Application of noninvasive signal-averaged electrocardiogram analysis in predicting the requirement of epicardial ablation in patients with arrhythmogenic right ventricular cardiomyopathy

Chung, Fa Po; Lin, Chin Yu; Lin, Yenn Jiang; Chang, Shih Lin; Lo, Li Wei; Hu, Yu Feng; Tuan, Ta Chuan; Chao, Tze Fan; Liao, Jo Nan; Chang, Tsan‐Kuo; Gerull, Brenda; Kuo, Ling; Wu, Chen-Tu; Liu, Chih-Min; Vicera, Jennifer Jeanne B.; Chen, Chun Chao; Chin, Chye Gen; Liu, Shin Huei; Cheng, Wood-Hi; Chou, Ching Yao; Lugtu, Isaiah C.; Liu, Ching Han; Chen, Shih Ann

doi:10.1016/j.hrthm.2019.11.018

Cited by 5 publications

(8 citation statements)

References 31 publications

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“…In brief, after obtaining informed consent, we performed a standardized EP study and RFCA in all patients under conscious sedation or general anesthesia. All antiarrhythmic drugs except amiodarone were discontinued for at least five half‐lives before RFCA 22–24 . The selection of patients for epicardial mapping and ablation was based on the operators' discretion, failed endocardial ablation, ECG features, etiologies of cardiomyopathy, and epicardial scar identified using cardiac MRI.…”

Section: Methodsmentioning

confidence: 99%

“…All antiarrhythmic drugs except amiodarone were discontinued for at least five half-lives before RFCA. [22][23][24] The selection of patients for epicardial Endocardial bipolar scar and low voltage zone (LVZ) were defined as areas with a peak-to-peak bipolar voltage <0.5 mV and 0.5-1.5 mV, respectively. Epicardial LVZ was defined as a bipolar voltage of 0.5-1.0 mV.…”

Section: Ep Study and Substrate Mappingmentioning

confidence: 99%

“…The details of the EP study and substrate mapping have been described in our previous work. [22][23][24] In brief, after obtaining informed consent, we performed a standardized EP study and RFCA in all patients under conscious sedation or general anesthesia. All antiarrhythmic drugs except amiodarone were discontinued for at least five half-lives before RFCA.…”

Section: Ep Study and Substrate Mappingmentioning

confidence: 99%

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Application of Ensite™ LiveView function for identification of scar‐related ventricular tachycardia isthmus

Kao

Chung

Lin

et al. 2022

Cardiovasc electrophysiol

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Introduction Dynamic display of real‐time wavefront activation pattern may facilitate the recognition of reentrant circuits, particularly the diastolic path of ventricular tachycardia (VT). Objective We aimed to evaluate the feasibility of LiveView Dynamic Display for mapping the critical isthmus of scar‐related reentrant VT. Methods Patients with mappable scar‐related reentrant VT were selected. The characteristics of the underlying substrates and VT circuits were assessed using HD grid multielectrode catheter. The VT isthmuses were identified based on the activation map, entrainment, and ablation results. The accuracy of the LiveView findings in detecting potential VT isthmus was assessed. Results We studied 18 scar‐related reentrant VTs in 10 patients (median age: 59.5 years, 100% male) including 6 and 4 patients with ischemic and nonischemic cardiomyopathy, respectively. The median VT cycle length was 426 ms (interquartile range: 386–466 ms). Among 590 regional mapping displays, 92.0% of the VT isthmus sites were identified by LiveView Dynamic Display. The accuracy of LiveView for isthmus identification was 84%, with positive and negative predictive values of 54.8% and 97.8%, respectively. The area with abnormal electrograms was negatively correlated with the accuracy of LiveView Dynamic Display (r = −.506, p = .027). The median time interval to identify a VT isthmus using LiveView was significantly shorter than that using conventional activation maps (50.5 [29.8–120] vs. 219 [157.5–400.8] s, p = .015). Conclusion This study demonstrated the feasibility of LiveView Dynamic Display in identifying the critical isthmus of scar‐related VT with modest accuracy.

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Section: Methodsmentioning

confidence: 99%

Section: Ep Study and Substrate Mappingmentioning

confidence: 99%

Section: Ep Study and Substrate Mappingmentioning

confidence: 99%

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Application of Ensite™ LiveView function for identification of scar‐related ventricular tachycardia isthmus

Kao

Chung

Lin

et al. 2022

Cardiovasc electrophysiol

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“…6% patients were free from VA recurrences or ICD therapy through the combination of endocardial and epicardial ablation [38,39]. Epicardial approach is required in more than one third ARVC patients for achieving non-inducibility in the prior reports [40]. The number of fulfilled SAECG criteria was correlated to the extent of diseased epicardial substrate and could be a potential surrogate marker to predict the requirement of epicardial ablation in ARVC with drug-refractory VA [40].…”

Section: Arrhythmogenic Right Ventricular Cardiomyopathymentioning

confidence: 99%

Epicardial Radiofrequency Ablation: Who, When, and How?

Lin¹

2022

Cardiac Rhythm Management - Pacing, Ablation, Devices

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In the past decades, it has been known that reentry circuits for ventricular tachycardia or focal triggers of premature ventricular complexes are not limited to the subendocardial myocardium. Rather, intramural or subepicardial substrates may also give rise to ventricular tachycardia, particularly in those with non-ischemic cardiomyopathy. Besides, some of the idiopathic ventricular tachycardia might be originated from epicardial foci. Percutaneous epicardial mapping and ablation have been successfully introduced to treat this sub-epicardiac ventricular tachycardia. Herein, this chapter reviews the indications for epicardial ablation and the identification of epicardial ventricular tachycardia by disease entity, electrocardiography and imaging modalities. This chapter also described the optimal technique for epicardial access and the potential complication.

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“…Combined epicardial and endocardial ablation may be required in some patients. 5,6 End-stage RV failure or biventricular pump failure may develop in patients with long-standing disease. [7][8][9] The involvement of epicardial substrate is usually more extensive than the endocardium, with an epicardium-toendocardium progression pattern.…”

Section: Introductionmentioning

confidence: 99%

Clinical significance of structural remodeling concerning substrate characteristics and outcomes in arrhythmogenic right ventricular cardiomyopathy

et al. 2022

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Application of noninvasive signal-averaged electrocardiogram analysis in predicting the requirement of epicardial ablation in patients with arrhythmogenic right ventricular cardiomyopathy

Cited by 5 publications

References 31 publications

Application of Ensite™ LiveView function for identification of scar‐related ventricular tachycardia isthmus

Application of Ensite™ LiveView function for identification of scar‐related ventricular tachycardia isthmus

Epicardial Radiofrequency Ablation: Who, When, and How?

Clinical significance of structural remodeling concerning substrate characteristics and outcomes in arrhythmogenic right ventricular cardiomyopathy

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