Close-coupled pacing to identify the “functional” substrate of ventricular tachycardia: Long-term outcomes of the paced electrogram feature analysis technique

Crinion, Derek; Neira, Víctor; Hamad, Nasser Al; León, Ana de; Bakker, D. de; Korogyi, Adam; Abdollah, Hoshiar; Glover, Ben; Simpson, Christopher S.; Baranchuk, Adrián; Chacko, Sanoj; Enríquez, Andrés; Redfearn, Damián P.

doi:10.1016/j.hrthm.2020.12.022

Cited by 9 publications

(3 citation statements)

References 25 publications

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“…3 ). Also, a variety of functional mapping protocols to identify zones of deceleration [ 17 ], fractionation [ 18 ], rotational activation [ 19 ] and decremental conduction [ 20 ] to delineate possible target zones have been proposed. In selected patients, a combined endo-epicardial approach may be preferred as a first-line strategy in non-ischemic/arrhythmogenic but also ischemic cardiomyopathies [ 21 , 22 ].…”

Section: Characterization Of Vt Substrate For Procedural Planningmentioning

confidence: 99%

Exploring the Full Potential of Radiofrequency Technology: A Practical Guide to Advanced Radiofrequency Ablation for Complex Ventricular Arrhythmias

Tonko,

Lambiase

2024

Curr Cardiol Rep

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Purpose of Review Percutaneous radiofrequency (RF) catheter ablation is an established strategy to prevent ventricular tachycardia (VT) recurrence and ICD shocks. Yet delivery of durable lesion sets by means of traditional unipolar radiofrequency ablation remains challenging, and left ventricular transmurality is rarely achieved. Failure to ablate and eliminate functionally relevant areas is particularly common in deep intramyocardial substrates, e.g. septal VT and cardiomyopathies. Here, we aim to give a practical-orientated overview of advanced and emerging RF ablation technologies to target these complex VT substrates. We summarize recent evidence in support of these technologies and share experiences from a tertiary VT centre to highlight important “hands-on” considerations for operators new to advanced RF ablation strategies. Recent Findings A number of innovative and modified radiofrequency ablation approaches have been proposed to increase energy delivery to the myocardium and maximize RF lesion dimensions and depth. These include measures of impedance modulation, combinations of simultaneous unipolar ablations or true bipolar ablation, intramyocardial RF delivery via wires or extendable RF needles and investigational linear or spherical catheter designs. Recent new clinical evidence for the efficacy and safety of these investigational technologies and strategies merits a re-evaluation of their role and clinic application for percutaneous VT ablations. Summary Complexity of substrates targeted with percutaneous VT ablation is increasing and requires detailed preprocedural imaging to characterize the substrate to inform the procedural approach and selection of ablation technology. Depending on local experience, options for additional and/or complementary interventional treatments should be considered upfront in challenging substrates to improve the success rates of index procedures. Advanced RF technologies available for clinical VT ablations include impedance modulation via hypotonic irrigation or additional dispersive patches and simultaneous unipolar as well as true bipolar ablation. Promising investigational RF technologies involve an extendable needle RF catheter, intramyocardial RF delivery over intentionally perforated wires as well as a variety of innovative ablation catheter designs including multipolar linear, spherical and partially insulated ablation catheters.

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Section: Characterization Of Vt Substrate For Procedural Planningmentioning

confidence: 99%

Exploring the Full Potential of Radiofrequency Technology: A Practical Guide to Advanced Radiofrequency Ablation for Complex Ventricular Arrhythmias

Tonko,

Lambiase

2024

Curr Cardiol Rep

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“…The anatomical reentry is very stable and always rotates around a fixed area (Fernández-Armenta et al, 2013;Josephson et al, 2014;Soto-Iglesias et al, 2020). For the functional reentry, the electric impulse proceeds as a single wavefront through a constrained region known as the central common pathway or isthmus of the reentrant circuit (Ciaccio et al, 2016;Martin et al, 2018;Crinion et al, 2020). In clinic, the critical isthmuses which sustain that the anatomical reentry can be measured by the high-density electroanatomic multipolar mapping system, but it is not easy to directly measure the critical isthmuses which sustain functional reentry (Martin et al, 2018;Crinion et al, 2020), especially for those unstable or non-sustained reentries (Nishimura et al, 2020).…”

Section: Introductionmentioning

confidence: 99%

Preliminary Study: Learning the Impact of Simulation Time on Reentry Location and Morphology Induced by Personalized Cardiac Modeling

Tong

Zhao

et al. 2021

Front. Physiol.

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Personalized cardiac modeling is widely used for studying the mechanisms of cardiac arrythmias. Due to the high demanding of computational resource of modeling, the arrhythmias induced in the models are usually simulated for just a few seconds. In clinic, it is common that arrhythmias last for more than several minutes and the morphologies of reentries are not always stable, so it is not clear that whether the simulation of arrythmias for just a few seconds is long enough to match the arrhythmias detected in patients. This study aimed to observe how long simulation of the induced arrhythmias in the personalized cardiac models is sufficient to match the arrhythmias detected in patients. A total of 5 contrast enhanced MRI datasets of patient hearts with myocardial infarction were used in this study. Then, a classification method based on Gaussian mixture model was used to detect the infarct tissue. For each reentry, 3 s and 10 s were simulated. The characteristics of each reentry simulated for different duration were studied. Reentries were induced in all 5 ventricular models and sustained reentries were induced at 39 stimulation sites in the model. By analyzing the simulation results, we found that 41% of the sustained reentries in the 3 s simulation group terminated in the longer simulation groups (10 s). The second finding in our simulation was that only 23.1% of the sustained reentries in the 3 s simulation did not change location and morphology in the extended 10 s simulation. The third finding was that 35.9% reentries were stable in the 3 s simulation and should be extended for the simulation time. The fourth finding was that the simulation results in 10 s simulation matched better with the clinical measurements than the 3 s simulation. It was shown that 10 s simulation was sufficient to make simulation results stable. The findings of this study not only improve the simulation accuracy, but also reduce the unnecessary simulation time to achieve the optimal use of computer resources to improve the simulation efficiency and shorten the simulation time to meet the time node requirements of clinical operation on patients.

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“…This dynamic EGM response arises from non-uniform anisotropic conduction through multiple conducing pathways, 4 and has also been demonstrated at the critical isthmus of VT circuits in patients with ischaemic and non-ischaemic cardiomyopathy. 5 Thus, close-coupled pacing is a rational approach to identify abnormal substrate and VT/VF risk in a variety of cardiomyopathy subtypes, including HCM. However, this approach is quite invasive and time-consuming, making it challenging to implement in clinical practice for risk stratification.…”

mentioning

confidence: 99%

Predicting lethal ventricular arrhythmias in hypertrophic cardiomyopathy using electrophysiologic methods: Invasive EGM vs. non-invasive ECG analysis of fragmentation

2023

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Close-coupled pacing to identify the “functional” substrate of ventricular tachycardia: Long-term outcomes of the paced electrogram feature analysis technique

Cited by 9 publications

References 25 publications

Exploring the Full Potential of Radiofrequency Technology: A Practical Guide to Advanced Radiofrequency Ablation for Complex Ventricular Arrhythmias

Exploring the Full Potential of Radiofrequency Technology: A Practical Guide to Advanced Radiofrequency Ablation for Complex Ventricular Arrhythmias

Preliminary Study: Learning the Impact of Simulation Time on Reentry Location and Morphology Induced by Personalized Cardiac Modeling

Predicting lethal ventricular arrhythmias in hypertrophic cardiomyopathy using electrophysiologic methods: Invasive EGM vs. non-invasive ECG analysis of fragmentation

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