 Pessac Cedex, France
| | - Philipp Krisai
- Electrophysiology and Ablation Unit, Hôpital Cardiologique du Haut Lévêque, Avenue de Magellan, 33604 Pessac Cedex, France
| | - F Daniel Ramirez
- Electrophysiology and Ablation Unit, Hôpital Cardiologique du Haut Lévêque, Avenue de Magellan, 33604 Pessac Cedex, France
| | - Tsukasa Kamakura
- Electrophysiology and Ablation Unit, Hôpital Cardiologique du Haut Lévêque, Avenue de Magellan, 33604 Pessac Cedex, France
| | - Takamitsu Takagi
- Electrophysiology and Ablation Unit, Hôpital Cardiologique du Haut Lévêque, Avenue de Magellan, 33604 Pessac Cedex, France
| | - Yosuke Nakatani
- Electrophysiology and Ablation Unit, Hôpital Cardiologique du Haut Lévêque, Avenue de Magellan, 33604 Pessac Cedex, France
| | - Takeshi Kitamura
- Electrophysiology and Ablation Unit, Hôpital Cardiologique du Haut Lévêque, Avenue de Magellan, 33604 Pessac Cedex, France
| | - Ghassen Cheniti
- Electrophysiology and Ablation Unit, Hôpital Cardiologique du Haut Lévêque, Avenue de Magellan, 33604 Pessac Cedex, France
| | - Frédéric Sacher
- Electrophysiology and Ablation Unit, Hôpital Cardiologique du Haut Lévêque, Avenue de Magellan, 33604 Pessac Cedex, France
| | - Mélèze Hocini
- Electrophysiology and Ablation Unit, Hôpital Cardiologique du Haut Lévêque, Avenue de Magellan, 33604 Pessac Cedex, France
| | - Michel Haïssaguerre
- Electrophysiology and Ablation Unit, Hôpital Cardiologique du Haut Lévêque, Avenue de Magellan, 33604 Pessac Cedex, France
| | - Pierre Jaïs
- Electrophysiology and Ablation Unit, Hôpital Cardiologique du Haut Lévêque, Avenue de Magellan, 33604 Pessac Cedex, France
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15
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Jáuregui B, Penela D, Fernández-Armenta J, Acosta J, Terés C, Soto-Iglesias D, Silva E, Ordóñez A, San Antonio R, Chauca A, Carreño JM, Scherer C, Falasconi G, Pedrote A, Berruezo A. Impact of a predefined pacemapping protocol use for ablation of infrequent premature ventricular complexes: A prospective, multicenter study. Heart Rhythm 2021; 18:1709-1716. [PMID: 34029733 DOI: 10.1016/j.hrthm.2021.05.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Revised: 05/12/2021] [Accepted: 05/17/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND Pacemapping (PM) is a useful maneuver for aiding premature ventricular complex (PVC) ablation. Its standalone clinical value is still to be defined. OBJECTIVES The purpose of this study was to analyze the efficacy of a predefined PM protocol for low-burden PVC ablation, regardless of their site of origin (SOO) and the presence of structural heart disease. METHODS This was a prospective, nonrandomized, multicenter study. The PM protocol was performed when <1 PVC/min was found. The "target area" was delimited by the 3 best matching points >94% correlation, and 3 radiofreqency (RF) applications were delivered. RESULTS Of 185 patients, 105 (57%) underwent activation mapping, 60 (32%) were PM-guided, and 20 (11%) were canceled due to absence of PVCs. Baseline QRS, PVC burden, and outflow tract origin were independent predictors of PM-guided ablation. A higher proportion of right ventricular outflow tract SOO in the PM group (52% vs 40%; P = .03) was observed. Mean target area was 0.6 ± 0.9 cm2. Mean 10-ms isochronal area in local activation time (LAT)-guided procedures was higher (1.7 ± 2.3 cm2; P <.001). Mean number of PM matching points acquired was 39 ± 21 (range 6-98). Mean mapping and RF times were similar in both groups. However, significantly shorter procedural (53 ± 24 vs 61 ± 26 minutes; P = .04) as well as RF times (111 ± 51 vs 149 ± 149 seconds; P = .05) were needed in the PM group using the proposed protocol. Global clinical success reached 87% for the PM group and 90% (P = .58) the for LAT mapping group. CONCLUSION When LAT mapping is precluded, application of a PM-guided ablation protocol directed to >94% matching correlation target area is a more efficient alternative with comparable clinical results.
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Affiliation(s)
| | - Diego Penela
- Heart Institute, Teknon Medical Center, Barcelona, Spain
| | | | - Juan Acosta
- Virgen del Rocío University Hospital, Sevilla, Spain
| | - Cheryl Terés
- Heart Institute, Teknon Medical Center, Barcelona, Spain
| | | | | | | | | | - Alfredo Chauca
- Heart Institute, Teknon Medical Center, Barcelona, Spain
| | - Jose M Carreño
- Heart Institute, Teknon Medical Center, Barcelona, Spain
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16
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Rossi P, Cauti FM, Niscola M, Calore F, Fanti V, Polselli M, Di Pastena A, Iaia L, Bianchi S. A novel Ventricular map of Electrograms DUration as a Method to identify areas of slow conduction for ventricular tachycardia ablation: The VEDUM pilot study. Heart Rhythm 2021; 18:1253-60. [PMID: 33957317 DOI: 10.1016/j.hrthm.2021.04.030] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Revised: 04/26/2021] [Accepted: 04/27/2021] [Indexed: 11/21/2022]
Abstract
BACKGROUND Bipolar electrogram (EGM) duration is indicative of local activation property and, if prolonged, is useful to discover areas of slow conduction favoring arrhythmias. OBJECTIVE The present study aimed to create a map of EGM duration during the ventricular tachycardia (VT) (Ventricular Electrograms DUration as a Method map [VEDUM map]) to verify if the slowest activation area is crucial for reentry and could represent a suitable target for rapid VT interruption during ablation. METHODS Prospectively 30 patients were enrolled for this study. Twenty-one patients were selected, and 24 VT maps with complete circuit delineation (>90% tachycardia cycle length) were analyzed. Activation and VEDUM maps during VT as well as voltage maps during sinus rhythm were created. RESULTS Twenty-two of 24 VTs (88%) were interrupted during the first radiofrequency delivery (mean time 7.3 ± 5.4 seconds; range 3-25 seconds) at the area with the longest EGM duration (212 ± 47 ms; range 113-330 ms). The mean percentage of the cycle length of VT covered by the EGM with the longest duration was 58% ± 12%. In 9 patients (37%), the longest EGM was located at the isthmus entrance, at the exit in 7 maps (30%), and the mid-isthmuses in 8 maps (33%). In 6 patients (25%), the EGM covered the full diastolic phase. The mean isthmus width was 28 ± 11 mm (range 16-48 mm; median 25 mm). CONCLUSION A VEDUM map is highly accurate in defining a conductive vulnerable zone of the VT circuit. The longest EGM duration within the isthmus is highly predictive of rapid VT termination at the first radiofrequency delivery even in the case of large isthmuses.
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17
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Singleton MJ, Koneru JN, Bhave PD, Whalen SP. An Incessant Tachycardia: What Is the Mechanism? J Innov Card Rhythm Manag 2021; 12:4477-4481. [PMID: 33959407 PMCID: PMC8095334 DOI: 10.19102/icrm.2021.120407] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Accepted: 10/07/2020] [Indexed: 11/25/2022] Open
Abstract
A 39-year-old man presented with lifelong palpitations, a mildly reduced left ventricular ejection fraction, and incessant tachycardia. Electrocardiography revealed a regular, one-to-one supraventricular tachycardia with superiorly directed P-waves and a long R–P interval. The differential diagnosis of the tachycardia, response to invasive electrophysiologic maneuvers, and treatment with catheter ablation are discussed.
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Affiliation(s)
- Matthew J Singleton
- Section of Cardiology, Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Jayanthi N Koneru
- Division of Cardiology, Department of Internal Medicine, Virginia Commonwealth University School of Medicine, Richmond, VI, USA
| | - Prashant D Bhave
- Section of Cardiology, Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - S Patrick Whalen
- Section of Cardiology, Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, NC, USA
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18
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Jáuregui B, Fernández-Armenta J, Acosta J, Penela D, Terés C, Ordóñez A, Soto-Iglesias D, Silva E, Chauca A, Carreño JM, Scherer C, Pedrote A, Berruezo A. MANual vs. automatIC local activation time annotation for guiding Premature Ventricular Complex ablation procedures (MANIaC-PVC study). Europace 2021; 23:1285-1294. [PMID: 33846728 DOI: 10.1093/europace/euab080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Accepted: 03/17/2021] [Indexed: 11/13/2022] Open
Abstract
AIMS To assess potential benefits of a local activation time (LAT) automatic acquisition protocol using wavefront annotation plus an ECG pattern matching algorithm [automatic (AUT)-arm] during premature ventricular complex (PVC) ablation procedures. METHODS AND RESULTS Prospective, randomized, controlled, and international multicentre study (NCT03340922). One hundred consecutive patients with indication for PVC ablation were enrolled and randomized to AUT (n = 50) or manual (MAN, n = 50) annotation protocols using the CARTO3 navigation system. The primary endpoint was mapping success. Clinical success was defined as a PVC-burden reduction of ≥80% in the 24-h Holter within 6 months after the procedure. Mean age was 56 ± 14 years, 54% men. The mean baseline PVC burden was 25 ± 13%, and mean left ventricular ejection fraction (LVEF) 55 ± 11%. Baseline characteristics were similar between the groups. The most frequent PVC-site of origin were right ventricular outflow tract (41%), LV (25%), and left ventricular outflow tract (17%), without differences between groups. Radiofrequency (RF) time and number of RF applications were similar for both groups. Mapping and procedure times were significantly shorter in the AUT-arm (25.5 ± 14.3 vs. 32.8 ± 12.6 min, P = 0.009; and 54.8 ± 24.8 vs. 67.4 ± 25.2, P = 0.014, respectively), while more mapping points were acquired [136 (94-222) AUT vs. 79 (52-111) MAN; P < 0.001]. Mapping and clinical success were similar in both groups. There were no procedure-related complications. CONCLUSION The use of a complete automatic protocol for LAT annotation during PVC ablation procedures allows to achieve similar clinical endpoints with higher procedural efficiency when compared with conventional, manual annotation carried out by expert operators.
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Affiliation(s)
- Beatriz Jáuregui
- Heart Institute, Teknon Medical Center, C/Vilana, 12, 08022 Barcelona, Spain
| | | | - Juan Acosta
- Virgen del Rocío University Hospital, Sevilla, Spain
| | - Diego Penela
- Heart Institute, Teknon Medical Center, C/Vilana, 12, 08022 Barcelona, Spain.,Ospedale Guglielmo da Saliceto, Piacenza, Italy
| | - Cheryl Terés
- Heart Institute, Teknon Medical Center, C/Vilana, 12, 08022 Barcelona, Spain
| | - Augusto Ordóñez
- Heart Institute, Teknon Medical Center, C/Vilana, 12, 08022 Barcelona, Spain
| | - David Soto-Iglesias
- Heart Institute, Teknon Medical Center, C/Vilana, 12, 08022 Barcelona, Spain
| | | | - Alfredo Chauca
- Heart Institute, Teknon Medical Center, C/Vilana, 12, 08022 Barcelona, Spain
| | - José M Carreño
- Heart Institute, Teknon Medical Center, C/Vilana, 12, 08022 Barcelona, Spain
| | - Claudia Scherer
- Heart Institute, Teknon Medical Center, C/Vilana, 12, 08022 Barcelona, Spain
| | | | - Antonio Berruezo
- Heart Institute, Teknon Medical Center, C/Vilana, 12, 08022 Barcelona, Spain
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19
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Demir S, Gulsen K, Kepez A, Uslu A, Kup A, Kanar BG, Kayan F, Yildirim C, Akgun T. Predictors of adequate intraprocedural premature ventricular complex (PVC) frequency during idiopathic PVC ablation. Herz 2021; 46:476-481. [PMID: 33464357 DOI: 10.1007/s00059-020-05017-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Revised: 11/10/2020] [Accepted: 12/20/2020] [Indexed: 11/26/2022]
Abstract
BACKGROUND The aim of the present study was to determine the predictors of adequate intraprocedural premature ventricular complex (PVC) frequency for successful mapping and ablation of idiopathic PVCs. METHODS A total of 101 consecutive patients (45 men; age: 47.9 ± 14.2 years) who had undergone idiopathic PVC ablation between 01 November 2018 and 24 June 2020 constituted our study population. Clinical and demographic data, procedural details and 24 h rhythm recordings that had been recorded before the procedure were retrospectively evaluated. Total PVC burden and diurnal variability assessed by the ratio of night time (22:00-06:00) over day time (06:00-22:00) PVC burden was calculated. The relationship between hourly PVC number and heart rate was also evaluated for each patient. Clinical characteristics and Holter parameters were compared between groups with and without adequate intraprocedural frequency of PVCs that permitted activation mapping. RESULTS In all, 27 patients (26.7%) had infrequent intraprocedural PVCs which necessitated isoproterenol infusion or cancellation of ablation procedure due to inability of activation mapping. PVC burden was significantly higher in the group with frequent intraprocedural PVCs (26.1 ± 9.4% vs 21.2 ± 10.3%; p: 0.026). There were no significant differences between groups regarding the relationship between hourly PVC number and heart rate or the ratio of night/day PVC burden. Binary logistic regression analysis revealed the 24 h Holter PVC burden as the sole parameter that is significant predictor of frequent intraprocedural PVCs permitting activation mapping. CONCLUSION The 24 h PVC burden was the only predictor of adequate intraprocedural PVC frequency permitting activation mapping during idiopathic PVC ablation.
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Affiliation(s)
- Serdar Demir
- Cardiology Clinic, Kartal Kosuyolu High Speciality Educational and Research Hospital, Istanbul, Turkey
| | - Kamil Gulsen
- Cardiology Clinic, Kartal Kosuyolu High Speciality Educational and Research Hospital, Istanbul, Turkey
| | - Alper Kepez
- Department of Cardiology, Marmara University School of Medicine, Istanbul, Turkey.
| | - Abdulkadir Uslu
- Cardiology Clinic, Kartal Kosuyolu High Speciality Educational and Research Hospital, Istanbul, Turkey
| | - Ayhan Kup
- Cardiology Clinic, Kartal Kosuyolu High Speciality Educational and Research Hospital, Istanbul, Turkey
| | - Batur Gonenc Kanar
- Department of Cardiology, Marmara University School of Medicine, Istanbul, Turkey
| | - Fethullah Kayan
- Cardiology Clinic, Mardin Kiziltepe State Hospital, Mardin, Turkey
| | - Cagan Yildirim
- Department of Cardiology, Marmara University School of Medicine, Istanbul, Turkey
| | - Taylan Akgun
- Cardiology Clinic, Kartal Kosuyolu High Speciality Educational and Research Hospital, Istanbul, Turkey
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Kishihara J, Fukaya H, Oikawa J, Ako J. Unique feature of novel activation mapping to identify the successful ablation site of atrial tachycardia. Heart Rhythm 2020; 18:653-654. [PMID: 33383225 DOI: 10.1016/j.hrthm.2020.12.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Revised: 12/20/2020] [Accepted: 12/21/2020] [Indexed: 10/22/2022]
Affiliation(s)
- Jun Kishihara
- Department of Cardiovascular Medicine, Kitasato University School of Medicine, Sagamihara, Japan.
| | - Hidehira Fukaya
- Department of Cardiovascular Medicine, Kitasato University School of Medicine, Sagamihara, Japan
| | - Jun Oikawa
- Department of Cardiovascular Medicine, Kitasato University School of Medicine, Sagamihara, Japan
| | - Junya Ako
- Department of Cardiovascular Medicine, Kitasato University School of Medicine, Sagamihara, Japan
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21
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Ciaccio EJ, Coromilas J, Wan EY, Yarmohammadi H, Saluja DS, Biviano AB, Wit AL, Peters NS, Garan H. Slow uniform electrical activation during sinus rhythm is an indicator of reentrant VT isthmus location and orientation in an experimental model of myocardial infarction. Comput Methods Programs Biomed 2020; 196:105666. [PMID: 32717622 DOI: 10.1016/j.cmpb.2020.105666] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Accepted: 07/12/2020] [Indexed: 06/11/2023]
Abstract
BACKGROUND To validate the predictability of reentrant circuit isthmus locations without ventricular tachycardia (VT) induction during high-definition mapping, we used computer methods to analyse sinus rhythm activation in experiments where isthmus location was subsequently verified by mapping reentrant VT circuits. METHOD In 21 experiments using a canine postinfarction model, bipolar electrograms were obtained from 196-312 recordings with 4mm spacing in the epicardial border zone during sinus rhythm and during VT. From computerized electrical activation maps of the reentrant circuit, areas of conduction block were determined and the isthmus was localized. A linear regression was computed at three different locations about the reentry isthmus using sinus rhythm electrogram activation data. From the regression analysis, the uniformity, a measure of the constancy at which the wavefront propagates, and the activation gradient, a measure that may approximate wavefront speed, were computed. The purpose was to test the hypothesis that the isthmus locates in a region of slow uniform activation bounded by areas of electrical discontinuity. RESULTS Based on the regression parameters, sinus rhythm activation along the isthmus near its exit proceeded uniformly (mean r2= 0.95±0.05) and with a low magnitude gradient (mean 0.37±0.10mm/ms). Perpendicular to the isthmus long-axis across its boundaries, the activation wavefront propagated much less uniformly (mean r2= 0.76±0.24) although of similar gradient (mean 0.38±0.23mm/ms). In the opposite direction from the exit, at the isthmus entrance, there was also less uniformity (mean r2= 0.80±0.22) but a larger magnitude gradient (mean 0.50±0.25mm/ms). A theoretical ablation line drawn perpendicular to the last sinus rhythm activation site along the isthmus long-axis was predicted to prevent VT reinduction. Anatomical conduction block occurred in 7/21 experiments, but comprised only small portions of the isthmus lateral boundaries; thus detection of sinus rhythm conduction block alone was insufficient to entirely define the VT isthmus. CONCLUSIONS Uniform activation with a low magnitude gradient during sinus rhythm is present at the VT isthmus exit location but there is less uniformity across the isthmus lateral boundaries and at isthmus entrance locations. These factors may be useful to verify any proposed VT isthmus location, reducing the need for VT induction to ablate the isthmus. Measured computerized values similar to those determined herein could therefore be assistive to sharpen specificity when applying sinus rhythm mapping to localize EP catheter ablation sites.
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Affiliation(s)
- Edward J Ciaccio
- Department of Medicine - Division of Cardiology, Columbia University College of Physicians and Surgeons, New York, NY 10032, USA; ElectroCardioMaths Programme, Imperial Centre for Cardiac Engineering, Imperial College London, London, UK.
| | - James Coromilas
- Department of Medicine - Division of Cardiovascular Disease and Hypertension, Rutgers University, New Brunswick, NJ, USA
| | - Elaine Y Wan
- Department of Medicine - Division of Cardiology, Columbia University College of Physicians and Surgeons, New York, NY 10032, USA
| | - Hirad Yarmohammadi
- Department of Medicine - Division of Cardiology, Columbia University College of Physicians and Surgeons, New York, NY 10032, USA
| | - Deepak S Saluja
- Department of Medicine - Division of Cardiology, Columbia University College of Physicians and Surgeons, New York, NY 10032, USA
| | - Angelo B Biviano
- Department of Medicine - Division of Cardiology, Columbia University College of Physicians and Surgeons, New York, NY 10032, USA
| | - Andrew L Wit
- Department of Pharmacology, Columbia University College of Physicians and Surgeons, New York, NY, USA
| | - Nicholas S Peters
- ElectroCardioMaths Programme, Imperial Centre for Cardiac Engineering, Imperial College London, London, UK
| | - Hasan Garan
- Department of Medicine - Division of Cardiology, Columbia University College of Physicians and Surgeons, New York, NY 10032, USA
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22
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Abstract
To characterize cardiac activity and arrhythmias, electrophysiologists can record the electrical activity of the heart in relation to its anatomy through a process called cardiac mapping (electroanatomic mapping, EAM). A solid understanding of the basic cardiac biopotentials, called electrograms, is imperative to construct and interpret the cardiac EAM correctly. There are several mapping approaches available to the electrophysiologist, each optimized for specific arrhythmia mechanisms. This article provides an overview of the fundamentals of EAM.
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Affiliation(s)
- Thomas P Ladas
- Department of Cardiovascular Medicine, Division of Heart Rhythm Services, Mayo Clinic, Rochester, MN, USA
| | - Alan Sugrue
- Department of Cardiovascular Medicine, Division of Heart Rhythm Services, Mayo Clinic, Rochester, MN, USA
| | - John Nan
- Department of Cardiovascular Medicine, Division of Heart Rhythm Services, Mayo Clinic, Rochester, MN, USA
| | - Vaibhav R Vaidya
- Department of Cardiovascular Medicine, Division of Heart Rhythm Services, Mayo Clinic, Rochester, MN, USA
| | - Deepak Padmanabhan
- Department of Cardiovascular Medicine, Division of Heart Rhythm Services, Mayo Clinic, Rochester, MN, USA
| | - K L Venkatachalam
- Department of Cardiovascular Medicine, Division of Heart Rhythm Services, Mayo Clinic, Jacksonville, Florida, USA
| | - Samuel J Asirvatham
- Department of Cardiovascular Medicine, Division of Heart Rhythm Services, Mayo Clinic, Rochester, MN, USA; Department of Pediatric and Adolescent Medicine, Division of Pediatric Cardiology, Mayo Clinic, Rochester, MN, USA; Physiology and Biomedical Engineering, Mayo Clinic, Rochester, MN, USA.
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23
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Affiliation(s)
- Dai Inagaki
- Department of Cardiology, Tokyo Metropolitan Hiroo Hospital, Tokyo, Japan
| | - Rintaro Hojo
- Department of Cardiology, Tokyo Metropolitan Hiroo Hospital, Tokyo, Japan
| | - Seiji Fukamizu
- Department of Cardiology, Tokyo Metropolitan Hiroo Hospital, Tokyo, Japan
| | - Harumizu Sakurada
- Tokyo Metropolitan Health and Medical Treatment Corporation, Ohkubo Hospital, Tokyo, Japan
| | - Masayasu Hiraoka
- Department of Cardiovascular Diseases, Tokyo Medical and Dental University, Tokyo, Japan
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24
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Alcaine A, Soto-Iglesias D, Acosta J, Korshunov V, Penela D, Martínez M, Linhart M, Andreu D, Fernández-Armenta J, Laguna P, Martínez JP, Camara O, Berruezo A. Automatic activation mapping and origin identification of idiopathic outflow tract ventricular arrhythmias. J Electrocardiol 2017; 51:239-246. [PMID: 29242053 DOI: 10.1016/j.jelectrocard.2017.10.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2017] [Indexed: 11/17/2022]
Abstract
PURPOSE Activation mapping is used to guide ablation of idiopathic outflow tract ventricular arrhythmias (OTVAs). Isochronal activation maps help to predict the site of origin (SOO): left vs right outflow tract (OT). We evaluate an algorithm for automatic activation mapping based on the onset of the bipolar electrogram (EGM) signal for predicting the SOO and the effective ablation site in OTVAs. METHODS Eighteen patients undergoing ablation due to idiopathic OTVAs were studied (12 with left ventricle OT origin). Right ventricle activation maps were obtained offline with an automatic algorithm and compared with manual annotation maps obtained during the intervention. Local activation time (LAT) accuracy was assessed, as well as the performance of the 10ms earliest activation site (EAS) isochronal area in predicting the SOO. RESULTS High correlation was observed between manual and automatic LATs (Spearman's: 0.86 and Lin's: 0.85, both p<0.01). The EAS isochronal area were closely located in both map modalities (5.55 ± 3.56mm) and at a similar distance from the effective ablation site (0.15±2.08mm difference, p=0.859). The 10ms isochronal area longitudinal/perpendicular diameter ratio measured from automatic maps showed slightly superior SOO identification (67% sensitivity, 100% specificity) compared with manual maps (67% sensitivity, 83% specificity). CONCLUSIONS Automatic activation mapping based on the bipolar EGM onset allows fast, accurate and observer-independent identification of the SOO and characterization of the spreading of the activation wavefront in OTVAs.
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Affiliation(s)
- Alejandro Alcaine
- BSICoS Group, Aragón Institute of Engineering Research (I3A), IIS Aragón, Universidad de Zaragoza, Zaragoza, Spain; CIBER en Bioingeniería, Biomateriales y Nanomedicina (CIBER-BBN), Madrid, Spain
| | - David Soto-Iglesias
- Arrhythmia Section, Cardiology Dept., Thorax Institute, Hospital Clínic, Universitat de Barcelona, Barcelona, Spain; IDIBAPS (Institut d'Investigació Agustí Pi i Sunyer), Barcelona, Spain
| | - Juan Acosta
- IDIBAPS (Institut d'Investigació Agustí Pi i Sunyer), Barcelona, Spain
| | - Viatcheslav Korshunov
- Arrhythmia Section, Cardiology Dept., Thorax Institute, Hospital Clínic, Universitat de Barcelona, Barcelona, Spain; IDIBAPS (Institut d'Investigació Agustí Pi i Sunyer), Barcelona, Spain
| | - Diego Penela
- IDIBAPS (Institut d'Investigació Agustí Pi i Sunyer), Barcelona, Spain
| | - Mikel Martínez
- Arrhythmia Section, Cardiology Dept., Thorax Institute, Hospital Clínic, Universitat de Barcelona, Barcelona, Spain; IDIBAPS (Institut d'Investigació Agustí Pi i Sunyer), Barcelona, Spain
| | - Markus Linhart
- Arrhythmia Section, Cardiology Dept., Thorax Institute, Hospital Clínic, Universitat de Barcelona, Barcelona, Spain; IDIBAPS (Institut d'Investigació Agustí Pi i Sunyer), Barcelona, Spain
| | - David Andreu
- IDIBAPS (Institut d'Investigació Agustí Pi i Sunyer), Barcelona, Spain
| | | | - Pablo Laguna
- BSICoS Group, Aragón Institute of Engineering Research (I3A), IIS Aragón, Universidad de Zaragoza, Zaragoza, Spain; CIBER en Bioingeniería, Biomateriales y Nanomedicina (CIBER-BBN), Madrid, Spain
| | - Juan Pablo Martínez
- BSICoS Group, Aragón Institute of Engineering Research (I3A), IIS Aragón, Universidad de Zaragoza, Zaragoza, Spain; CIBER en Bioingeniería, Biomateriales y Nanomedicina (CIBER-BBN), Madrid, Spain
| | - Oscar Camara
- Physense Group, Dept. of Information and Communication Technologies, Universitat Pompeu Fabra, Barcelona, Spain
| | - Antonio Berruezo
- Arrhythmia Section, Cardiology Dept., Thorax Institute, Hospital Clínic, Universitat de Barcelona, Barcelona, Spain; IDIBAPS (Institut d'Investigació Agustí Pi i Sunyer), Barcelona, Spain.
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25
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Inaba O, Nitta J, Kuroda S, Sekigawa M, Suzuki M, Inamura Y, Satoh A, Isobe M, Hirao K. A new mapping method to estimate exit sites of ventricular arrhythmias using intracardiac echocardiography and M-mode for catheter ablation. J Arrhythm 2017; 33:440-446. [PMID: 29021847 PMCID: PMC5634681 DOI: 10.1016/j.joa.2017.05.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2016] [Revised: 05/10/2017] [Accepted: 05/30/2017] [Indexed: 12/02/2022] Open
Abstract
Background Catheter ablation of premature ventricular complexes (PVCs) has been used as a curative therapy in many cases. Intracardiac ultrasound with a magnetic sensor probe has recently become available for catheter ablation. In this study, we assessed a new mapping method, contraction mapping, for determining the optimal ablation sites using intracardiac ultrasound and M-mode. This study sought to assess the accuracy of the new mapping method using intracardiac echocardiography. Methods Eighteen patients (10 males and eight females; mean age, 63±12 years) with 104 mapping points diagnosed as idiopathic PVCs were included in this study. At the mapping points, the time interval from the onset of the QRS to the onset of the contraction (QRS-c-time) and the local activation time were measured using M-mode with an intracardiac echo probe and using the conventional method. The correlation between the QRS-c-time and local activation time were studied. Results The QRS-c-time was significantly correlated with the local activation time (activation time=−66.8+0.882 * QRS-c-time, R2=0.728, p<0.0001). Conclusions Contraction mapping could help determine the local activation time without the delivery of a catheter to the mapping points.
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Affiliation(s)
- Osamu Inaba
- Department of Cardiology, Saitama Red Cross Hospital, Japan.,Department of Cardiology, Tokyo Medical and Dental University, Japan.,Heart Rhythm Center, Tokyo Medical and Dental University, Japan
| | - Junichi Nitta
- Department of Cardiology, Saitama Red Cross Hospital, Japan
| | | | | | | | | | - Akira Satoh
- Department of Cardiology, Saitama Red Cross Hospital, Japan
| | - Mitsuaki Isobe
- Department of Cardiology, Tokyo Medical and Dental University, Japan
| | - Kenzo Hirao
- Heart Rhythm Center, Tokyo Medical and Dental University, Japan
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26
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Bun SS, Delassi T, Latcu DG, El Jamili M, Ayari A, Errahmouni A, Berte B, Saoudi N. A comparison between multipolar mapping and conventional mapping of atrial tachycardias in the context of atrial fibrillation ablation. Arch Cardiovasc Dis 2017; 111:33-40. [PMID: 28927960 DOI: 10.1016/j.acvd.2017.04.005] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2016] [Revised: 04/07/2017] [Accepted: 04/18/2017] [Indexed: 10/18/2022]
Abstract
BACKGROUND Activation mapping can be challenging and time-consuming in patients with multiple atrial tachycardias (ATs). AIMS To compare multielectrode mapping using a dedicated mapping catheter - PentaRay (Biosense Webster Inc.) - and the conventional technique for mapping ATs in the context of atrial fibrillation (AF) ablation. METHODS All procedures where PentaRay mapping of AT were used - after or during persistent AF ablation - were analysed. These were compared to a historical group - using conventional mapping. RESULTS A mean of 449±520 points within 14±6min were acquired per AT in the PentaRay group (n=17) versus 42±18 points (P<0.0001) within 33±25min (P=0.04) in the conventional group (n=17). All 25 AT isthmuses were easily identified and ablated in the PentaRay group (100%) versus 20/23 (87%) in the conventional group (P=0.056). The ablation time was shorter in the PentaRay group (760±540 vs 1347±962 s; P=0.037). However, procedure and fluoroscopy times were not significantly different between the PentaRay and conventional groups: 253±77 vs 267±73min (P=0.80) and 13.1±8.0min vs 15.1±10.0min (P=0.98), respectively. Recurrence occurred in less patients in the PentaRay group (0 vs 23.5%; P=0.033) during a mean follow-up of nearly 1 year. CONCLUSION In patients with multiple ATs, multielectrode PentaRay mapping was faster than the conventional technique, with less radiofrequency delivery and a better mid-term outcome.
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Affiliation(s)
- Sok-Sithikun Bun
- Department of Cardiology, Princess Grace Hospital, Pasteur Avenue, Monaco.
| | - Tahar Delassi
- Department of Cardiology, Princess Grace Hospital, Pasteur Avenue, Monaco
| | | | - Mohammed El Jamili
- Department of Cardiology, Princess Grace Hospital, Pasteur Avenue, Monaco
| | - Anis Ayari
- Department of Cardiology, Princess Grace Hospital, Pasteur Avenue, Monaco
| | | | - Benjamin Berte
- Department of Cardiology, Klinik Im Park, Zurich, Switzerland
| | - Nadir Saoudi
- Department of Cardiology, Princess Grace Hospital, Pasteur Avenue, Monaco
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27
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Wasmer K, Eckardt L. [3-D mapping and ablation of recurrent ventricular tachycardia in patients with ischemic cardiomyopathy]. Herzschrittmacherther Elektrophysiol 2017; 28:199-205. [PMID: 28534206 DOI: 10.1007/s00399-017-0506-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2017] [Accepted: 04/18/2017] [Indexed: 10/19/2022]
Abstract
Catheter ablation of ventricular tachycardia (VT) is an established therapy for patients with ischemic cardiomyopathy to reduce implantable cardioverter-defibrillator (ICD) interventions and is a class I recommendation in international guidelines. Numerous publications confirm its value. Use of three-dimensional mapping systems with or without image integration is standard for ablation of complex arrhythmias. In patients with history of myocardial infarction they help to understand activation of reentrant circuits and are prerequisite for substrate mapping. While a combination of activation and substrate mapping is performed in many patients based on clinical presentation, substrate-based ablation appears to be superior to clinical VT ablation alone.
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Affiliation(s)
- Kristina Wasmer
- Abteilung für Rhythmologie, Department für Kardiologie und Angiologie, Universitätsklinikum Münster, Albert-Schweitzer-Campus 1, Gebäude A1, 48149, Münster, Deutschland.
| | - Lars Eckardt
- Abteilung für Rhythmologie, Department für Kardiologie und Angiologie, Universitätsklinikum Münster, Albert-Schweitzer-Campus 1, Gebäude A1, 48149, Münster, Deutschland
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28
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Knecht S, Spies F, Altmann D, Reichlin T, Sticherling C, Kühne M. Electroanatomic mapping of atrial tachycardia-Manual vs automated annotation. HeartRhythm Case Rep 2016; 3:145-147. [PMID: 28491790 PMCID: PMC5420056 DOI: 10.1016/j.hrcr.2016.11.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- Sven Knecht
- Cardiology/Electrophysiology, University Hospital Basel, Basel, Switzerland.,CRIB - Cardiovascular Research Institute Basel, Basel, Switzerland
| | - Florian Spies
- Cardiology/Electrophysiology, University Hospital Basel, Basel, Switzerland.,CRIB - Cardiovascular Research Institute Basel, Basel, Switzerland
| | | | - Tobias Reichlin
- Cardiology/Electrophysiology, University Hospital Basel, Basel, Switzerland.,CRIB - Cardiovascular Research Institute Basel, Basel, Switzerland
| | - Christian Sticherling
- Cardiology/Electrophysiology, University Hospital Basel, Basel, Switzerland.,CRIB - Cardiovascular Research Institute Basel, Basel, Switzerland
| | - Michael Kühne
- Cardiology/Electrophysiology, University Hospital Basel, Basel, Switzerland.,CRIB - Cardiovascular Research Institute Basel, Basel, Switzerland
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29
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Winkle RA, Moskovitz R, Mead RH, Engel G, Kong MH, Fleming W, Patrawala RA. Ablation of atypical atrial flutters using ultra high density-activation sequence mapping. J Interv Card Electrophysiol 2016; 48:177-184. [PMID: 27832399 PMCID: PMC5325851 DOI: 10.1007/s10840-016-0207-5] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2016] [Accepted: 10/30/2016] [Indexed: 10/24/2022]
Abstract
PURPOSE The purpose of this study was to evaluate ultra high density-activation sequence mapping (UHD-ASM) for ablating atypical atrial flutters. METHODS For 23 patients with 31 atypical atrial flutters (AAF), we created UHD-ASM. RESULTS Demographics age = 65.3 ± 8.5 years, male = 78%, left atrial size = 4.66 ± 0.64 cm, redo ablation 20/23(87%). AAF were left atrial in 30 (97%). For each AAF, 1273 ± 697 points were used for UHD-ASM. Time to create and interpret the UHD-ASM was 20 ± 11 min. For every AAF, the entire circuit was identified. Thirty (97%) were macroreentry. AAF cycle length was 267 ± 49 ms, and the circuit length was 138 ± 38 mm (range 35-187). Macroreentry atrial flutters took varied pathways, but each had an area of slow conduction (ASC) averaging 16 ± 6 mm (range 6-29) in length. Entrainment was not utilized. We targeted the ASC and ablation terminated AAF directly in 19/31 (61.3%) and altered AAF activation in 7/31 (22.6%), all of which terminated directly with additional mapping/ablation. AAF degenerated to atrial fibrillation in 2/31 (6.5%) with RF and could not be reinduced after ASC ablation. Median time from initial ablation to AAF termination was 64 s. Thus, 28/31 (90.3%) terminated with RF energy and/or could not be reinduced after ASC ablation. At 1 year of follow-up, 77% were free of atrial tachycardia or atrial flutter and 61% were free of all atrial arrhythmias. CONCLUSIONS Using rapidly acquired UHD-ASM, the entire AAF circuit as well as the target ASC could be identified. Most AAF were left atrial macroreentry. Ablation of the ASC or microreentry focuses directly terminated or eliminated AAF in 90.3% without the need for entrainment mapping.
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Affiliation(s)
- Roger A Winkle
- Silicon Valley Cardiology, 1950 University Avenue, Suite 160, E. Palo Alto, CA, 94303, USA. .,Sequoia Hospital, Redwood City, CA, USA.
| | | | - R Hardwin Mead
- Silicon Valley Cardiology, 1950 University Avenue, Suite 160, E. Palo Alto, CA, 94303, USA.,Sequoia Hospital, Redwood City, CA, USA
| | - Gregory Engel
- Silicon Valley Cardiology, 1950 University Avenue, Suite 160, E. Palo Alto, CA, 94303, USA.,Sequoia Hospital, Redwood City, CA, USA
| | - Melissa H Kong
- Silicon Valley Cardiology, 1950 University Avenue, Suite 160, E. Palo Alto, CA, 94303, USA.,Sequoia Hospital, Redwood City, CA, USA
| | - William Fleming
- Silicon Valley Cardiology, 1950 University Avenue, Suite 160, E. Palo Alto, CA, 94303, USA.,Sequoia Hospital, Redwood City, CA, USA
| | - Rob A Patrawala
- Silicon Valley Cardiology, 1950 University Avenue, Suite 160, E. Palo Alto, CA, 94303, USA.,Sequoia Hospital, Redwood City, CA, USA
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30
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Ciaccio EJ, Coromilas J, Ashikaga H, Cervantes DO, Wit AL, Peters NS, McVeigh ER, Garan H. Reprint of 'Model of unidirectional block formation leading to reentrant ventricular tachycardia in the infarct border zone of postinfarction canine hearts'. Comput Biol Med 2015; 65:256-66. [PMID: 26372420 PMCID: PMC4593299 DOI: 10.1016/j.compbiomed.2015.08.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2015] [Accepted: 04/14/2015] [Indexed: 12/04/2022]
Abstract
BACKGROUND When the infarct border zone is stimulated prematurely, a unidirectional block line (UBL) can form and lead to double-loop (figure-of-eight) reentrant ventricular tachycardia (VT) with a central isthmus. The isthmus is composed of an entrance, center, and exit. It was hypothesized that for certain stimulus site locations and coupling intervals, the UBL would coincide with the isthmus entrance boundary, where infarct border zone thickness changes from thin-to-thick in the travel direction of the premature stimulus wavefront. METHOD A quantitative model was developed to describe how thin-to-thick changes in the border zone result in critically convex wavefront curvature leading to conduction block, which is dependent upon coupling interval. The model was tested in 12 retrospectively analyzed postinfarction canine experiments. Electrical activation was mapped for premature stimulation and for the first reentrant VT cycle. The relationship of functional conduction block forming during premature stimulation to functional block during reentrant VT was quantified. RESULTS For an appropriately placed stimulus, in accord with model predictions: 1. The UBL and reentrant VT isthmus lateral boundaries overlapped (error: 4.8±5.7mm). 2. The UBL leading edge coincided with the distal isthmus where the center-entrance boundary would be expected to occur. 3. The mean coupling interval was 164.6±11.0ms during premature stimulation and 190.7±20.4ms during the first reentrant VT cycle, in accord with model calculations, which resulted in critically convex wavefront curvature and functional conduction block, respectively, at the location of the isthmus entrance boundary and at the lateral isthmus edges. DISCUSSION Reentrant VT onset following premature stimulation can be explained by the presence of critically convex wavefront curvature and unidirectional block at the isthmus entrance boundary when the premature stimulation interval is sufficiently short. The double-loop reentrant circuit pattern is a consequence of wavefront bifurcation around this UBL followed by coalescence, and then impulse propagation through the isthmus. The wavefront is blocked from propagating laterally away from the isthmus by sharp increases in border zone thickness, which results in critically convex wavefront curvature at VT cycle lengths.
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Affiliation(s)
- Edward J Ciaccio
- Division of Cardiology, Department of Medicine, Columbia University Medical Center, New York, United States.
| | - James Coromilas
- Division of Cardiovascular Diseases & Hypertension, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, United States
| | - Hiroshi Ashikaga
- Division of Cardiology, Johns Hopkins University, Baltimore, MD, United States; Department of Biomedical Engineering, Johns Hopkins University, Baltimore, MD, United States
| | | | - Andrew L Wit
- Division of Cardiology, Department of Pharmacology, Columbia University Medical Center, New York, United States
| | - Nicholas S Peters
- Myocardial Function Section, Imperial College and Imperial NHS Trust, London, United Kingdom
| | - Elliot R McVeigh
- Department of Biomedical Engineering, Johns Hopkins University, Baltimore, MD, United States
| | - Hasan Garan
- Division of Cardiology, Department of Medicine, Columbia University Medical Center, New York, United States
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31
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Ciaccio EJ, Coromilas J, Ashikaga H, Cervantes DO, Wit AL, Peters NS, McVeigh ER, Garan H. Model of unidirectional block formation leading to reentrant ventricular tachycardia in the infarct border zone of postinfarction canine hearts. Comput Biol Med 2015; 62:254-63. [PMID: 25966920 PMCID: PMC4533242 DOI: 10.1016/j.compbiomed.2015.04.032] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2015] [Revised: 03/09/2015] [Accepted: 04/14/2015] [Indexed: 11/30/2022]
Abstract
BACKGROUND When the infarct border zone is stimulated prematurely, a unidirectional block line (UBL) can form and lead to double-loop (figure-of-eight) reentrant ventricular tachycardia (VT) with a central isthmus. The isthmus is composed of an entrance, center, and exit. It was hypothesized that for certain stimulus site locations and coupling intervals, the UBL would coincide with the isthmus entrance boundary, where infarct border zone thickness changes from thin-to-thick in the travel direction of the premature stimulus wavefront. METHOD A quantitative model was developed to describe how thin-to-thick changes in the border zone result in critically convex wavefront curvature leading to conduction block, which is dependent upon coupling interval. The model was tested in 12 retrospectively analyzed postinfarction canine experiments. Electrical activation was mapped for premature stimulation and for the first reentrant VT cycle. The relationship of functional conduction block forming during premature stimulation to functional block during reentrant VT was quantified. RESULTS For an appropriately placed stimulus, in accord with model predictions: (1) The UBL and reentrant VT isthmus lateral boundaries overlapped (error: 4.8±5.7mm). (2) The UBL leading edge coincided with the distal isthmus where the center-entrance boundary would be expected to occur. (3) The mean coupling interval was 164.6±11.0ms during premature stimulation and 190.7±20.4ms during the first reentrant VT cycle, in accord with model calculations, which resulted in critically convex wavefront curvature with functional conduction block, respectively, at the location of the isthmus entrance boundary and at the lateral isthmus edges. DISCUSSION Reentrant VT onset following premature stimulation can be explained by the presence of critically convex wavefront curvature and unidirectional block at the isthmus entrance boundary when the premature stimulation interval is sufficiently short. The double-loop reentrant circuit pattern is a consequence of wavefront bifurcation around this UBL followed by coalescence, and then impulse propagation through the isthmus. The wavefront is blocked from propagating laterally away from the isthmus by sharp increases in border zone thickness, which results in critically convex wavefront curvature at VT cycle lengths.
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Affiliation(s)
- Edward J Ciaccio
- Division of Cardiology, Department of Medicine, Columbia University Medical Center, New York, NY, United States.
| | - James Coromilas
- Division of Cardiovascular Diseases & Hypertension, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, United States
| | - Hiroshi Ashikaga
- Division of Cardiology, Johns Hopkins University, Baltimore, MD, United States; Department of Biomedical Engineering, Johns Hopkins University, Baltimore, MD, United States
| | | | - Andrew L Wit
- Department of Pharmacology, Columbia University Medical Center, New York, NY, United States
| | - Nicholas S Peters
- Myocardial Function Section, Imperial College and Imperial NHS Trust, London, United Kingdom
| | - Elliot R McVeigh
- Department of Biomedical Engineering, Johns Hopkins University, Baltimore, MD, United States
| | - Hasan Garan
- Division of Cardiology, Department of Medicine, Columbia University Medical Center, New York, NY, United States
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Littmann L, Saxonhouse SJ. Repetitive, incessant supraventricular tachycardia: Noninvasive determination of the electrophysiologic mechanism. Int J Cardiol 2015; 190:256-9. [PMID: 25932798 DOI: 10.1016/j.ijcard.2015.04.181] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2015] [Accepted: 04/21/2015] [Indexed: 11/30/2022]
Affiliation(s)
- Laszlo Littmann
- Department of Internal Medicine, Carolinas Medical Center, Charlotte, NC, USA.
| | - Sherry J Saxonhouse
- Sanger Heart and Vascular Institute, Carolinas Medical Center, Charlotte, NC, USA
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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] [What about the content of this article? (0)] [Affiliation(s)] [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.
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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
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