New Unipolar Electrogram Criteria to Identify Irreversibility of Nonischemic Left Ventricular Cardiomyopathy

Campos, Bieito; Jauregui, Miguel E.; Park, Kyoung-Min; Mountantonakis, Stavros; Gerstenfeld, Edward P.; Haqqani, Haris M.; García, Fermin C.; Hutchinson, Mathew D.; Callans, David J.; Dixit, Sanjay; Lin, David; Riley, Michael P.; Tzou, Wendy S.; Cooper, Joshua M.; Bala, Rupa; Zado, Erica S.; Marchlinski, Francis E.

doi:10.1016/j.jacc.2012.08.977

Cited by 78 publications

(61 citation statements)

References 13 publications

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“…This is in line with prior comparative studies, which showed that electroanatomic voltage mapping is significantly more sensitive than cardiac magnetic resonance to disclose areas of cardiomyopathic involvement. [39][40][41] This may be related to the inadequate spatial resolution of current magnetic resonance scanners especially for thin structures such as the right ventricular wall, with high risk of artifacts due to partial volume effect.…”

Section: Substrate Mapping: General Considerationsmentioning

confidence: 99%

Substrate mapping for unstable ventricular tachycardia

Santangeli

Marchlinski

2016

Heart Rhythm

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The primary goal of catheter ablation of scar-related ventricular tachycardia (VT) is the interruption of critical areas of slow conduction responsible for the development and maintenance of the reentrant VT circuit. Most patients with scar-related VT present with unstable arrhythmias that are not amenable to interrogation from multiple sites to define the VT circuit based on the intracardiac activation sequence and the response to entrainment mapping. In order to effectively target unstable VTs, a number of ablation approaches have been described with the aim of targeting the abnormal substrate defined with mapping in sinus or paced rhythm. Some of these strategies (eg, late potential and local abnormal ventricular activity ablation or scar homogenization) target the entire abnormal substrate harboring abnormal electrograms, defined with a variety of different criteria. Scar dechanneling, linear ablation through sites matching VT with pacing, and the core isolation approach focus on more discrete regions within the abnormal substrate that have been proven relevant to the clinical and/or inducible arrhythmias by means of physiologic maneuvers, although this does not necessarily translate to fewer radiofrequency lesions to achieve the procedural end-point. Observational studies evaluating different substrate-based ablation techniques have reported fairly uniform arrhythmia-free survivals at short- and mid-term follow-up, although direct comparisons between different techniques are lacking. In this article, we summarize the different state-of-the-art substrate mapping and ablation approaches for targeting unstable VT, with a particular focus on the relative merits and limitations of the described techniques.

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Section: Substrate Mapping: General Considerationsmentioning

confidence: 99%

Substrate mapping for unstable ventricular tachycardia

Santangeli

Marchlinski

2016

Heart Rhythm

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“…Interestingly, there was a strong correlation between parameters of RV function and viability of IVS, suggesting that ventricular interdependence may at least partially account for the observed changes 15, 16. Previously it has been demonstrated that measurement of endocardial UV can be used to identify left ventricular dysfunction in the absence of macroscopic scar defined with standard cardiac magnetic resonance imaging (cMRI) criteria, which suggests that unipolar electrograms could also detect a more diffuse underlying myocardial process 17. Moreover, an inverse relation between amplitude of unipolar endocardial recordings and myocardial fibrosis burden has been described already in an experimental model of nonischemic cardiomyopathy and in an anatomic study of explanted human hearts 18, 19.…”

Section: Discussionmentioning

confidence: 98%

CD34+ Cell Transplantation Improves Right Ventricular Function in Patients with Nonischemic Dilated Cardiomyopathy

Frljak

Jaklič

Zemljic

et al. 2018

Stem Cells Translational Medicine

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We investigated the effects of CD34+ cell therapy on right ventricular (RV) function in patients with nonischemic dilated cardiomyopathy (DCM). We enrolled 60 patients with DCM who were randomized to CD34+ cell therapy (Stem Cells (SC) Group n = 30), or no cell therapy (Controls, n = 30). The SC Group received granulocyte‐colony stimulating factor, and CD34+ cells were collected by apheresis and injected transendocardially. Patients were followed for 6 months. At baseline, the groups did not differ in age, gender, left ventricular ejection fraction, N‐terminal probrain natriuretic peptide, or parameters of RV function. At 6 months, we found a significant improvement in RV function in the SC Group (tricuspid annular plane systolic excursion [TAPSE]: +0.44 ± 0.64 cm, p = .001; peak systolic tissue Doppler velocity of tricuspid annulus [St]: +1.5 ± 2.1 cm/s; p = .001; percent of fractional area change [FAC]: +8.6% ± 5%, p = .01), but not in Controls (TAPSE: −0.07 ± 0.32 cm, p = .40; St: −0.1 ± 1.2 cm/s; p = .44; FAC: −1.2% ± 3.2%, p = .50). On repeat electroanatomical mapping, we found an improvement in interventricular septum viability in 19 of 30 patients from the SC Group; this correlated with the improvements in RV function (13/19 in the improved septum group versus 3/11 in the remaining cohort, p = .029). These results suggest that patients with DCM, changes in RV function correlate with changes of viability of interventricular septum. CD34+ cell therapy appears to be associated with improved right ventricular function in this patient cohort. (Clinical Trial Registration Information: www.clinicaltrials.gov; NCT02248532). Stem Cells Translational Medicine 2018;7:168–172

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“…6,7,15 Further, unipolar voltage by EMM has been shown to identify areas of myocardial fibrosis and possibly to help identify suitable targets for cell therapy 16 and therapeutic angiogenesis. 17 That EMM's identification of viable myocardial tissue as a target in ischemic cardiomyopathy patients can be used to maximize the effects of cell therapy is still hypothetical, however.…”

Section: Were Engaged By Needle and Injected (With Bmc Or Placebo)mentioning

confidence: 99%

Association between High Endocardial Unipolar Voltage and Improved Left Ventricular Function in Patients with Ischemic Cardiomyopathy

Park¹,

Lai²,

Handberg³

et al. 2016

Texas Heart Institute Journal

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We know that endocardial mapping reports left ventricular electrical activity (voltage) B one marrow cell therapy for chronic ischemic heart failure has resulted in some evidence of left ventricular (LV) functional improvement upon metaanalysis. However, the magnitude of this effect is small and might not, in application, improve patient outcomes.1,2 Consistent with this notion, we found-in the Cardiovascular Cell Therapy Research Network's (CCTRN's) trial of First Mononuclear Cells injected in the United States (FOCUS) 3 -no detectable improvement in maximal oxygen consumption (Vo 2 max) or New York Heart Association (NYHA) functional class, despite a 2.7% increase in LV ejection fraction (LVEF) (difference between bone marrow mononuclear cell [BMC] and placebo groups [95% confidence interval (CI), 0.3-5.1, P=0.03]). Although there is promise, it is clear that a better un-

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New Unipolar Electrogram Criteria to Identify Irreversibility of Nonischemic Left Ventricular Cardiomyopathy

Cited by 78 publications

References 13 publications

Substrate mapping for unstable ventricular tachycardia

Substrate mapping for unstable ventricular tachycardia

CD34+ Cell Transplantation Improves Right Ventricular Function in Patients with Nonischemic Dilated Cardiomyopathy

Association between High Endocardial Unipolar Voltage and Improved Left Ventricular Function in Patients with Ischemic Cardiomyopathy

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