Relative timing of near-field and far-field electrograms can determine the tachyarrhythmia site of origin

Caldwell, Jane C.; Gula, Lorne J.; Ali, Fariha Sadiq; Miranda, Rodrigo; Abdollah, Hoshiar; Baranchuk, Adrián; Michael, Kevin; Simpson, Christopher S.; Redfearn, Damián P.

doi:10.1016/j.hrthm.2017.12.015

Cited by 4 publications

(3 citation statements)

References 13 publications

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“…Our study provides a helpful approach to preprocedurally identify the putative VT origin in patients with NICM based on far‐field and near‐field ICD‐EGM timing. Caldwell et al evaluated an overall similar ICD‐EGM timing concept in comparison with our investigation, albeit with salient differences. The study by Caldwell et al primarily focused on the discrimination between supraventricular tachycardia (SVT) and VT.…”

Section: Discussionmentioning

confidence: 72%

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Ventricular tachycardia in nonischemic cardiomyopathy: Anteroseptal vs inferolateral origin based on ICD ventricular electrogram timing

Kodali

Shirai

Muser

et al. 2019

Cardiovasc electrophysiol

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Introduction The majority of patients with nonischemic cardiomyopathy (NICM) present a perivalvular substrate that is either predominantly antero‐septal (AS) or infero‐lateral (IL), corresponding to specific ventricular tachycardia (VT) morphologies. The relative timing of far‐field and near‐field ventricular electrograms (EGMs) from stored implantable cardioverter‐defibrillator (ICD) events of VT may be used to distinguish AS from IL VT in NICM. Methods and Results We analyzed 48 patients with NICM with either a primarily AS (54%) or IL (56%) VT source undergoing catheter ablation between 2003 and 2018. Only patients with retrievable ICD‐EGMs of spontaneous VT events which could be matched with VTs induced during the ablation procedure were included. A total of 56 VT events (52% AS origin and 48% IL origin) were analyzed, yielding a mean far‐field to near‐field interval of 31 ± 13 milliseconds for AS VTs and 47 ± 19 milliseconds for IL VTs (P = .001). At receiver operating characteristic analysis (AUC = 0.734), a far‐field to near‐field interval of ≥ 60 milliseconds ruled out AS VTs in 29 (100%) cases and diagnosed IL VTs with a positive predictive value (PPV) of 100% and a negative predictive value (NPV) of 63%. An interval of ≤ 20 milliseconds ruled out IL VTs in 25 (93%) cases and diagnosed AS VTs with a PPV of 83% and NPV of 57%. Significant overlap between the two groups was observed among far‐field to near‐field intervals in between 20 milliseconds and 60 milliseconds. Conclusions The relative timing of far‐field and near‐field EGMs from stored clinical ICD events of VT can be helpful to differentiate AS vs IL origin of VT in NICM.

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Section: Discussionmentioning

confidence: 72%

“…ICD-EGM timing. Caldwell et al20 evaluated an overall similar ICD-EGM timing concept in comparison with our investigation, albeit with salient differences. The study by Caldwell et al primarily focused on the discrimination between supraventricular tachycardia (SVT) and VT.…”

mentioning

confidence: 85%

Ventricular tachycardia in nonischemic cardiomyopathy: Anteroseptal vs inferolateral origin based on ICD ventricular electrogram timing

Kodali

Shirai

Muser

et al. 2019

Cardiovasc electrophysiol

View full text Add to dashboard Cite

show abstract

“…It is important to note that the specific A to D sampling rates, bandpass filters, the T wave attenuating filter, and the exact downsampling rate are proprietary and vary from one manufacturer to another. I was informed in response to my specific inquiry that current ICD wide band EGM sampling rates vary from 400 to 1024 Hz, bandpass from 10 to 100 Hz, to 3‐65 Hz, 0‐80 Hz, or 3 to 100 Hz . Finally, the telemetry printer resolution (dpi, dots per inch) also determines the quality of the end‐printout from which the authors made measurements.…”

mentioning

confidence: 99%

Can an epicardially exiting VT be discerned from inside the heart?

Shah

2019

Cardiovasc electrophysiol

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Tachyarrhythmia discriminator for implantable cardioverter-defibrillators in bundle branch block

et al. 2020

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Relative timing of near-field and far-field electrograms can determine the tachyarrhythmia site of origin

Cited by 4 publications

References 13 publications

Ventricular tachycardia in nonischemic cardiomyopathy: Anteroseptal vs inferolateral origin based on ICD ventricular electrogram timing

Ventricular tachycardia in nonischemic cardiomyopathy: Anteroseptal vs inferolateral origin based on ICD ventricular electrogram timing

Can an epicardially exiting VT be discerned from inside the heart?

Tachyarrhythmia discriminator for implantable cardioverter-defibrillators in bundle branch block

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