High density mapping of ventricular scar- a comparison of ventricular tachycardia supporting channels with channels that do not support VT

Nayyar, Sachin; Ganesan, Anand N.; Wilson, Lauren; Brooks, A.; Sanders, P.; Roberts‐Thomson, Kurt C.

doi:10.1093/eurheartj/eht310.p4972

Cited by 8 publications

(10 citation statements)

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“…We found iLP in areas distant from the critical VT isthmus in 29% of patients. This supports the hypothesis, that the latest potentials are not the most specific ones 5,20 . They might only represent normal late activation during sinus or paced rhythm without being a VT substrate.…”

Section: Discussionsupporting

confidence: 87%

Specific electrogram characteristics impact substrate ablation target area in patients with scar‐related ventricular tachycardia—insights from automated ultrahigh‐density mapping

Schwarzl

Kahle

Höller

et al. 2021

Cardiovasc electrophysiol

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Introduction Substrate‐based catheter ablation approaches to ventricular tachycardia (VT) focus on low‐voltage areas and abnormal electrograms. However, specific electrogram characteristics in sinus rhythm are not clearly defined and can be subject to variable interpretation. We analyzed the potential ablation target size using automatic abnormal electrogram detection and studied findings during substrate mapping in the VT isthmus area. Methods and Results Electrogram characteristics in 61 patients undergoing scar‐related VT ablation using ultrahigh‐density 3D‐mapping with a 64‐electrode mini‐basket catheter were analyzed retrospectively. Forty‐four complete substrate maps with a mean number of 10319 ± 889 points were acquired. Fractionated potentials detected by automated annotation and manual review were present in 43 ± 21% of the entire low‐voltage area (<1.0 mV), highly fractionated potentials in 7 ± 8%, late potentials in 13 ± 15%, fractionated late potentials in 7 ± 9% and isolated late potentials in 2 ± 4%, respectively. Highly fractionated potentials (>10 ± 1 fractionations) were found in all isthmus areas of identified VT during substrate mapping, while isolated late potentials were distant from the critical isthmus area in 29%. Conclusion The ablation target area varies enormously in size, depending on the definition of abnormal electrograms. Clear linking of abnormal electrograms with critical VT isthmus areas during substrate mapping remains difficult due to a lack of specificity rather than sensitivity. However, highly fractionated, low‐voltage electrograms were found to be present in all critical VT isthmus sites.

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Section: Discussionsupporting

confidence: 87%

Specific electrogram characteristics impact substrate ablation target area in patients with scar‐related ventricular tachycardia—insights from automated ultrahigh‐density mapping

Schwarzl

Kahle

Höller

et al. 2021

Cardiovasc electrophysiol

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“…Ablation targets are typically chosen using a combination of anatomic context, electrogram characteristics, pace mapping, and electro-anatomical mapping (EAM) in more complex cases. This information is used to identify locations of reentrant circuits or aberrant focal sources of triggers (1)(2)(3). These methods also indicate, in real time, any restorative effects of the ablation lesions to normal activation patterns.…”

Section: Introductionmentioning

confidence: 99%

Non‐contrast‐enhanced T₁‐weighted MRI of myocardial radiofrequency ablation lesions

Guttman

Tao

Fink

et al. 2017

Magnetic Resonance in Med

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Purpose To demonstrate imaging of radiofrequency ablation lesions with non-contrast-enhanced T1-weighted (T1w) MRI. Methods Fifteen swine underwent left ventricular ablation followed by MRI using different preparations: endocardial or epicardial ablation of naïve animal, or endocardial ablation of animal with myocardial infarction. Lesion imaging was performed using free-breathing, non-contrast-enhanced, T1w sequence with long inversion time (TI). Also acquired were T1 maps and delayed contrast-enhanced (DCE) imaging. Hearts were excised for ex vivo imaging, and sliced for gross pathology and histology. Results All ablations were visibly enhanced in non-contrast-enhanced T1w imaging using TI =700 ms. T1w enhancement agreed with regions of necrosis in gross pathology and histology. Enhanced lesion cores were surrounded by dark bands containing contraction band necrosis, hematoma, and edema. In animals with myocardial infarction, chronic scar was hypointense in T1w, whereas acute ablations were enhanced, allowing discrimination between chronic scar and acute lesions, unlike DCE. Contrast was sufficient to create 3D volume renderings of lesions after minor postprocessing. Conclusions Non-contrast-enhanced T1w imaging with long TI promises to be an effective method for visualizing necrosis within radiofrequency ablation lesions. Enhancement is more specific and stationary than that from DCE. The imaging can be repeated as needed, unlike DCE, and may be especially useful for assessing ablations during or after a procedure.

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“…The organization of ventricular scar in cardiomyopathy patients with prior spontaneous VA is more complex, with a larger proportion of very‐low‐voltage electrograms, more frequent abnormal electrograms of wide duration, and a greater number of myocyte channels with very slow conduction than patients without spontaneous VA . These observations suggest there is more extensive heterogeneous scarring and advanced electrical remodeling in VA patients .…”

Section: Discussionmentioning

confidence: 97%

Differential pacing from two sites to diagnose risk of ventricular arrhythmia and death

Nayyar

Kuklik

Tomlinson

et al. 2018

Pacing Clinical Electrophis

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Background QRS abnormalities may not be apparent in sinus rhythm in electrically stable cardiomyopathy patients who can have quiescent but highly arrhythmogenic substrate. Here, we test the hypothesis that differential changes in QRS construction during right‐ventricular apex pacing (RVP) as opposed to atrial pacing (AP) will identify latent substrate for ventricular arrhythmias (VA) and death. Methods Forty patients with cardiomyopathy free of VA underwent baseline 114‐electrode body‐surface electrocardiogram during AP (100 beats per minute [bpm]) and RVP (100 and 120 bpm). The filtered‐averaged QRS at each electrode was deconstructed into individual intra‐QRS and post‐QRS ventricular myopotentials (VMP). The primary outcome was VA or death. Prognostic accuracy of VMP was validated using V1 to V6 leads in another prospective cohort of 44‐cardiomyopathy patients. Results Twenty‐six patients were eligible for initial analysis. After 5 ± 2 years of follow‐up, eight (31%) patients had VA (VAPos) while rest were uneventful (VANeg). During AP100, VAPos patients expressed more VMP than VANeg patients (16 ± 1 vs 12 ± 1, P = 0.02). RVP100 and RVP120 in VAPos patients introduced an additional 5.5 ± 0.5 and 6.0 ± 0.5 VMP (P < 0.0001 vs AP100). The relative change with RVP120 versus AP100 in VANeg patients exceeded VAPos patients by 1.2 ± 0.5 VMP (P = 0.03). Increment in VMP count of <8 in lead‐V5 with RVP120 compared to AP100 best predicted VA (area under curve 0.81, P = 0.01). In the validation cohort, primary outcome occurred in 13 (33%) patients. Native QRS features and AP100 alone failed to predict primary outcome. Patients with increment in VMP count of <8 in lead‐V5 with RVP120 versus AP100 had 7.9‐fold increased risk of primary outcome (95% confidence interval 1.01, 61.61; P = 0.049). Conclusion Cardiomyopathy patients at risk of VA or death perturb the QRS less than low‐risk patients with differential pacing. This functional response may be useful to identify arrhythmogenic substrate.

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High density mapping of ventricular scar- a comparison of ventricular tachycardia supporting channels with channels that do not support VT

Cited by 8 publications

References 0 publications

Specific electrogram characteristics impact substrate ablation target area in patients with scar‐related ventricular tachycardia—insights from automated ultrahigh‐density mapping

Specific electrogram characteristics impact substrate ablation target area in patients with scar‐related ventricular tachycardia—insights from automated ultrahigh‐density mapping

Non‐contrast‐enhanced T₁‐weighted MRI of myocardial radiofrequency ablation lesions

Differential pacing from two sites to diagnose risk of ventricular arrhythmia and death

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High density mapping of ventricular scar- a comparison of ventricular tachycardia supporting channels with channels that do not support VT

Cited by 8 publications

References 0 publications

Specific electrogram characteristics impact substrate ablation target area in patients with scar‐related ventricular tachycardia—insights from automated ultrahigh‐density mapping

Specific electrogram characteristics impact substrate ablation target area in patients with scar‐related ventricular tachycardia—insights from automated ultrahigh‐density mapping

Non‐contrast‐enhanced T1‐weighted MRI of myocardial radiofrequency ablation lesions

Differential pacing from two sites to diagnose risk of ventricular arrhythmia and death

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Product

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Non‐contrast‐enhanced T₁‐weighted MRI of myocardial radiofrequency ablation lesions