Is it feasible to offer ‘targeted ablation’ of ventricular tachycardia circuits with better understanding of isthmus anatomy and conduction characteristics?

Bourier, Félix; Martin, Ruairidh; Martin, Claire; Takigawa, Masateru; Kitamura, Τakeshi; Frontera, Antonio; Cheniti, Ghassen; Lam, Anna; Vlachos, Konstantinos; Duchâteau, Josselin; Pambrun, Thomas; Derval, Nicolas; Denis, Arnaud; Klotz, Nicolas; Hocini, Mélèze; Haı̈ssaguerre, Michel; Jaı̈s, Pierre; Cochet, Hubert; Sacher, Frédéric

doi:10.1093/europace/euy173

Cited by 15 publications

(9 citation statements)

References 36 publications

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“…The identification of AP is an operator-dependent process supported by the use of multielectrode catheters and different tools integrated in off-the-shelf 3D mapping systems such as Rhythmia HDx (Boston Scientific, Cambridge, MA, USA), CARTO3v6, (Biosense Webster, Diamond Barr, CA, USA), EnSite Precision (Abbott, Chicago, IL, USA) [7], [8]. Tools such as CARTO3 Ripple Mapping Module, which provides a dynamic visual representation of bipolar electrograms shown as bars [9], are time-domain based.…”

Section: Introductionmentioning

confidence: 99%

Automatic Recognition of Ventricular Abnormal Potentials in Intracardiac Electrograms

Baldazzi¹,

Orrù²,

Matraxia³

et al. 2019

Computing in Cardiology Conference (CinC)

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Ventricular abnormal potentials are low-amplitude electrical signals that appear in intracardiac electrograms during a QRS or with an unpredictable delay with respect to it. Their spatial localization can be exploited by cardiologists for the identification of the ablation targets in substrate-guided mapping and ablation procedures. In this work, an automatic approach for a reliable detection of such potentials in intracardiac electrograms is proposed. To this aim, 86 intracardiac electrograms from five patients with post-ischemic ventricular tachycardia, acquired by the CARTO3 System, were retrospectively annotated by an expert cardiologist, to be used for a supervised classifier training and test. The automatic detection was based on a non-linear denoising followed by a timescale decomposition based on the continuous wavelet transform. Then, different morphological features were extracted from both the timescale domain and the time domain, and used to feed a support vector machine trained to discriminate between physiological and abnormal potentials. The recognition accuracy exceeded 93%, paving the way to further developments and more extensive studies.

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Section: Introductionmentioning

confidence: 99%

Automatic Recognition of Ventricular Abnormal Potentials in Intracardiac Electrograms

Baldazzi¹,

Orrù²,

Matraxia³

et al. 2019

Computing in Cardiology Conference (CinC)

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“…The utility of VT activation mapping has been recently described. 19,20 Hadjis et al 19 showed that VT recurrence was significantly lower among those patients with complete delineation of the diastolic pathway (12%) during VT when compared with partial or no recording of the diastolic pathway (50% and 45%, respectively, p = .02).…”

Section: Utility Of Baseline Inducibility and Activation Mapping During Vt Ablationmentioning

confidence: 99%

Influence of baseline inducibility and activation mapping on ablation outcomes in patients with structural heart disease and ventricular tachycardia

Cano

Pérez-Roselló

Ayala

et al. 2021

Cardiovasc electrophysiol

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Introduction: Stand-alone substrate ablation has become a standard ventricular tachycardia (VT) ablation strategy. We sought to evaluate the influence of baseline VT inducibility and activation mapping on ablation outcomes in patients with structural heart disease (SHD) undergoing VT ablation.Methods: Single center, observational and retrospective study including consecutive patients with SHD and documented VT undergoing ablation. Baseline VT induction was attempted before ablation in all patients and VT activation mapping performed when possible. Ablation was guided by activation mapping for mappable VTs plus substrate ablation for all patients. Ablation outcomes and complications were evaluated.Results: One hundred and sixty patients were included and were classified in three groups according to baseline VT inducibility:group 1 (non inducible, n = 18), group 2 (1 VT morphology induced, n = 53), and group 3 (>1 VT morphology induced, n = 89).VT activation mapping was possible in 35%. After a median follow-up of 38.5 months, baseline inducibility of greater than 1 VT morphology was associated with a significant incidence of VT recurrence (42% for group 3 vs. 15.1% for group 2% and 5.6% for group 1, Log-rank p < .0001) and activation mapping with a lower rate of VT recurrence (24% vs. 36.3%, Log-rank p = .035). Baseline inducibility of greater than 1 VT morphology (hazards ratio [HR]: 12.05, 95% confidence interval [CI]:1.60-90.79, p = .016) was an independent predictor of VT recurrence while left ventricular ejection fraction less than 30% (HR: 1.93, 95% CI: 1.13-3.25, p = .014) and advanced heart failure (HR: 4.69, 95% CI: 2.75-8.01, p < .0001) were predictors of mortality or heart transplantation. Complications occurred in 11.2% (5.6% hemodynamic decompensation). Conclusion:Baseline VT inducibility and activation mapping may add significant prognostic information during VT ablation procedures.

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“…While novel strategies and imaging techniques for VT ablation offering more specific ablation targets are being researched and developed, 23,24 negative PVS at the end of the procedure still carries high recurrence rates, reported at 20% to 30%. There are multiple possible reasons for these findings.…”

Section: Advantages and Pitfalls Of Nipsmentioning

confidence: 99%

Noninvasive programmed stimulation in the setting of ventricular tachycardia catheter ablation

Frontera

Kalinšek

Hadjis

et al. 2020

Cardiovasc electrophysiol

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In the setting of catheter ablation of ventricular tachycardia (VT), invasive programmed ventricular stimulation (PVS) is considered an important tool to assess the (residual) inducibility of ventricular arrhythmias and determine the acute success of the procedure. In patients with cardiovascular implantable electronic devices, noninvasive programmed stimulation via implantable cardioverter‐defibrillator (ICD) leads can be an alternative to the invasive PVS with intracardiac catheters. The advantages of noninvasive programmed stimulation include preprocedure planning of the electrophysiology procedure to ensure optimal conditions for successful catheter ablation of VT. Following the procedure, noninvasive programmed stimulation has been shown to be used as a guide for repeat early ablation, to offer better programming of ICD, to offer prognostic value regarding the VT recurrence, and to guide antiarrhythmic drug therapy. The noninvasive nature of noninvasive programmed stimulation makes it an attractive alternative to PVS in patients with ICD who have not undergone catheter ablation of VT to obtain prognostic value regarding the occurrence of VT.

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Is it feasible to offer ‘targeted ablation’ of ventricular tachycardia circuits with better understanding of isthmus anatomy and conduction characteristics?

Cited by 15 publications

References 36 publications

Automatic Recognition of Ventricular Abnormal Potentials in Intracardiac Electrograms

Automatic Recognition of Ventricular Abnormal Potentials in Intracardiac Electrograms

Influence of baseline inducibility and activation mapping on ablation outcomes in patients with structural heart disease and ventricular tachycardia

Noninvasive programmed stimulation in the setting of ventricular tachycardia catheter ablation

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