Fractionated electrograms in dilated cardiomyopathy: Origin and relation to abnormal conduction

Bakker, Jacques M de; Capelle, F J van; Janse, Michiel J.; Tasseron, Sara; Vermeulen, Jessica; Jonge, N. De; Lahpor, Jaap R.

doi:10.1016/0735-1097(95)00612-5

Cited by 149 publications

(80 citation statements)

References 41 publications

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“…This will cause the OI to decrease. A similar scenario occurs with fractionated electrograms, as they have been shown to occur near regions of conduction block (7). This study also supported this finding, as the high-frequency areas corresponded to fractionated electrograms.…”

Section: Discussionsupporting

confidence: 87%

Structural atrial remodeling alters the substrate and spatiotemporal organization of atrial fibrillation: a comparison in canine models of structural and electrical atrial remodeling

Everett

Wilson

Verheule

et al. 2006

American Journal of Physiology-Heart and Circulatory Physiology

110

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. Structural atrial remodeling alters the substrate and spatiotemporal organization of atrial fibrillation: a comparison in canine models of structural and electrical atrial remodeling. Am J Physiol Heart Circ Physiol 291: H2911-H2923, 2006. First published July 28, 2006 doi:10.1152/ajpheart.01128.2005.-Several animal models of atrial fibrillation (AF) have been developed that demonstrate either atrial structural remodeling or atrial electrical remodeling, but the characteristics and spatiotemporal organization of the AF between the models have not been compared. Thirty-nine dogs were divided into five groups: rapid atrial pacing (RAP), chronic mitral regurgitation (MR), congestive heart failure (CHF), methylcholine (Meth), and control. Right and left atria (RA and LA, respectively) were simultaneously mapped during episodes of AF in each animal using highdensity (240 electrodes) epicardial arrays. Multiple 30-s AF epochs were recorded in each dog. Fast Fourier transform was calculated every 1 s over a sliding 2-s window, and dominant frequency (DF) was determined. Stable, discrete, high-frequency areas were seen in none of the RAP or control dogs, four of nine MR dogs, four of six CHF dogs, and seven of nine Meth dogs in either the RA or LA or both. Average DFs in the Meth model were significantly greater than in all other models in both LA and RA except LA DFs in the RAP model. The RAP model was the only one with a consistent LA-to-RA DF gradient (9.5 Ϯ 0.2 vs. 8.3 Ϯ 0.3 Hz, P Ͻ 0.00005). The Meth model had a higher spatial and temporal variance of DFs and lower measured organization levels compared with the other AF models, and it was the only model to show a linear relationship between the highest DF and dispersion (R 2 ϭ 0.86). These data indicate that structural remodeling of atria (models known to have predominantly altered conduction) leads to an AF characterized by a stable highfrequency area, whereas electrical remodeling of atria (models known to have predominantly shortened refractoriness without significant conduction abnormalities) leads to an AF characterized by multiple high-frequency areas and multiple wavelets. Fourier analysis; mapping; arrhythmia; electrophysiology ATRIAL FIBRILLATION (AF) is a common arrhythmia that is associated with varied underlying structural heart diseases or can be idiopathic. Because of the variety of clinical settings in which AF occurs, several animal models have been developed to study the pathophysiology of AF in each setting (10,17,20,25,27,36,40,43,44). Although AF occurs in each of the animal models, the atrial substrate of the AF appears to be different among the animal models. For example, the rapid atrial pacing (RAP) and methylcholine (Meth) models have been shown to be dominated by atrial electrical remodeling, which includes a shortening of the atrial refractoriness without atrial structural changes or changes in conduction (25,36,42). In contrast, the mitral regurgitation (MR) and congestive heart failure (CHF) models do not appear to have significant ...

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Section: Discussionsupporting

confidence: 87%

Structural atrial remodeling alters the substrate and spatiotemporal organization of atrial fibrillation: a comparison in canine models of structural and electrical atrial remodeling

Everett

Wilson

Verheule

et al. 2006

American Journal of Physiology-Heart and Circulatory Physiology

110

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“…Both endocardial or epicardial diseased substrates in NICM could exist and contain critical isthmuses for a successful ablation 53. These abnormal substrates frequently harbor fibrotic and scar tissue that lead to slow conduction and fractionated electrograms in human tissue experiments 54. Aside from the electroanatomic mapping, CMRI can help to delineate the scar distribution as well 10, 12, 13…”

Section: Management Of Vt In Nicmmentioning

confidence: 99%

Ventricular arrhythmias in nonischemic cardiomyopathy

Chung

Lin

et al. 2018

Journal of Arrhythmia

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Nonischemic cardiomyopathies (NICMs) are composed of variable disease entities, including primary and secondary cardiomyopathies. Determining the etiology of NICM provides pivotal roles of not only the understanding of the individual pathogenesis, but also the clinical management, such as risk stratification, pharmacological treatment, and intervention therapies. Despite the diverse causes of NICM, these cases mostly require clinical attention owing to progressive myocardial injury, resulting in ventricular dysfunction and heart failure. The interaction between the diseased ventricular substrates and systemic/neurophysiological factors contributes to the cornerstones responsible for ventricular arrhythmogenesis and sudden cardiac death (SCD). Prevention of SCD and diminishing ventricular tachyarrhythmias are the important mainstays for the management of NICM patients. Given the understanding of the abnormal ventricular substrates and advancement of navigation systems, radiofrequency catheter ablation (RFCA) has become an adjunctive or alternative strategy for NICM patients who experience drug‐refractory ventricular tachycardias (VTs). Successful ablation can frequently be achieved at the expense of an epicardial intervention. A recent study has proven the survival benefits for NICM patients who are free from recurrent VTs after a successful RFCA, regardless of the New York Heart Association (NYHA) functional class status or left ventricular ejection fraction. Additionally, recent evidence has highlighted the better delineation of a diseased myocardium through the incorporation of cardiovascular magnetic resonance imaging (CMRI) and 3D mapping systems, which can facilitate the identification of critical ventricular arrhythmogenic substrates in NICM patients.

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“…33,34 The electrophysiological properties of cardiomyopathic myocardium are also altered by lines of conduction block resulting from fibrosis and areas of abnormal conductibility and refractoriness. 35 The zones with altered electrophysiological properties are not homogenous throughout the dysfunctional myocardium, 36 and the patterns of their distribution appear to differ between ischemic and non-ischemic dilated cardiomyopathy, 36 with more diffuse involvement, mainly in the basal segments, in the latter compared to the former, in which these zones tend to be restricted to particular arterial territories and typically affect the endocardium more extensively. 37,38 In the case presented, the patient had severe valvular disease and had undergone mitral valve replacement, which may have altered the tissue architecture and hence the distribution of zones with altered electrophysiological properties.…”

Section: Discussionmentioning

confidence: 99%

The proarrhythmic effect of cardiac resynchronization therapy: An issue that should be borne in mind

Cabanelas

Oliveira

Silva

et al. 2014

Revista Portuguesa de Cardiologia (English Edition)

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The demonstrated benefits of cardiac resynchronization therapy (CRT) in reducing mortality and hospitalizations for heart failure, improving NYHA functional class and inducing reverse remodeling have led to its increasing use in clinical practice. However, its potential contribution to complex ventricular arrhythmias is controversial.We present the case of a female patient with valvular heart failure and severe systolic dysfunction, in NYHA class III and under optimal medical therapy, without previous documented ventricular arrhythmias. After implantation of a CRT defibrillator, she suffered an arrhythmic storm with multiple episodes of monomorphic ventricular tachycardia (VT), requiring 12 shocks. Subsequently, a pattern of ventricular bigeminy was observed, as well as reproducible VT runs induced by biventricular pacing.Since no other vein of the coronary sinus system was accessible, it was decided to implant an epicardial lead to stimulate the left ventricle, positioned in the left ventricular mid-lateral wall. No arrhythmias were detected in the following six months.This case highlights the possible proarrhythmic effect of biventricular pacing with a left ventricular lead positioned in the coronary sinus venous system. © 2012 Sociedade Portuguesa de Cardiologia. Published by Elsevier España, S.L. All rights reserved. 309.e2 N. Cabanelas et al. PALAVRAS-CHAVE Heterogeneidade da repolarizaçãode remodelagem inversa em doentes selecionados com insuficiência cardíaca (ICC), têm contribuído para a crescente utilização destes dispositivos na prática clínica. No entanto, permanece controverso o impacto da TRC como fator causador de arritmias ventriculares complexas. Apresentamos o caso duma doente com cardiopatia valvular operada, disfunção sistólica grave e ICC classe III da NYHA, com terapêutica médica otimizada, sem documentação prévia de arritmias ventriculares significativas. Após implantação do sistema de TRC com cardioversor-desfibrilhador, desenvolveu quadro de tempestade arrítmica com múltiplos episódios de taquicardia ventricular monomórfica (TV) e necessidade de 12 choques, mantendo padrão de bigeminismo ventricular reprodutível e indução de salvas de TV pelo pacing biventricular. Dada a inacessibilidade a outra veia tributária do seio coronário foi decidido implantar elétrodo epicárdico em localização diferente (de veia póstero-lateral para posição lateral-mediana), sem registo de recorrência de arritmias num follow-up de seis meses. Este caso sugere que a TRC pode contribuir para um efeito pró-arrítmico com consequências clínicas potencialmente graves.

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Fractionated electrograms in dilated cardiomyopathy: Origin and relation to abnormal conduction

Cited by 149 publications

References 41 publications

Structural atrial remodeling alters the substrate and spatiotemporal organization of atrial fibrillation: a comparison in canine models of structural and electrical atrial remodeling

Structural atrial remodeling alters the substrate and spatiotemporal organization of atrial fibrillation: a comparison in canine models of structural and electrical atrial remodeling

Ventricular arrhythmias in nonischemic cardiomyopathy

The proarrhythmic effect of cardiac resynchronization therapy: An issue that should be borne in mind

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