Nicholas Child1, Martin J Bishop2, Ben Hanson3, Ruben Coronel4, Tobias Opthof5, Bastiaan J Boukens6, Richard D Walton7, Igor R Efimov8, Julian Bostock9, Yolanda Hill2, Christopher A Rinaldi9, Reza Razavi2, Jaswinder Gill2, Peter Taggart10. 1. Division of Imaging Sciences, King's College London, London, United Kingdom. Electronic address: nchild@hotmail.com. 2. Division of Imaging Sciences, King's College London, London, United Kingdom. 3. Department of Mechanical Engineering, University College London, London, United Kingdom. 4. Academic Medical Center, Amsterdam, The Netherlands; L'Institut de RYthmologieet de Modelisation Cardiaque (LIRYC), Fondation Université Bordeaux, Bordeaux, France. 5. Academic Medical Center, Amsterdam, The Netherlands. 6. Department of Biomedical Engineering, George Washington University, Washington, DC. 7. L'Institut de RYthmologieet de Modelisation Cardiaque (LIRYC), Fondation Université Bordeaux, Bordeaux, France; INSERM, Universite de Bordeaux, Centre Recherche, Cario-Thoracique de Bordeaux U1045, Bordeaux, France. 8. L'Institut de RYthmologieet de Modelisation Cardiaque (LIRYC), Fondation Université Bordeaux, Bordeaux, France; Department of Biomedical Engineering, George Washington University, Washington, DC; Department of Biomedical Engineering, Washington University, St Louis, Missouri. 9. Department of Cardiology, Guy's and St Thomas' Hospital, London, United Kingdom. 10. Department of Cardiovascular Sciences, University College London, London, United Kingdom.
Abstract
BACKGROUND: Initiation of reentrant ventricular tachycardia (VT) involves complex interactions between front and tail of the activation wave. Recent experimental work has identified the time interval between S2 repolarization proximal to a line of functional block and S2 activation at the adjacent distal side as a critical determinant of reentry. OBJECTIVES: We hypothesized that (1) an algorithm could be developed to generate a spatial map of this interval ("reentry vulnerability index" [RVI]), (2) this would accurately identify a site of reentry without the need to actually induce the arrhythmia, and (3) it would be possible to generate an RVI map in patients during routine clinical procedures. METHODS: An algorithm was developed that calculated RVI between all pairs of electrodes within a given radius. RESULTS: The algorithm successfully identified the region with increased susceptibility to reentry in an established Langendorff pig heart model and the site of reentry and rotor formation in an optically mapped sheep ventricular preparation and computational simulations. The feasibility of RVI mapping was evaluated during a clinical procedure by coregistering with cardiac anatomy and physiology of a patient undergoing VT ablation. CONCLUSION: We developed an algorithm to calculate a reentry vulnerability index from intervals between local repolarization and activation. The algorithm accurately identified the region of reentry in 2 animal models of functional reentry. The clinical application was demonstrated in a patient with VT and identified the area of reentry without the need of inducing the arrhythmia.
BACKGROUND: Initiation of reentrant ventricular tachycardia (VT) involves complex interactions between front and tail of the activation wave. Recent experimental work has identified the time interval between S2 repolarization proximal to a line of functional block and S2 activation at the adjacent distal side as a critical determinant of reentry. OBJECTIVES: We hypothesized that (1) an algorithm could be developed to generate a spatial map of this interval ("reentry vulnerability index" [RVI]), (2) this would accurately identify a site of reentry without the need to actually induce the arrhythmia, and (3) it would be possible to generate an RVI map in patients during routine clinical procedures. METHODS: An algorithm was developed that calculated RVI between all pairs of electrodes within a given radius. RESULTS: The algorithm successfully identified the region with increased susceptibility to reentry in an established Langendorff pig heart model and the site of reentry and rotor formation in an optically mapped sheep ventricular preparation and computational simulations. The feasibility of RVI mapping was evaluated during a clinical procedure by coregistering with cardiac anatomy and physiology of a patient undergoing VT ablation. CONCLUSION: We developed an algorithm to calculate a reentry vulnerability index from intervals between local repolarization and activation. The algorithm accurately identified the region of reentry in 2 animal models of functional reentry. The clinical application was demonstrated in a patient with VT and identified the area of reentry without the need of inducing the arrhythmia.
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