Characterisation of Conduction System Activation in the Post-Infarct Ventricle using Ripple Mapping.

BACKGROUND

Three dimensional (3D) mapping of the ventricular conduction system is challenging.

OBJECTIVES

We used Ripple Mapping to distinguish conduction system activation to that of adjacent myocardium, to characterise the conduction system in the post-infarct LV.

METHODS

High-density mapping (PentaRay, CARTO) was performed during normal rhythm in patients undergoing VT ablation. Ripple Maps were viewed from the end of the P wave to QRS onset in 1ms increments. Clusters of >3 Ripple bars were interrogated for the presence of Purkinje potentials, which were tagged on the 3D geometry. Repeating this process allowed conduction system delineation.

RESULTS

Maps were reviewed in 24pts (mean 3112 ± 613 points). There were 150.9 ± 24.5 Purkinje potentials per map, at the location of the left posterior fascicle (LPF) in 22pts (92%) and at the location of the left anterior fascicle (LAF) in 15pts (63%). The LAF was shorter (41.4 vs 68.8mm, p= 0.0005) activating for a shorter duration (40.6 vs 64.9ms, p=0.002). 14/24pts had LBBB with 11/14 (78%) having Purkinje potential associated breakout. There were fewer breakouts from the conduction system during LBBB (1.8 vs 3.4 (1.6 ± 0.6, p=0.039)) and an inverse correlation between breakout sites and QRS duration (p=0.0035).

CONCLUSION

We applied Ripple Mapping to present a detailed electroanatomic characterisation of the conduction system in the post-infarct LV. Patients with broader QRS had fewer LV breakout sites from the conduction system. However, there was 3D mapping evidence of LV breakout from an intact conduction system in the majority of patients with LBBB.

Informations de copyright

Copyright © 2024. Published by Elsevier Inc.