BACKGROUND: Detailed anatomic characterization of endocardial substrate of ventricular tachycardia (VT) is limited. OBJECTIVES: The purpose of this study was to determine the endocardial dimensions and local electrogram voltage characteristics of the reentrant circuit. VT-related conducting channels corresponding to zones of slow conduction may be identified. METHODS: Electroanatomic mapping was performed in 26 patients with uniform VT. Entrainment mapping was performed in 53 VTs, of which 19 entrance, 37 isthmus, 48 exit, and 32 outer loop sites were identified. The color display of voltage maps was adjusted to identify conducting channels associated with VT circuits. A conducting channel was defined as a path of multiple orthodromically activated sites within the VT circuit that demonstrated an electrogram amplitude higher than that of surrounding areas as evidenced by voltage color differences. RESULTS: Forty-seven (84%) of 56 entrance or isthmus sites were located within dense scar (<0.5 mV). Nearly all exits (92%) were located in abnormal endocardium (<1.5 mV), with more than half (54%) located in the border zone (0.5-1.5 mV). VT-related conducting channels was identified in 18 of 32 VTs with detailed mapping (average length 32 +/- 22 mm). The voltage threshold in the conducting channels ranges from 0.1 to 0.7 mV (mean 0.33 +/- 0.15 mV). CONCLUSION: (1) Most entrance and isthmus sites of hemodynamically stable VT are located in dense scar, whereas exits are located in the border zone. (2) VT-related conducting channels may be identified by careful voltage threshold adjustment. These findings have important implications regarding strategies for substrate-based VT ablation.
BACKGROUND: Detailed anatomic characterization of endocardial substrate of ventricular tachycardia (VT) is limited. OBJECTIVES: The purpose of this study was to determine the endocardial dimensions and local electrogram voltage characteristics of the reentrant circuit. VT-related conducting channels corresponding to zones of slow conduction may be identified. METHODS: Electroanatomic mapping was performed in 26 patients with uniform VT. Entrainment mapping was performed in 53 VTs, of which 19 entrance, 37 isthmus, 48 exit, and 32 outer loop sites were identified. The color display of voltage maps was adjusted to identify conducting channels associated with VT circuits. A conducting channel was defined as a path of multiple orthodromically activated sites within the VT circuit that demonstrated an electrogram amplitude higher than that of surrounding areas as evidenced by voltage color differences. RESULTS: Forty-seven (84%) of 56 entrance or isthmus sites were located within dense scar (<0.5 mV). Nearly all exits (92%) were located in abnormal endocardium (<1.5 mV), with more than half (54%) located in the border zone (0.5-1.5 mV). VT-related conducting channels was identified in 18 of 32 VTs with detailed mapping (average length 32 +/- 22 mm). The voltage threshold in the conducting channels ranges from 0.1 to 0.7 mV (mean 0.33 +/- 0.15 mV). CONCLUSION: (1) Most entrance and isthmus sites of hemodynamically stable VT are located in dense scar, whereas exits are located in the border zone. (2) VT-related conducting channels may be identified by careful voltage threshold adjustment. These findings have important implications regarding strategies for substrate-based VT ablation.
Authors: Shuanglun Xie; Maciej Kubala; Jackson J Liang; Jiandu Yang; Benoit Desjardins; Pasquale Santangeli; Rob J van der Geest; Robert Schaller; Michael Riley; Gregory Supple; David S Frankel; David Callans; Erica Zado Pac; Francis Marchlinski; Saman Nazarian Journal: J Cardiovasc Electrophysiol Date: 2019-01-06
Authors: Edmond M Cronin; Frank M Bogun; Philippe Maury; Petr Peichl; Minglong Chen; Narayanan Namboodiri; Luis Aguinaga; Luiz Roberto Leite; Sana M Al-Khatib; Elad Anter; Antonio Berruezo; David J Callans; Mina K Chung; Phillip Cuculich; Andre d'Avila; Barbara J Deal; Paolo Della Bella; Thomas Deneke; Timm-Michael Dickfeld; Claudio Hadid; Haris M Haqqani; G Neal Kay; Rakesh Latchamsetty; Francis Marchlinski; John M Miller; Akihiko Nogami; Akash R Patel; Rajeev Kumar Pathak; Luis C Saenz Morales; Pasquale Santangeli; John L Sapp; Andrea Sarkozy; Kyoko Soejima; William G Stevenson; Usha B Tedrow; Wendy S Tzou; Niraj Varma; Katja Zeppenfeld Journal: J Interv Card Electrophysiol Date: 2020-10 Impact factor: 1.900
Authors: Tadanobu Irie; Ricky Yu; Jason S Bradfield; Marmar Vaseghi; Eric F Buch; Olujimi Ajijola; Carlos Macias; Osamu Fujimura; Ravi Mandapati; Noel G Boyle; Kalyanam Shivkumar; Roderick Tung Journal: Circ Arrhythm Electrophysiol Date: 2015-03-04
Authors: Takeshi Sasaki; Christopher F Miller; Rozann Hansford; Juemin Yang; Brian S Caffo; Menekhem M Zviman; Charles A Henrikson; Joseph E Marine; David Spragg; Alan Cheng; Harikrishna Tandri; Sunil Sinha; Aravindan Kolandaivelu; Stefan L Zimmerman; David A Bluemke; Gordon F Tomaselli; Ronald D Berger; Hugh Calkins; Henry R Halperin; Saman Nazarian Journal: Circ Arrhythm Electrophysiol Date: 2012-11-13
Authors: Takeshi Sasaki; Christopher F Miller; Rozann Hansford; Vadim Zipunnikov; Menekhem M Zviman; Joseph E Marine; David Spragg; Alan Cheng; Harikrishna Tandri; Sunil Sinha; Aravindan Kolandaivelu; Stefan L Zimmerman; David A Bluemke; Gordon F Tomaselli; Ronald D Berger; Henry R Halperin; Hugh Calkins; Saman Nazarian Journal: Circ Arrhythm Electrophysiol Date: 2013-11-14