Juan Acosta1, David Soto-Iglesias2, Beatriz Jáuregui2, Juan Fernández Armenta3, Diego Penela2, Manuel Frutos-López1, Eduardo Arana-Rueda1, Alonso Pedrote1, Lluís Mont4, Antonio Berruezo5. 1. Arrhythmia Unit, Virgen del Rocío University Hospital, Seville, Spain. 2. Heart Institute, Teknon Medical Center, Barcelona, Spain; Arrhythmia Unit, Department of Cardiology, Cardiovascular Clinical Institute, Hospital Clinic, Universitat de Barcelona, Barcelona, Spain. 3. Arrhythmia Section, Cardiology Department, Puerta del Mar University Hospital, Cádiz, Spain. 4. Arrhythmia Unit, Department of Cardiology, Cardiovascular Clinical Institute, Hospital Clinic, Universitat de Barcelona, Barcelona, Spain. 5. Heart Institute, Teknon Medical Center, Barcelona, Spain; Arrhythmia Unit, Department of Cardiology, Cardiovascular Clinical Institute, Hospital Clinic, Universitat de Barcelona, Barcelona, Spain. Electronic address: antonio.berruezo@quironsalud.es.
Abstract
BACKGROUND: Ventricular tachycardia substrate ablation (VTSA) incorporating hidden slow conduction (HSC) analysis allows further arrhythmic substrate identification. OBJECTIVE: The purpose of this study was to analyze whether the elimination of HSC electrograms (HSC-EGMs) during VTSA results in better short- and long-term outcomes. METHODS: Consecutive patients (N = 70; 63% ischemic; mean age 64 ± 14.6 years) undergoing VTSA were prospectively included. Bipolar EGMs with >3 deflections and duration <133 ms were considered as potential HSC-EGMs. Whenever a potential HSC-EGM was identified, double or triple ventricular extrastimuli were delivered. If a local potential showed up as a delayed component, it was annotated as HSC-EGM. Ablation was delivered at conducting channel entrances and HSC-EGMs. Radiofrequency time, ventricular tachycardia (VT) inducibility after VTSA, and VT/ventricular fibrillation recurrence at 24 months after the procedure were compared with data from a historical control group. RESULTS: A total of 5076 EGMs were analyzed; 1029 (20.2%) qualified as potential HSC-EGMs, and 475 of them were tagged as HSC-EGMs. Scars in patients with HSC-EGMs (n = 43 [61.4%]) were smaller (32.2 [17-58] cm2 vs 85 [41-92.4] cm2; P = .006) and more heterogeneous (core/scar area ratio 0.15 [0.05-0.44] vs 0.44 [0.33-0.57]; P = .017); 32.4% of HSC-EGMs were located in normal voltage tissue. Patients undergoing VTSA incorporating HSC analysis required less radiofrequency time (15.6 [8-23.1] vs 23.9 [14.9-30.8]; P < .001) and had a lower rate of VT inducibility after VTSA (28.6% vs 52.9%; P = .003) than did the historical controls. Patients undergoing VTSA incorporating HSC analysis showed a higher 2-year VT/ventricular fibrillation-free survival (75.7% vs 58.8%; log-rank, P = .046) after VTSA. CONCLUSION: VTSA incorporating HSC analysis allowed further arrhythmic substrate identification (especially in the border zone and normal voltage areas) and was associated with increased VTSA efficiency and better short- and long-term outcomes.
BACKGROUND:Ventricular tachycardia substrate ablation (VTSA) incorporating hidden slow conduction (HSC) analysis allows further arrhythmic substrate identification. OBJECTIVE: The purpose of this study was to analyze whether the elimination of HSC electrograms (HSC-EGMs) during VTSA results in better short- and long-term outcomes. METHODS: Consecutive patients (N = 70; 63% ischemic; mean age 64 ± 14.6 years) undergoing VTSA were prospectively included. Bipolar EGMs with >3 deflections and duration <133 ms were considered as potential HSC-EGMs. Whenever a potential HSC-EGM was identified, double or triple ventricular extrastimuli were delivered. If a local potential showed up as a delayed component, it was annotated as HSC-EGM. Ablation was delivered at conducting channel entrances and HSC-EGMs. Radiofrequency time, ventricular tachycardia (VT) inducibility after VTSA, and VT/ventricular fibrillation recurrence at 24 months after the procedure were compared with data from a historical control group. RESULTS: A total of 5076 EGMs were analyzed; 1029 (20.2%) qualified as potential HSC-EGMs, and 475 of them were tagged as HSC-EGMs. Scars in patients with HSC-EGMs (n = 43 [61.4%]) were smaller (32.2 [17-58] cm2 vs 85 [41-92.4] cm2; P = .006) and more heterogeneous (core/scar area ratio 0.15 [0.05-0.44] vs 0.44 [0.33-0.57]; P = .017); 32.4% of HSC-EGMs were located in normal voltage tissue. Patients undergoing VTSA incorporating HSC analysis required less radiofrequency time (15.6 [8-23.1] vs 23.9 [14.9-30.8]; P < .001) and had a lower rate of VT inducibility after VTSA (28.6% vs 52.9%; P = .003) than did the historical controls. Patients undergoing VTSA incorporating HSC analysis showed a higher 2-year VT/ventricular fibrillation-free survival (75.7% vs 58.8%; log-rank, P = .046) after VTSA. CONCLUSION: VTSA incorporating HSC analysis allowed further arrhythmic substrate identification (especially in the border zone and normal voltage areas) and was associated with increased VTSA efficiency and better short- and long-term outcomes.
Authors: Neil T Srinivasan; Jason Garcia; Richard J Schilling; Syed Ahsan; Ross J Hunter; Martin Lowe; Anthony W Chow; Pier D Lambiase Journal: Heart Rhythm O2 Date: 2021-05-11