A swine model of infarct-related reentrant ventricular tachycardia: Electroanatomic, magnetic resonance, and histopathological characterization

Tschabrunn, Cory M.; Roujol, Sébastien; Nezafat, Reza; Faulkner-Jones, Beverly E.; Buxton, Alfred E.; Josephson, Mark E.; Anter, Elad

doi:10.1016/j.hrthm.2015.07.030

Cited by 90 publications

(83 citation statements)

References 33 publications

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“…4 While bipolar voltage amplitude in healthy and scar tissue are similar between swine and human, this has not been validated for 1mm electrode catheters. 13,14 However, our limited experience in human with post-infarction VT is consistent with findings of this study, showing improved mapping resolution with ability to identify surviving myocardial bundles with multielectrode catheters.…”

Section: Discussionmentioning

confidence: 99%

“…Our swine model has been previously described and closely approximates human-related subendocardial infarction and reentrant VT. 4 In brief, Yorkshire swine (male, 30-35Kg) underwent selective balloon occlusion of the left anterior descending (LAD) artery for duration of 180 minutes. After a survival period of 6-8 weeks, animals underwent mapping of the LV during sinus rhythm, followed by electroanatomical mapping including mapping of any hemodynamically tolerated monomorphic VT.…”

Section: Methodsmentioning

confidence: 99%

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High-Resolution Mapping of Ventricular Scar

Tschabrunn

Roujol

Dorman

et al. 2016

Circ: Arrhythmia and Electrophysiology

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129

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Background Mapping resolution is influenced by electrode size and interelectrode spacing. The aims of this study were to establish normal electrogram criteria for 1mm multielectrode-mapping catheters (Pentaray®) in the ventricle and to compare its mapping resolution within scar to standard 3.5mm catheters (Smart-Touch Thermocool®). Methods and Results Three healthy swine and 11 swine with healed myocardial infarction underwent sequential mapping of the left ventricle with both catheters. Bipolar voltage amplitude in healthy tissue was similar between 3.5mm and 1mm multielectrode catheters with a 5th percentile of 1.61mV and 1.48mV, respectively. In swine with healed infarction, the total area of low bipolar voltage amplitude (defined as <1.5mV) was 22.5% smaller using 1mm multielectrode catheters (21.7cm2 versus 28.0cm2; p=0.003). This was more evident in the area of “dense scar” (bipolar amplitude <0.5mV) with a 47% smaller very low voltage area identified using 1mm electrode catheters (7.1cm2 vs. 15.2cm2; p=0.003). In this region, 1mm multielectrode catheters recorded higher voltage amplitude (0.72±0.81mV vs. 0.30±0.12mV, p<0.001). Importantly, 27% of these “dense scar” electrograms showed distinct triphasic electrograms when mapped using a 1mm multielectrode catheter compared with fractionated multicomponent electrogram recorded with the 3.5mm electrode catheter. In 8 mapped reentrant VTs, the circuits included regions of preserved myocardial tissue “channels” identified with 1mm multielectrode catheters but not 3.5mm electrode catheters. Pacing threshold within the area of low voltage was lower with 1mm electrode catheters (0.9±1.3mV vs. 3.8±3.7mV, p=0.001). Conclusions Mapping with small closely spaced electrode catheters can improve mapping resolution within areas of low voltage.

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Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

High-Resolution Mapping of Ventricular Scar

Tschabrunn

Roujol

Dorman

et al. 2016

Circ: Arrhythmia and Electrophysiology

Self Cite

129

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“…In post-MI swine, Tschabrunn et al . showed that deposition of transmural fibrosis, along with preserved borders of subendocardial tissue, contributed to slowed conduction and non-uniform anisotropy, giving rise to reentrant VT [63]. …”

Section: Post-mi Fibrosis and Arrhythmiamentioning

confidence: 99%

The crossroads of inflammation, fibrosis, and arrhythmia following myocardial infarction

Stuart

Jesus

Lindsey

et al. 2016

Journal of Molecular and Cellular Cardiology

179

113

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Optimal healing of damaged tissue following myocardial infarction (MI) requires a coordinated cellular response that can be divided into three phases: inflammatory, proliferative/reparative, and maturation. The inflammatory phase, characterized by rapid influx of cytokines, chemokines, and immune cells, is critical to the removal of damaged tissue. The onset of the proliferative/reparative phase is marked by increased proliferation of myofibroblasts and secretion of collagen to replace dead tissue. Lastly, crosslinking of collagen fibers and apoptosis of immune cells marks the maturation phase. Excessive inflammation or fibrosis has been linked to increased incidence of arrhythmia and other MI-related pathologies. This review describes the roles of inflammation and fibrosis in arrhythmogenesis and prospective therapies for anti-arrhythmic treatment.

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“…42 High-density, multielectrode mapping minimizes the effects of farfield signals and helps to identify heterogeneity within the low-voltage scar, allowing for better localization of channels of surviving myocardial bundles and fractionated electrograms or LAVA detected within these channels. 41,46 The use of multipolar catheter mapping is associated with a higher mapping density with better endocardial LAVA identification in patients with post-myocardial infarction VT. Overall, the impact of multipolar catheter use on patient outcomes seems to be mediated by a more comprehensive characterization of the VT substrate, which translated to a lower VT recurrence rate following catheter ablation.…”

Section: Pacemappingmentioning

confidence: 99%