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

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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.

Item Type:

Journal Article (Original Article)

Division/Institute:

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

UniBE Contributor:

Reichlin, Tobias Roman

Subjects:

600 Technology > 610 Medicine & health

ISSN:

1045-3873

Publisher:

Wiley-Blackwell

Language:

English

Submitter:

Vjollca Coli

Date Deposited:

21 Jan 2022 11:48

Last Modified:

05 Dec 2022 16:00

Publisher DOI:

10.1111/jce.14796

PubMed ID:

33118678

Uncontrolled Keywords:

RVOT PVC/VT ablation activation mapping high density multielectrode mapping

BORIS DOI:

10.48350/163312

URI:

https://boris.unibe.ch/id/eprint/163312

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