Modification of Late Potentials by Intracoronary Ethanol Infusion

Sm, Dailey; Gn, Kay; Ae, Epstein; Vj, Plumb

doi:10.1111/j.1540-8159.1992.tb02949.x

Cited by 3 publications

(1 citation statement)

References 23 publications

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“…All these observations suggest that the subtle changes of the SAECG can be used as an adjunctive tool to evaluate the efficacy of the RFCA. An additional evidence for this was provided by Dailey et al who demonstrated that intracoronary infusion of ethanol can eliminate the late potentials in SAECG and terminate the VT [ 21 ]. Notably, RMS40 was not affected by the RFCA and did not show any difference between patients with and without VT recurrence, suggesting rather low sensitivity to detect modifications of the arrhythmogenic substrate and therefore can possibly be omitted as a component of the SAECG.…”

Section: Discussionmentioning

confidence: 99%

Dynamic changes in the signal-averaged electrocardiogram are associated with the long-term outcomes after ablation of ischemic ventricular tachycardia

Dinov

Schramm

Koenig

et al. 2020

J Interv Card Electrophysiol

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Purpose Signal-averaged ECG (SAECG) can detect inhomogeneous myocardial conduction in patients presenting with ventricular tachycardia (VT) after myocardial infarction. Radiofrequency ablation (RFCA) aims at elimination of the endocardial late potentials and non-inducibility of VT. Previously, we demonstrated that abnormal SAECG at baseline can return to normal after a successful VT ablation. The present research investigates the post-ablation changes in SAECG after RFCA of VT and their relation to the procedural long-term outcomes. Methods Thirty-three patients (31 male; age 68 ± 9 years; EF 36 ± 12%) with ischemic VT were prospectively enrolled to receive RFCA. One VT (range 1–7) per patient was ablated using substrate-guided RFCA and complete success was achieved in 28 (85%) cases. SAECG was performed before (t1), immediately after (t2), and at least 6 months (t3) after the RFCA. Results After RFCA, the amount of patients showing abnormal SAECG decreased from 82% initially (t1) to 57.6% post-interventionally (t2); P = 0.008; and remained unchanged thereafter in 57% (t3). Patients who experienced VT recurrence (VT+) during the follow-up period had broader averaged QRS (t2): (VT+) 150 ± 26 vs. (VT−) 129 ± 21 ms; P = 0.015, as well as longer LAS40 (t2): (VT+) 60 ± 26 vs. (VT−) 43 ± 18 ms; P = 0.03. Abnormal SAECG (t2) was a strong predictor for VT recurrence: HR 5.4; 95% CI 1.5–21. SAECG detected more late potentials in patients with inferior than in those with anterior scars: 95% vs. 58%; P = 0.016. Conclusions RFCA of VT in the left ventricle can improve an abnormal SAECG in some patients after myocardial infarction. Normal SAECG after RFCA of VT is associated with a lower risk for VT recurrence and death.

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Section: Discussionmentioning

confidence: 99%

Dynamic changes in the signal-averaged electrocardiogram are associated with the long-term outcomes after ablation of ischemic ventricular tachycardia

Dinov

Schramm

Koenig

et al. 2020

J Interv Card Electrophysiol

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Alternative Approaches for Ablation of Resistant Ventricular Tachycardia

Gianni

Mohanty

Trivedi

et al. 2017

Cardiac Electrophysiology Clinics

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Late Potentials Are Unaffected by Radiofrequency Catheter Ablation in Patients with Ventricular Tachycardia

Twidale

Hazlitt²,

Berbari³

et al. 1994

Pacing Clinical Electrophis

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Reentrant ventricular tachycardia is dependent on an area of myofibers, embedded in scar tissue, which exhibit slow conduction. Late potentials recorded by signal-averaged electrocardiography appear to correspond to these zones of slow conduction and frequently are present in patients with VT. We hypothesized that elimination of inducible VT by catheter-mediated ablation of critical areas of slow conduction would alter late potentials. Four patients underwent catheter ablation in which radiofrequency current was delivered to zones of slow conduction exhibiting isolated mid-diastolic potentials that could not be dissociated from the tachycardia. The four patients had developed VT (cycle length 382 +/- 50 msec; mean +/- SEM) 13-180 months after inferior myocardial infarction. Late potentials were present in each patient before catheter ablation was attempted. Although VT was not inducible in any patient immediately after ablation, late potentials were still present in all four patients and there was no significant difference in the QRS duration (136.5 +/- 4.0 msec postablation; 135.7 +/- 4.5 msec preablation), root mean square voltage in the terminal 40 msec of the QRS (10.0 +/- 1.0 microV postablation; 5.9 +/- 0.4 microV preablation), or in the duration of the low amplitude signal (69.2 +/- 2.0 msec postablation; 62.7 +/- 3.4 msec preablation). At follow-up electrophysiology study performed 14 +/- 7 days after ablation, one of the four patients had inducible VT. In conclusion, late potentials persist even after successful radiofrequency catheter ablation and do not appear to be useful for predicting results of follow-up electrophysiology study.

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Modification of Late Potentials by Intracoronary Ethanol Infusion

Cited by 3 publications

References 23 publications

Dynamic changes in the signal-averaged electrocardiogram are associated with the long-term outcomes after ablation of ischemic ventricular tachycardia

Dynamic changes in the signal-averaged electrocardiogram are associated with the long-term outcomes after ablation of ischemic ventricular tachycardia

Alternative Approaches for Ablation of Resistant Ventricular Tachycardia

Late Potentials Are Unaffected by Radiofrequency Catheter Ablation in Patients with Ventricular Tachycardia

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