Riccardo Proietti1, Ahmed M Adlan2, Rory Dowd2, Shershah Assadullah2, Bashar Aldhoon2,3, Sandeep Panikker2, Will Foster2,3, Shamil Yusuf2,4, Sajad Hayat2, Faizel Osman2,5, Prithwish Banerjee2,5, Tarvinder Dhanjal6,7. 1. Department of Cardiac, Thoracic, Vascular Sciences, University of Padua, Padua, Italy. 2. Department of Cardiology, University Hospital Coventry, University Hospital, Coventry & Warwickshire NHS Trust, Clifford Bridge Road, Coventry, CV2 2DX, UK. 3. Department of Cardiology, Worcestershire Royal Hospital, Worcestershire Acute Hospitals NHS Trust, Charles Hastings Way, Worcester, WR5 1DD, UK. 4. Department of Cardiology, Good Hope Hospital, University Hospitals Birmingham NHS Foundation Trust, Rectory Road, Sutton Coldfield, B75 7RR, UK. 5. University of Warwick (Medical School), Gibbet Hill, Coventry, CV4 7AJ, UK. 6. Department of Cardiology, University Hospital Coventry, University Hospital, Coventry & Warwickshire NHS Trust, Clifford Bridge Road, Coventry, CV2 2DX, UK. tarv.dhanjal@uhcw.nhs.uk. 7. University of Warwick (Medical School), Gibbet Hill, Coventry, CV4 7AJ, UK. tarv.dhanjal@uhcw.nhs.uk.
Abstract
BACKGROUND: Defining diastolic slow-conduction channels within the borderzone (BZ) of scar-dependent re-entrant ventricular tachycardia (VT) is key for effective mapping and ablation strategies. Understanding wavefront propagation is driving advances in high-density (HD) mapping. The newly developed Advisor™ HD Grid Mapping Catheter (HD GRID) has equidistant spacing of 16, 1 mm electrodes in a 4 × 4 3 mm interspaced arrangement allowing bipolar recordings along and uniquely across the splines (orthogonal vector) to facilitate substrate mapping in a WAVE configuration (WAVE). The purpose of this study was to determine the relative importance of the WAVE configuration compared to the STANDARD linear-only bipolar configuration (STANDARD) in defining VT substrate. METHODS: Thirteen patients underwent VT ablation at our institution. In all cases, a substrate map was constructed with the HD GRID in the WAVE configuration (conWAVE) to guide ablation strategy. At the end of the procedure, the voltage map was remapped in the STANDARD configuration (conSTANDARD) using the turbo-map function. Detailed post-hoc analysis of the WAVE and STANDARD maps was performed blinded to the configuration. Quantification of total scar area, BZ and dense scar area with assessment of conduction channels (CC) was performed. RESULTS: The substrate maps conSTANDARD vs conWAVE showed statistically significant differences in the total scar area (56 ± 32 cm2 vs 51 ± 30 cm2; p = 0.035), dense scar area (36 ± 25 cm2 vs 29 ± 22 cm2; p = 0.002) and number of CC (3.3 ± 1.6 vs 4.8 ± 2.5; p = 0.026). conWAVE collected more points than the conSTANDARD settings (p = 0.001); however, it used fewer points in map construction (p = 0.023). CONCLUSIONS: The multipolar Advisor™ HD Grid Mapping Catheter in conWAVE provides more efficient point acquisition and greater VT substrate definition of the borderzone particularly at the low-voltage range compared to conSTANDARD. This greater resolution within the low-voltage range facilitated CC definition and quantification within the scar, which is essential in guiding the ablation strategy.
BACKGROUND: Defining diastolic slow-conduction channels within the borderzone (BZ) of scar-dependent re-entrant ventricular tachycardia (VT) is key for effective mapping and ablation strategies. Understanding wavefront propagation is driving advances in high-density (HD) mapping. The newly developed Advisor™ HD Grid Mapping Catheter (HD GRID) has equidistant spacing of 16, 1 mm electrodes in a 4 × 4 3 mm interspaced arrangement allowing bipolar recordings along and uniquely across the splines (orthogonal vector) to facilitate substrate mapping in a WAVE configuration (WAVE). The purpose of this study was to determine the relative importance of the WAVE configuration compared to the STANDARD linear-only bipolar configuration (STANDARD) in defining VT substrate. METHODS: Thirteen patients underwent VT ablation at our institution. In all cases, a substrate map was constructed with the HD GRID in the WAVE configuration (conWAVE) to guide ablation strategy. At the end of the procedure, the voltage map was remapped in the STANDARD configuration (conSTANDARD) using the turbo-map function. Detailed post-hoc analysis of the WAVE and STANDARD maps was performed blinded to the configuration. Quantification of total scar area, BZ and dense scar area with assessment of conduction channels (CC) was performed. RESULTS: The substrate maps conSTANDARD vs conWAVE showed statistically significant differences in the total scar area (56 ± 32 cm2 vs 51 ± 30 cm2; p = 0.035), dense scar area (36 ± 25 cm2 vs 29 ± 22 cm2; p = 0.002) and number of CC (3.3 ± 1.6 vs 4.8 ± 2.5; p = 0.026). conWAVE collected more points than the conSTANDARD settings (p = 0.001); however, it used fewer points in map construction (p = 0.023). CONCLUSIONS: The multipolar Advisor™ HD Grid Mapping Catheter in conWAVE provides more efficient point acquisition and greater VT substrate definition of the borderzone particularly at the low-voltage range compared to conSTANDARD. This greater resolution within the low-voltage range facilitated CC definition and quantification within the scar, which is essential in guiding the ablation strategy.
Authors: Karl Magtibay; Stéphane Massé; Ahmed Niri; Robert D Anderson; Ram B Kumar; D Curtis Deno; Kumaraswamy Nanthakumar Journal: Heart Rhythm O2 Date: 2021-09-04
Authors: Sara Vázquez-Calvo; Paz Garre; Paula Sanchez-Somonte; Roger Borras; Levio Quinto; Gala Caixal; Margarida Pujol-Lopez; Till Althoff; Eduard Guasch; Elena Arbelo; José Maria Tolosana; Josep Brugada; Lluís Mont; Ivo Roca-Luque Journal: Front Cardiovasc Med Date: 2022-08-01