Quentin Voglimacci-Stephanopoli1, Frederic Sacher2,3, Claire Martin4, Christian Meyer5, Ruairidh Martin6, Anne Rollin1, Stefano Capellino7, Pierre Mondoly1, Franck Mandel1, Pierre Jaïs2,3, Maud Tabuteau7, Philippe Maury8,9. 1. Department of Cardiology, University Hospital Rangueil, 31059, Toulouse, Cedex 09, France. 2. Bordeaux University Hospital, Bordeaux, France. 3. LIRYC Institute/INSERM 1045, Bordeaux University, Bordeaux, France. 4. Papworth Hospital NHS Foundation Trust, Cambridge, UK. 5. University Hospital Hamburg-Eppendorf, Hamburg, Germany. 6. Freeman Hospital, Newcastle upon Tyne, UK. 7. Boston Scientific, Voisins-le-Bretoneux, France. 8. Department of Cardiology, University Hospital Rangueil, 31059, Toulouse, Cedex 09, France. mauryjphil@hotmail.com. 9. Unité Inserm U 1048, Toulouse, France. mauryjphil@hotmail.com.
Abstract
PURPOSE: Scars and abnormal electrograms may significantly differ according to the activation wavefront. We propose a new fast technique for reliable comparison between sinus rhythm and ventricular pacing using a single map acquisition and the Rhythmia™ 3D mapping system. METHODS: A special programming of the external stimulator was assuring full stable regular paced-beat bigeminy during spontaneous rhythm. A first map was acquired for the spontaneous cardiac beat. Then the window of detection was moved to the following paced beat, and a second map was available after recalculation by the system, depicting activation and voltage of the paced cardiac beat at the same locations, with an exactly the same number of beats in both maps. RESULTS: Thirty patients with structural heart disease referred for ablation of ventricular tachycardia underwent this protocol, who were compared with 19 similar patients undergoing repeated maps. Duration of the mapping was significantly shorter compared to controls (34 ± 12 vs 57 ± 14 min, p < 0.0001) without differences in the number of electrograms (6978 ± 7067 vs 9554 ± 4424 for sinus rhythm map and 6610 ± 7240 vs 7783 ± 3804 for paced map, p = ns for both). The technique cannot be completed in five patients (17%), because of arrhythmogenicity, mechanical right bundle branch block, hemodynamical impairment, or bradycardia. CONCLUSION: We propose a novel technique for performing maps during sinus rhythm and ventricular pacing using a single acquisition. Beside time saving, this will allow more strict comparisons between different activation wavefronts.
PURPOSE: Scars and abnormal electrograms may significantly differ according to the activation wavefront. We propose a new fast technique for reliable comparison between sinus rhythm and ventricular pacing using a single map acquisition and the Rhythmia™ 3D mapping system. METHODS: A special programming of the external stimulator was assuring full stable regular paced-beat bigeminy during spontaneous rhythm. A first map was acquired for the spontaneous cardiac beat. Then the window of detection was moved to the following paced beat, and a second map was available after recalculation by the system, depicting activation and voltage of the paced cardiac beat at the same locations, with an exactly the same number of beats in both maps. RESULTS: Thirty patients with structural heart disease referred for ablation of ventricular tachycardia underwent this protocol, who were compared with 19 similar patients undergoing repeated maps. Duration of the mapping was significantly shorter compared to controls (34 ± 12 vs 57 ± 14 min, p < 0.0001) without differences in the number of electrograms (6978 ± 7067 vs 9554 ± 4424 for sinus rhythm map and 6610 ± 7240 vs 7783 ± 3804 for paced map, p = ns for both). The technique cannot be completed in five patients (17%), because of arrhythmogenicity, mechanical right bundle branch block, hemodynamical impairment, or bradycardia. CONCLUSION: We propose a novel technique for performing maps during sinus rhythm and ventricular pacing using a single acquisition. Beside time saving, this will allow more strict comparisons between different activation wavefronts.