Characteristics of Scar-Related Ventricular Tachycardia Circuits Using Ultra-High-Density Mapping: A Multi-Center Study
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Characteristics of Scar-Related Ventricular Tachycardia Circuits Using Ultra-High-Density Mapping: A Multi-Center Study. / Martin, Ruairidh; Maury, Philippe; Bisceglia, Caterina; Wong, Tom; Estner, Heidi; Meyer, Christian; Dallet, Corentin; Martin, Claire A; Shi, Rui; Takigawa, Masateru; Rollin, Anne; Frontera, Antonio; Thompson, Nathaniel; Kitamura, Takeshi; Vlachos, Konstantinos; Wolf, Michael; Cheniti, Ghassen; Duchâteau, Josselin; Massoulié, Grégoire; Pambrun, Thomas; Denis, Arnaud; Derval, Nicolas; Hocini, Mélèze; Della Bella, Paolo; Haïssaguerre, Michel; Jaïs, Pierre; Dubois, Rémi; Sacher, Frédéric.
In: CIRC-ARRHYTHMIA ELEC, Vol. 11, No. 10, e006569, 10.2018.Research output: SCORING: Contribution to journal › SCORING: Journal article › Research › peer-review
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TY - JOUR
T1 - Characteristics of Scar-Related Ventricular Tachycardia Circuits Using Ultra-High-Density Mapping: A Multi-Center Study
AU - Martin, Ruairidh
AU - Maury, Philippe
AU - Bisceglia, Caterina
AU - Wong, Tom
AU - Estner, Heidi
AU - Meyer, Christian
AU - Dallet, Corentin
AU - Martin, Claire A
AU - Shi, Rui
AU - Takigawa, Masateru
AU - Rollin, Anne
AU - Frontera, Antonio
AU - Thompson, Nathaniel
AU - Kitamura, Takeshi
AU - Vlachos, Konstantinos
AU - Wolf, Michael
AU - Cheniti, Ghassen
AU - Duchâteau, Josselin
AU - Massoulié, Grégoire
AU - Pambrun, Thomas
AU - Denis, Arnaud
AU - Derval, Nicolas
AU - Hocini, Mélèze
AU - Della Bella, Paolo
AU - Haïssaguerre, Michel
AU - Jaïs, Pierre
AU - Dubois, Rémi
AU - Sacher, Frédéric
PY - 2018/10
Y1 - 2018/10
N2 - BACKGROUND: Ventricular tachycardia (VT) with structural heart disease is dependent on reentry within scar regions. We set out to assess the VT circuit in greater detail than has hitherto been possible, using ultra-high-density mapping.METHODS: All ultra-high-density mapping guided VT ablation cases from 6 high-volume European centers were assessed. Maps were analyzed offline to generate activation maps of tachycardia circuits. Topography, conduction velocity, and voltage of the VT circuit were analyzed in complete maps.RESULTS: Thirty-six tachycardias in 31 patients were identified, 29 male and 27 ischemic. VT circuits and isthmuses were complex, 11 were single loop and 25 double loop; 3 had 2 entrances, 5 had 2 exits, and 15 had dead ends of activation. Isthmuses were defined by barriers, which included anatomic obstacles, lines of complete block, and slow conduction (in 27/36 isthmuses). Median conduction velocity was 0.08 m/s in entrance zones, 0.29 m/s in isthmus regions ( P<0.001), and 0.11 m/s in exit regions ( P=0.002). Median local voltage in the isthmus was 0.12 mV during tachycardia and 0.06 mV in paced/sinus rhythm. Two circuits were identifiable in 5 patients. The median timing of activation was 16% of diastole in entrances, 47% in the mid isthmus, and 77% in exits.CONCLUSIONS: VT circuits identified were complex, some of them having multiple entrances, exits, and dead ends. The barriers to conduction in the isthmus seem to be partly functional in 75% of circuits. Conduction velocity in the VT isthmus slowed at isthmus entrances and exits when compared with the mid isthmus. Isthmus voltage is often higher in VT than in sinus or paced rhythms.
AB - BACKGROUND: Ventricular tachycardia (VT) with structural heart disease is dependent on reentry within scar regions. We set out to assess the VT circuit in greater detail than has hitherto been possible, using ultra-high-density mapping.METHODS: All ultra-high-density mapping guided VT ablation cases from 6 high-volume European centers were assessed. Maps were analyzed offline to generate activation maps of tachycardia circuits. Topography, conduction velocity, and voltage of the VT circuit were analyzed in complete maps.RESULTS: Thirty-six tachycardias in 31 patients were identified, 29 male and 27 ischemic. VT circuits and isthmuses were complex, 11 were single loop and 25 double loop; 3 had 2 entrances, 5 had 2 exits, and 15 had dead ends of activation. Isthmuses were defined by barriers, which included anatomic obstacles, lines of complete block, and slow conduction (in 27/36 isthmuses). Median conduction velocity was 0.08 m/s in entrance zones, 0.29 m/s in isthmus regions ( P<0.001), and 0.11 m/s in exit regions ( P=0.002). Median local voltage in the isthmus was 0.12 mV during tachycardia and 0.06 mV in paced/sinus rhythm. Two circuits were identifiable in 5 patients. The median timing of activation was 16% of diastole in entrances, 47% in the mid isthmus, and 77% in exits.CONCLUSIONS: VT circuits identified were complex, some of them having multiple entrances, exits, and dead ends. The barriers to conduction in the isthmus seem to be partly functional in 75% of circuits. Conduction velocity in the VT isthmus slowed at isthmus entrances and exits when compared with the mid isthmus. Isthmus voltage is often higher in VT than in sinus or paced rhythms.
KW - Action Potentials
KW - Aged
KW - Catheter Ablation
KW - Cicatrix/diagnosis
KW - Electrophysiologic Techniques, Cardiac
KW - Europe
KW - Female
KW - Heart Rate
KW - Humans
KW - Male
KW - Middle Aged
KW - Myocardial Infarction/complications
KW - Predictive Value of Tests
KW - Risk Factors
KW - Signal Processing, Computer-Assisted
KW - Tachycardia, Ventricular/diagnosis
KW - Time Factors
KW - Treatment Outcome
U2 - 10.1161/CIRCEP.118.006569
DO - 10.1161/CIRCEP.118.006569
M3 - SCORING: Journal article
C2 - 30354406
VL - 11
JO - CIRC-ARRHYTHMIA ELEC
JF - CIRC-ARRHYTHMIA ELEC
SN - 1941-3149
IS - 10
M1 - e006569
ER -