Predictive value of unipolar and bipolar electrograms in idiopathic outflow tract ventricular arrhythmia mapping and ablation

Niu, Guodong; Feng, Tianjie; Jiang, Chunlan; Suo, Ni; Lin, Jinxuan; Qu, Fujian; McSpadden, Luke C.; Yao, Yan; Zhang, Shu

doi:10.1111/jce.13491

Cited by 9 publications

(9 citation statements)

References 15 publications

(20 reference statements)

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“…However, there was no specific evidence supporting that opinion; in addition, conflicting study results about EAT have been reported. In a prospective study including 22 patients with idiopathic OT‐VAs, Guodong et al reported that the local activation time of successful sites was significantly earlier compared with that of unsuccessful sites (−40 ± 10 ms vs. −28 ± 11 ms; p < .01) and suggested that a local activation time with −30 ms was the best cut‐off value for predicting successful ablation 9 . In 2012, Yamada et al reported that there was no difference in EAT between an initial success group and a failure group, but EAT predicted recurrence after successful ablation in a retrospective study with idiopathic RVOT‐VAs 10 .…”

Section: Discussionmentioning

confidence: 99%

Earliest activation time is a good predictor of successful ablation of idiopathic outflow tract ventricular arrhythmias

Choi

Kwon

Kim

et al. 2021

Clinical Cardiology

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Background In idiopathic outflow tract ventricular arrhythmias (OT‐VAs), identifying the site with the earliest activation time (EAT) using activation mapping is critical to eliminating the arrhythmogenic focus. However, the optimal EAT for predicting successful radiofrequency catheter ablation (RFCA) has not been established. Hypothesis To evaluate the association between EAT and successful RFCA in idiopathic OT‐VAs and to determine the optimal cut‐off value of EAT for successful ablation. Methods We retrospectively analyzed patients undergoing RFCA for idiopathic OT‐VAs at a single center from January 2015 to December 2019. Results Acute procedural success was achieved in 168 patients (87.0%). Among these patients, 158 patients (81.9%) were classified in the clinical success group according to the recurrence of clinical VAs during median (Q1, Q3) follow‐up (330 days [182, 808]). EAT was significantly earlier in the clinical success group compared with the recurrence (p = .006) and initial failure (p < .0001) groups. The optimal EAT cut‐off value predicting clinical success was −30 ms in the right ventricular outflow tract (RVOT) with 77.4% sensitivity and 96.4% specificity. In all cases of successful ablation in the left ventricular outflow tract (LVOT), EAT in the RVOT was not earlier than −29 ms. Conclusions EAT in patients with successful catheter ablation was significantly earlier than that in patients with recurrence and initial failure. EAT earlier than −30 ms could be used as a key predictor of successful catheter ablation as well as an indicator of the need to shift focus from the RVOT to the LVOT.

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Section: Discussionmentioning

confidence: 99%

Earliest activation time is a good predictor of successful ablation of idiopathic outflow tract ventricular arrhythmias

Choi

Kwon

Kim

et al. 2021

Clinical Cardiology

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“…The sample size was estimated by the time to VA elimination since ablation and ablation applications. 7,10,13 The average IA successful rate (?) was assumed 85% and the difference (?)…”

Section: Discussionmentioning

confidence: 99%

Investigating Origins of Ventricular Arrhythmia Arising from Right Ventricular Outflow Tract and Comparing Initial Ablation Strategies

Jiang

Liu

Tian

et al. 2021

Preprint

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Background The origin distribution of right-ventricular-outflow-tract (RVOT) ventricular arrhythmias (VAs) remains unclear. There is limited data on the ablation effectiveness of the reversed U-curve method compared with the antegrade method. Objectives To investigate the origin distribution of RVOT-type VAs and compare the ablation effectiveness of the two methods. Method Consecutive patients who had idiopathic RVOT-type VAs were prospectively enrolled. After activation mapping, patients were randomly assigned to supravalvular strategy using the reversed U-curve or subvalvular strategy using the antegrade method. The primary outcome was initial ablation (IA) success, defining as the successful ablation within the first three attempts. Results 61 patients were enrolled from November 2018 to June 2020. Activation mapping revealed 34/61 (55.7%) of the earliest ventricular activating (EVA) sites were above the pulmonary valves (PVs). The IA success rate was 25/33(75.8%) in the patients assigned to supravalvular strategy as compared with 16/28(57.1%) in those assigned to subvalvular strategy (P=0.172). Logistic regression revealed a substantial and qualitative interaction between the EVA sites and IA strategies (Pinteraction<0.001). For multiple-comparison, either strategy had a remarkably higher IA success rate in treating its ipsilateral EVA sites than contralateral ones (P<0.0083). Conclusion Of the idiopathic RVOT-type VA origins, half were located above the PV. The two strategies did not differ in the primary outcomes. However, they complement locating the EVA sites and facilitate ipsilateral ablation, which produces a significantly higher IA success rate. (Chinese Clinical Trial Registry number, ChiCTR2000029331)

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“…4 However, these findings were not repeated by another study. 18 Therefore, the value of the N-uniEGM method is yet to be examined. A previous study reported that a ‘QS morphology’ on a uniEGM can present at both the effective and non-effective targets during mapping and ablation of RVOT-PVCs.…”

Section: Discussionmentioning

confidence: 99%

Role of the notched unipolar electrogram in guiding catheter ablation of frequent premature ventricular contractions originating from the ventricular outflow tract

et al. 2020

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Objective To investigate the value of a notched unipolar electrogram (N-uniEGM) in confirming the origin of premature ventricular contractions originating from the ventricular outflow tract (VOT-PVC) during mapping and ablation procedures. Methods This retrospective study enrolled consecutive patients with symptomatic idiopathic frequent VOT-PVCs that underwent radiofrequency ablation. The characteristics of the uniEGM of the successful ablation targets were analysed. N-uniEGM was defined as the uniEGM presenting a QS morphology with ≥1 steep notches on the downstroke deflection. All patients were followed-up for 3 months post-ablation. Results The study enrolled 190 patients with a mean ± SD age of 49.0 ± 15.3 years. N-uniEGMs were recorded in 124 of 190 (65.3%) patients. The N-uniEGM distribution area was limited to a mean ± SD of 0.8 ± 0.4 cm2. N-uniEGM showed consistency with the outcomes of activation mapping and pace mapping. Patients with an N-uniEGM had an ablation success rate of 98.4% (122 of 124) and their ablation times were significantly shorter than those without an N-uniEGM (7.6 ± 3.8 s versus 15.8 ± 8.8 s, respectively). The sensitivity and specificity of N-uniEGM in predicting successful ablation of VOT-PVCs were 72.6% and 91.7%, respectively. Conclusion N-uniEGM was a highly specific and moderately sensitive predictor of successful radiofrequency ablation in patients with VOT-PVCs.

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Predictive value of unipolar and bipolar electrograms in idiopathic outflow tract ventricular arrhythmia mapping and ablation

Cited by 9 publications

References 15 publications

Earliest activation time is a good predictor of successful ablation of idiopathic outflow tract ventricular arrhythmias

Earliest activation time is a good predictor of successful ablation of idiopathic outflow tract ventricular arrhythmias

Investigating Origins of Ventricular Arrhythmia Arising from Right Ventricular Outflow Tract and Comparing Initial Ablation Strategies

Role of the notched unipolar electrogram in guiding catheter ablation of frequent premature ventricular contractions originating from the ventricular outflow tract

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