An advanced algorithm for the online detection of abnormal and late potentials during sinus rhythm in the setting of ventricular tachycardia ablation.

We describe the case of a 40-year-old man with ischaemic cardiomyopathy and severe left ventricular dilatation, presented at our institution for recurrent, drug refractory, and ventricular tachycardia (VT). The left ventricle (LV) was approached anterogradely via transseptal puncture allowing the reconstruction of 2D, high density map, using a multielectrode basket catheter (Orion™)—Rhyhtmia™ suite (Boston Scientific, Marborough, MA, USA). The LV geometry was first acquired during sinus rhythm; bipolar voltage map documented an area of scar along the LV lateral wall extending from basal to apical segments (Figure ). The newest software algorithm ‘LUMIPOINT™’ allows a quick and online analysis of local abnormal activities and of late potentials (LPs). In our case, the highlighted zone (Figure ) follow to the selection of a specific timeframe where the search of LP is performed (+5 ms from QRS offset to +45 ms) (green bar). The LP area so far delimited exactly corresponded to the entrance and isthmus circuit of the clinical VT (CL 430 ms) induced later (Figure ). Pulses of radiofrequency (50 W) were delivered at the isthmus site and caused the termination of the arrhythmia within 5 s.

Bottom panels: Left ventricle geometry built during sinus rhythm before inducing the clinical VT. (A) Voltage (bipolar) map which shows an extended area of scar with patchy areas of normal voltage. (B) Sinus rhythm activation map with LUMIPOINT™ feature ON which allows a quick, online, identification of areas where late potentials cluster in a specific timeframe (green bar with correspective electrograms). This highlighted zone exactly corresponded to the entrance/isthmus of the clinical VT (dotted lines) pictured in the top panel. VT, ventricular tachycardia.

This clinical case supports the findings reported by another group: the use of this novel algorithm provides quick, online, analysis of abnormal activity which, combined with high density, gives a significant contribution to the identification of the critical substrate.

Funding

This paper was published as part of a supplement supported by a grant by Boston Scientific Italy.

Conflict of interest: P.D.B. is consultant for Abbott and Biosense Webster companies. Research grants from Biotronik, Biosense Webster, Abbott and Boston Scientific.