Use of an Orthogonal Electrode Array to Identify the Successful Ablation Site in Right Ventricular Outflow Tract Tachycardia

Abstract

A novel approach to localize the origin of a right ventricular outflow tract tachycardia using an ablation catheter having an orthogonally oriented electrode array is described. Bipolar electrogram polarity reversal using minimally filtered (1-500 Hz) electrograms simultaneously acquired in two axes from the ablation catheter permitted accurate localization of the tachycardia focus. A single radiofrequency energy application at the site identified by this technique resulted in successful tachycardia ablation. This technique may facilitate mapping of any arrhythmia which can be modeled as arising from a point source.

Target Characteristics and Voltage Mapping of the Matrix in Idiopathic Premature Ventricular Contractions Originating from the Right Ventricular Outflow Tract

“…We also found that the phenomenon of reversion of the distal and proximal polarity of the ablation catheter and fragmented wave is not rare, since this occurred in 11% of the patients in this study. Furthermore, Fisher et al [ 10 ] first reported a QS wave on the unipolar electrogram in addition to the frequent observations of a frustrated falling limb with W-shaped QS waves [ 10 ]. van Huls van Taxis et al [ 11 ] reported that the reversed polarity has 81% sensitivity in distinguishing a successful ablation target, but the prediction sensitivity reversed polarity is lower than that of unipolar QS (85%) and LAT (85%).…”

The use of a novel signal analysis to identify the origin of idiopathic right ventricular outflow tract ventricular tachycardia during sinus rhythm: Simultaneous amplitude frequency electrogram transformation mapping

“…[24] Furthermore, the polarity reversal of bipolar electrogram and negative concordance pattern in the bipolar and unipolar recordings can be useful predictors of the precise localization of the VT origin. [25,26] Although the assessment of the electrogram morphology by the operator’s subjective interpretation might be a feasible strategy for the mapping and ablation of RVOT-VTs, which can be caused by a mechanism of abnormal automaticity or triggered activity,[2,5] and in such a situation, activation mapping might be less helpful due to the transient and/or infrequent appearance of VAs. Recently, Kuteszko et al[27] reported the efficacy of an automated template matching technique using the surface 12 leads ECG during pace mapping and the clinically documented QRS morphology of VAs.…”