Literature DB >> 20488307

Characterization of the arrhythmogenic substrate in ischemic and nonischemic cardiomyopathy implications for catheter ablation of hemodynamically unstable ventricular tachycardia.

Shiro Nakahara1, Roderick Tung, Rafael J Ramirez, Yoav Michowitz, Marmar Vaseghi, Eric Buch, Jean Gima, Isaac Wiener, Aman Mahajan, Noel G Boyle, Kalyanam Shivkumar.   

Abstract

OBJECTIVES: The purpose of this study was to compare the characteristics and prevalence of late potentials (LP) in patients with nonischemic cardiomyopathy (NICM) and ischemic cardiomyopathy (ICM) etiologies and evaluate their value as targets for catheter ablation.
BACKGROUND: LP are frequently found in post-myocardial infarction scars and are useful ablation targets. The relative prevalence and characteristics of LP in patients with NICM is not well understood.
METHODS: Thirty-three patients with structural heart disease (NICM, n = 16; ICM, n = 17) referred for catheter ablation of ventricular tachycardia were studied. Electroanatomic mapping was performed endocardially (n = 33) and epicardially (n = 19). The LP were defined as low voltage electrograms (<1.5 mV) with onset after the QRS interval. Very late potentials (vLP) were defined as electrograms with onset >100 ms after the QRS.
RESULTS: We sampled an average of 564 +/- 449 points and 726 +/- 483 points in the left ventricle endocardium and epicardium, respectively. Mean total low voltage area in patients with ICM was 101 +/- 55 cm(2) and 56 +/- 33 cm(2), endocardial and epicardial, respectively, compared with NICM of 55 +/- 41 cm(2) and 53 +/- 28 cm(2), respectively. Within the total low voltage area, vLP were observed more frequently in ICM than in NICM in endocardium (4.1% vs. 1.3%; p = 0.0003) and epicardium (4.3% vs. 2.1%, p = 0.035). An LP-targeted ablation strategy was effective in ICM patients (82% nonrecurrence at 12 +/- 10 months of follow-up), whereas NICM patients had less favorable outcomes (50% at 15 +/- 13 months of follow-up).
CONCLUSIONS: The contribution of scar to the electrophysiological abnormalities targeted for ablation of unstable ventricular tachycardia differs between ICM and NICM. An approach incorporating LP ablation and pace-mapping had limited success in patients with NICM compared with ICM, and alternative ablation strategies should be considered. Copyright (c) 2010 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.

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Year:  2010        PMID: 20488307      PMCID: PMC2896717          DOI: 10.1016/j.jacc.2010.01.041

Source DB:  PubMed          Journal:  J Am Coll Cardiol        ISSN: 0735-1097            Impact factor:   24.094


  23 in total

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Journal:  Circulation       Date:  2004-08-30       Impact factor: 29.690

2.  The wavefront phenomenon of ischemic cell death. 1. Myocardial infarct size vs duration of coronary occlusion in dogs.

Authors:  K A Reimer; J E Lowe; M M Rasmussen; R B Jennings
Journal:  Circulation       Date:  1977-11       Impact factor: 29.690

3.  Electrophysiologic and anatomic basis for fractionated electrograms recorded from healed myocardial infarcts.

Authors:  P I Gardner; P C Ursell; J J Fenoglio; A L Wit
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4.  Ablation of electrograms with an isolated, delayed component as treatment of unmappable monomorphic ventricular tachycardias in patients with structural heart disease.

Authors:  Angel Arenal; Esteban Glez-Torrecilla; Mercedes Ortiz; Julian Villacastín; Javier Fdez-Portales; Elena Sousa; Silvia del Castillo; Leopoldo Perez de Isla; Javier Jimenez; Jesus Almendral
Journal:  J Am Coll Cardiol       Date:  2003-01-01       Impact factor: 24.094

5.  Endocardial and epicardial radiofrequency ablation of ventricular tachycardia associated with dilated cardiomyopathy: the importance of low-voltage scars.

Authors:  Kyoko Soejima; William G Stevenson; John L Sapp; Andrew P Selwyn; Gregory Couper; Laurence M Epstein
Journal:  J Am Coll Cardiol       Date:  2004-05-19       Impact factor: 24.094

6.  Characterization of endocardial electrophysiological substrate in patients with nonischemic cardiomyopathy and monomorphic ventricular tachycardia.

Authors:  Henry H Hsia; David J Callans; Francis E Marchlinski
Journal:  Circulation       Date:  2003-07-28       Impact factor: 29.690

7.  Ventricular mapping during atrial and ventricular pacing. Relationship of multipotential electrograms to ventricular tachycardia reentry circuits after myocardial infarction.

Authors:  C B Brunckhorst; W G Stevenson; W M Jackman; K-H Kuck; K Soejima; H Nakagawa; R Cappato; S A Ben-Haim
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8.  Endocardial catheter mapping in patients in sinus rhythm: relationship to underlying heart disease and ventricular arrhythmias.

Authors:  D M Cassidy; J A Vassallo; J M Miller; D S Poll; A E Buxton; F E Marchlinski; M E Josephson
Journal:  Circulation       Date:  1986-04       Impact factor: 29.690

9.  Catheter ablation of recurrent scar-related ventricular tachycardia using electroanatomical mapping and irrigated ablation technology: results of the prospective multicenter Euro-VT-study.

Authors:  Hildegard Tanner; Gerhard Hindricks; Marius Volkmer; Steve Furniss; Volker Kühlkamp; Dominique Lacroix; Christian DE Chillou; Jesús Almendral; Domenico Caponi; Karl-Heinz Kuck; Hans Kottkamp
Journal:  J Cardiovasc Electrophysiol       Date:  2009-07-28

10.  Cardiac histologic findings in patients with life-threatening ventricular arrhythmias of unknown origin.

Authors:  D D Sugrue; D R Holmes; B J Gersh; W D Edwards; C J McLaran; D L Wood; M J Osborn; S C Hammill
Journal:  J Am Coll Cardiol       Date:  1984-11       Impact factor: 24.094

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6.  Increased myocardial native T1 relaxation time in patients with nonischemic dilated cardiomyopathy with complex ventricular arrhythmia.

Authors:  Shiro Nakamori; An H Bui; Jihye Jang; Hossam A El-Rewaidy; Shingo Kato; Long H Ngo; Mark E Josephson; Warren J Manning; Reza Nezafat
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Review 7.  Ventricular tachycardia in ischemic heart disease substrates.

Authors:  Olujimi A Ajijola; Roderick Tung; Kalyanam Shivkumar
Journal:  Indian Heart J       Date:  2014-01-03

Review 8.  Anesthetic Management In Electrophysiology Laboratory: A Multidisciplinary Review.

Authors:  Mustafa Yildiz; Hulya Yilmaz Ak; Dogac Oksen; Sinan Oral
Journal:  J Atr Fibrillation       Date:  2018-02-28

9.  Freedom from recurrent ventricular tachycardia after catheter ablation is associated with improved survival in patients with structural heart disease: An International VT Ablation Center Collaborative Group study.

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Journal:  Heart Rhythm       Date:  2015-05-30       Impact factor: 6.343

Review 10.  Advances in ablation of ventricular tachycardia in nonischemic cardiomyopathy.

Authors:  Nilesh Mathuria; Roderick Tung; Kalyanam Shivkumar
Journal:  Curr Cardiol Rep       Date:  2012-10       Impact factor: 2.931

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