Electrophysiologic characterization of local abnormal ventricular activities in postinfarction ventricular tachycardia with respect to their anatomic location.

Komatsu, Yuki; Daly, Matthew; Sacher, Frédéric; Derval, Nicolas; Pascale, Patrizio; Roten, Laurent; Scherr, Daniel; Jadidi, Amir; Ramoul, Khaled; Denis, Arnaud; Jesel, Laurence; Zellerhoff, Stephan; Lim, Han S; Shah, Ashok; Cochet, Hubert; Hocini, Mélèze; Haïssaguerre, Michel; Jaïs, Pierre (2013). Electrophysiologic characterization of local abnormal ventricular activities in postinfarction ventricular tachycardia with respect to their anatomic location. Heart rhythm, 10(11), pp. 1630-7. Elsevier 10.1016/j.hrthm.2013.08.031

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BACKGROUND

Local abnormal ventricular activities (LAVA) in patients with scar-related ventricular tachycardia (VT) may appear at any time during or after the far-field electrogram. Although they may be separated from the far-field signal by an isoelectric line and extend beyond the end of surface QRS, they may also appear fused or buried within the QRS.

OBJECTIVE

The purpose of this study was to characterize LAVA in postinfarction VT patients with respect to their anatomic locations.

METHODS

Thirty-one patients with postinfarction VT underwent mapping/ablation during sinus rhythm with a three-dimensional electroanatomic mapping system. From a total of 18,270 electrograms reviewed in all study subjects, 1104 LAVA (endocardium 839, epicardium 265) were identified and analyzed.

RESULTS

The interval from onset of QRS complex to ventricular electrogram (EGM onset) on the endocardium was significantly shorter than the epicardium (P < .001). EGM onset was shortest in the septal endocardium and longest in the inferior and lateral epicardium. There was a significant positive correlation between EGM onset and LAVA lateness as estimated by the interval from surface QRS onset to LAVA (r = 0.52, P < .001). LAVA were more frequently detected after the QRS complex in the epicardium (241/265 [91%]) than in the endocardium (551/839 [66%], P < .001). Only 43% of endocardial septal LAVA were detected after the QRS complex.

CONCLUSION

Lateness of LAVA is affected to a large extent by their locations. The chance of detecting late LAVA increases when electrogram onset is later. Substrate-based approach targeting delayed signals relative to the QRS complex may miss critical the arrhythmogenic substrate, particularly in the septum and other early-to-activate regions.

Item Type:

Journal Article (Original Article)

Division/Institute:

04 Faculty of Medicine > Department of Cardiovascular Disorders (DHGE) > Clinic of Cardiology

UniBE Contributor:

Roten, Laurent

Subjects:

600 Technology > 610 Medicine & health

ISSN:

1547-5271

Publisher:

Elsevier

Language:

English

Submitter:

Laurent Roten

Date Deposited:

24 Feb 2014 09:27

Last Modified:

10 May 2014 01:01

Publisher DOI:

10.1016/j.hrthm.2013.08.031

PubMed ID:

23994727

Uncontrolled Keywords:

3D-EAM, Catheter ablation, ICD, LAVA, LV, Local abnormal ventricular activities, Mapping, Postmyocardial infarction, RV, Three-dimensional mapping, VT, Ventricular tachycardia, implantable cardioverter-defibrillator, left ventricle, local abnormal ventricular activities, right ventricle, three-dimensional electroanatomic mapping, ventricular tachycardiaimplantable cardioverter-defibrillator left ventricle local abnormal ventricular activities right ventricle three-dimensional electroanatomic mapping ventricular tachycardia

URI:

https://boris.unibe.ch/id/eprint/42247

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