Multicenter Study of Ischemic Ventricular Tachycardia Ablation With Decrement-Evoked Potential (DEEP) Mapping With Extra Stimulus

Porta‐Sánchez, Andreu; Jackson, N.; Lukáč, Peter; Kristiansen, Steen Buus; Nielsen, Jesper; Gizurarson, Sigfús; Massé, Stéphane; Labos, Christopher; Viswanathan, Karthik; King, Benjamin; Ha, Andrew C.T.; Downar, Eugene; Nanthakumar, Kumaraswamy

doi:10.1016/j.jacep.2017.12.005

Cited by 82 publications

(65 citation statements)

References 18 publications

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“…Application of DEEP mapping identified diastolic pathways with greater specificity than mapping of late potentials. In a prospective multicenter study, the viability of the decrement evoked potential approach to identify functional substrate modification for VT therapy has been confirmed …”

Section: Determining Target Sitesmentioning

confidence: 91%

Electrogram recording and analyzing techniques to optimize selection of target sites for ablation of cardiac arrhythmias

Bakker

2019

Pacing Clinical Electrophis

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The extracellular electrogram is caused by transmembrane currents that flow into extracellular space during propagation of the electrical impulse. Electrograms are usually recorded in unipolar or bipolar mode that have different characteristics, but provide complementary information. Both recording modes have specific advantages, but also suffer from disadvantages. Techniques to circumvent some of the weaknesses are reviewed. The origin of remote and fractionated deflections and their relation with electrode characteristics are discussed. Epicardial and endocardial sites of origin and breakthrough sites as well as the effect of fatty tissue on extracellular electrograms are presented. Induction of tachycardia to assess the arrhythmogenic area is not always possible because of hemodynamic instability of the patient. Techniques to assess sites with high reentry vulnerability without induction of arrhythmias are outlined such as activation‐repolarization mapping and decremental stimulation. Pitfalls of substrate mapping and techniques to avoid them as omnipolar mapping and characterization of complex electrograms by entropy are presented. Technical aspects that influence electrogram morphology as electrode size, filtering, contact force, and catheter position are delineated. Data from the various publications suggest that a combination of unipolar and bipolar electrogram analysis techniques is helpful to optimize determination of target sites for ablation.

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Section: Determining Target Sitesmentioning

confidence: 91%

Electrogram recording and analyzing techniques to optimize selection of target sites for ablation of cardiac arrhythmias

Bakker

2019

Pacing Clinical Electrophis

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“…Locations with such decremental conduction are thought to be susceptible to unidirectional block due to alterations in CV restitution, providing a mechanism for reentry. A small study of 20 patients with ICM demonstrated that DEEPs have increased specificity over LPs in identifying VT isthmuses with no significant difference in sensitivity (Porta‐Sánchez et al, ).…”

Section: State Of the Art In Ablation Of Vt In Ischemic Cardiomyopathmentioning

confidence: 99%

How personalized heart modeling can help treatment of lethal arrhythmias: A focus on ventricular tachycardia ablation strategies in post‐infarction patients

Trayanova

Doshi

Prakosa

2020

WIREs Mechanisms of Disease

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Precision Cardiology is a targeted strategy for cardiovascular disease prevention and treatment that accounts for individual variability. Computational heart modeling is one of the novel approaches that have been developed under the umbrella of Precision Cardiology. Personalized computational modeling of patient hearts has made strides in the development of models that incorporate the individual geometry and structure of the heart as well as other patient‐specific information. Of these developments, one of the potentially most impactful is the research aimed at noninvasively predicting the targets of ablation of lethal arrhythmia, ventricular tachycardia (VT), using patient‐specific models. The approach has been successfully applied to patients with ischemic cardiomyopathy in proof‐of‐concept studies. The goal of this paper is to review the strategies for computational VT ablation guidance in ischemic cardiomyopathy patients, from model developments to the intricacies of the actual clinical application. To provide context in describing the road these computational modeling applications have undertaken, we first review the state of the art in VT ablation in the clinic, emphasizing the benefits that personalized computational prediction of ablation targets could bring to the clinical electrophysiology practice. This article is characterized under: Analytical and Computational Methods > Computational Methods Models of Systems Properties and Processes > Organ, Tissue, and Physiological Models Translational, Genomic, and Systems Medicine > Translational Medicine

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“…However, it has been reported that a certain proportion of abnormal potentials are also located in regions with bipolar voltages of more than 1.5 mV, 19,21 with abnormal electrograms occasionally unmasked by extrastimuli. 51,52 We have recorded at least 3% of substrate defined as local abnormal ventricular activity (LAVA) in voltage zones of more than 1.5 mV (because of far-field signal annotation) 53 (Figures 2A-2D). Moreover, Tung et al 54 found that 18% of critical VT isthmuses were within low-voltage areas during pacing from the site but Comparison of bipolar voltage maps (endocardial: scar < 0.5 mV, border zone 0.5-1.5 mV, and healthy tissue > 1.5 mV; epicardial: border zone 0.5-1 mV and healthy tissue > 1 mV) using Navistar ® (Biosense Webster, Diamond Bar, CA, USA) (NAV) mapping versus PentaRay ® (Biosense Webster, Diamond Bar, CA, USA) (PR) mapping in the endocardium (A) and epicardium (B) of a sheep model with an iatrogenic-created anteroseptal scar and in humans (C) using the CARTO ® 3 system (Biosense Webster, Diamond Bar, CA, USA).…”

Section: Electrogram-based Substrate Detectionmentioning

confidence: 99%

“…29,90 CMR has been widely used in this regard, and several studies have shown good correlation with EAM 30,31,62,83,88 and a positive clinical impact. 27,52,87 Further potential benefits of real-time CMR guidance [91][92][93] could include improved procedural supervision without exposure to radiation/contact EAM as well as improved substrate detection and lesion visualization according to CMR-defined endpoints. However, CMR may be unavailable, contraindicated, or of suboptimal quality because of ICD-related artifacts, and MDCT represents a valuable alternative for imaging integration.…”

Section: Use Of Imaging To Identify Substratementioning

confidence: 99%

Substrate Mapping and Ablation for Ventricular Tachycardia in Patients with Structural Heart Disease: How to Identify Ventricular Tachycardia Substrate

Kitamura¹,

Martin²,

Vlachos³

et al. 2019

J Innov Cardiac Rhythm Manage.

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Catheter ablation for ventricular tachycardia (VT) has been increasingly used over the past two decades in patients with structural heart disease (SHD). In these individuals, a substrate mapping strategy is being more commonly applied to identify targets for VT ablation, which has been shown to be more effective versus targeting mappable VTs alone. There are a number of substrate mapping methods in existence that aim to explore potential VT isthmuses, although their success rates vary. Most of the reported electrogram-based mapping studies have been performed with ablation catheters; meanwhile, the use of multipolar mapping catheters with smaller electrodes and closer interelectrode spacing has emerged, which allows for an assessment of detailed near-field abnormal electrograms at a higher resolution. Another recent advancement has occurred in the use of imaging techniques in VT ablation, particularly in refining the substrate. The goal of this paper is to review the key developments and limitations of current mapping strategies of substrate-based VT ablation and their outcomes. In addition, we briefly summarize the role of cardiac imaging in delineating VT substrate.

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Multicenter Study of Ischemic Ventricular Tachycardia Ablation With Decrement-Evoked Potential (DEEP) Mapping With Extra Stimulus

Cited by 82 publications

References 18 publications

Electrogram recording and analyzing techniques to optimize selection of target sites for ablation of cardiac arrhythmias

Electrogram recording and analyzing techniques to optimize selection of target sites for ablation of cardiac arrhythmias

How personalized heart modeling can help treatment of lethal arrhythmias: A focus on ventricular tachycardia ablation strategies in post‐infarction patients

Substrate Mapping and Ablation for Ventricular Tachycardia in Patients with Structural Heart Disease: How to Identify Ventricular Tachycardia Substrate

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