Postinfarct ventricular tachycardia substrate: Characterization and ablation of conduction channels using ripple mapping.
Aged
Catheter Ablation
/ methods
Cicatrix
/ complications
Electrophysiologic Techniques, Cardiac
/ methods
Female
Heart Conduction System
/ physiopathology
Heart Rate
/ physiology
Humans
Imaging, Three-Dimensional
/ methods
Male
Myocardial Infarction
/ complications
Myocardium
/ pathology
Tachycardia, Ventricular
/ diagnosis
Ablation
Ripple mapping
Substrate modification
Three-dimensional mapping
Ventricular tachycardia
Journal
Heart rhythm
ISSN: 1556-3871
Titre abrégé: Heart Rhythm
Pays: United States
ID NLM: 101200317
Informations de publication
Date de publication:
10 2021
10 2021
Historique:
received:
12
03
2021
revised:
27
04
2021
accepted:
11
05
2021
pubmed:
19
5
2021
medline:
15
2
2022
entrez:
18
5
2021
Statut:
ppublish
Résumé
Conduction channels have been demonstrated within the postinfarct scar and seem to be co-located with the isthmus of ventricular tachycardia (VT). Mapping the local scar potentials (SPs) that define the conduction channels is often hindered by large far-field electrograms generated by healthy myocardium. The purpose of this study was to map conduction channel using ripple mapping to categorize SPs temporally and anatomically. We tested the hypothesis that ablation of early SPs would eliminate the latest SPs without direct ablation. Ripple maps of postinfarct scar were collected using the PentaRay (Biosense Webster) during normal rhythm. Maps were reviewed in reverse, and clusters of SPs were color-coded on the geometry, by timing, into early, intermediate, late, and terminal. Ablation was delivered sequentially from clusters of early SPs, checking for loss of terminal SPs as the endpoint. The protocol was performed in 11 patients. Mean mapping time was 65 ± 23 minutes, and a mean 3050 ± 1839 points was collected. SP timing ranged from 98.1 ± 60.5 ms to 214.8 ± 89.8 ms post QRS peak. Earliest SPs were present at the border, occupying 16.4% of scar, whereas latest SPs occupied 4.8% at the opposing border or core. Analysis took 15 ± 10 minutes to locate channels and identify ablation targets. It was possible to eliminate latest SPs in all patients without direct ablation (mean ablation time 16.3 ± 11.1 minutes). No VT recurrence was recorded (mean follow-up 10.1 ± 7.4 months). Conduction channels can be located using ripple mapping to analyze SPs. Ablation at channel entrances can eliminate the latest SPs and is associated with good medium-term results.
Sections du résumé
BACKGROUND
Conduction channels have been demonstrated within the postinfarct scar and seem to be co-located with the isthmus of ventricular tachycardia (VT). Mapping the local scar potentials (SPs) that define the conduction channels is often hindered by large far-field electrograms generated by healthy myocardium.
OBJECTIVE
The purpose of this study was to map conduction channel using ripple mapping to categorize SPs temporally and anatomically. We tested the hypothesis that ablation of early SPs would eliminate the latest SPs without direct ablation.
METHODS
Ripple maps of postinfarct scar were collected using the PentaRay (Biosense Webster) during normal rhythm. Maps were reviewed in reverse, and clusters of SPs were color-coded on the geometry, by timing, into early, intermediate, late, and terminal. Ablation was delivered sequentially from clusters of early SPs, checking for loss of terminal SPs as the endpoint.
RESULTS
The protocol was performed in 11 patients. Mean mapping time was 65 ± 23 minutes, and a mean 3050 ± 1839 points was collected. SP timing ranged from 98.1 ± 60.5 ms to 214.8 ± 89.8 ms post QRS peak. Earliest SPs were present at the border, occupying 16.4% of scar, whereas latest SPs occupied 4.8% at the opposing border or core. Analysis took 15 ± 10 minutes to locate channels and identify ablation targets. It was possible to eliminate latest SPs in all patients without direct ablation (mean ablation time 16.3 ± 11.1 minutes). No VT recurrence was recorded (mean follow-up 10.1 ± 7.4 months).
CONCLUSION
Conduction channels can be located using ripple mapping to analyze SPs. Ablation at channel entrances can eliminate the latest SPs and is associated with good medium-term results.
Identifiants
pubmed: 34004345
pii: S1547-5271(21)00443-4
doi: 10.1016/j.hrthm.2021.05.016
pii:
doi:
Types de publication
Journal Article
Research Support, Non-U.S. Gov't
Video-Audio Media
Langues
eng
Sous-ensembles de citation
IM
Pagination
1682-1690Subventions
Organisme : British Heart Foundation
ID : FS/15/12/31239
Pays : United Kingdom
Organisme : British Heart Foundation
ID : RG/16/3/32175
Pays : United Kingdom
Informations de copyright
Copyright © 2021 Heart Rhythm Society. Published by Elsevier Inc. All rights reserved.