Noncentrifugal activation patterns in focal RVOT PVC/VT: New insights from high density multielectrode mapping.

Ng, Justin; Chhachhi, Binita; Stobie, Paul; Keren, Arieh; Popal, Sohail; Reichlin, Tobias (2021). Noncentrifugal activation patterns in focal RVOT PVC/VT: New insights from high density multielectrode mapping. Journal of cardiovascular electrophysiology, 32(1), pp. 102-109. Wiley-Blackwell 10.1111/jce.14796

Text Cardiovasc_electrophysiol_-_2020_-_Ng_-_Noncentrifugal_activation_patterns_in_focal_RVOT_PVC_VT__New_insights_from_high.pdf - Published Version Restricted to registered users only Available under License Publisher holds Copyright. Download (6MB) | Request a copy

BACKGROUND

Activation from an automatic focus is thought to show centrifugal spread. In patients with premature ventricular complex/ventricular tachycardia (PVC/VT) from the right ventricular outflow tract (RVOT), the presence of preferential conduction and epicardial connections could however also lead to noncentrifugal wavefront propagation.

OBJECTIVE

To study endocardial activation in RVOT PVC/VT using high-resolution 3D activation mapping.

METHODS

Consecutive patients with frequent idiopathic PVC/VT were studied. High-resolution 3D activation maps were acquired using a multielectrode mapping catheter (Orion, Rhythmia, Boston Scientific). Noncentrifugal activation was defined as a pattern of wavefront propagation which does not show uniform propagation in all directions from one focus. Patients without sustained ablation success and patients with a left-sided PVC origin or with insufficient map density were excluded from the analysis.

RESULTS

Sixteen patients (44% female) with a median age of 54 years (interquartile range [IQR], 47-64) and a median PVC burden of 19% (IQR, 15-27) were studied. High-resolution activation maps consisting of a median number of 1863 mapping points (IQR, 1195-2463 points) demonstrated a centrifugal activation in 6/16 (38%) and a noncentrifugal activation in 10/16 (62%). When comparing patients with centrifugal and noncentrifugal activation, patients with centrifugal activation were older (p = .01), but no differences were found in age, gender, QRS duration of the PVC's and sites of origin in the RVOT. No procedural complications occurred.

CONCLUSIONS

High-resolution multielectrode mapping demonstrates the presence of noncentrifugal activation patterns in some of the patients with idiopathic RVOT PVC/VT. This may indicate the presence of preferential conduction and or epicardial/intramural connections in the outflow tract.

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