scholarly journals B-AB16-01 EPICARDIAL MAPPING OF SPONTANEOUS ATRIAL EXTRASYSTOLES

Heart Rhythm ◽  
2021 ◽  
Vol 18 (8) ◽  
pp. S31
Author(s):  
Mathijs S. van Schie ◽  
Rohit K. Kharbanda ◽  
Ad J.J.C. Bogers ◽  
Natasja M.S. De Groot
Keyword(s):  
Epicardial Mapping

P1006Conduction disorders in patients with congenital heart disease and right atrial volume overload: an intraoperative epicardial mapping study

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
C Houck ◽  
E A H Lanters ◽  
P Knops ◽  
P C Van De Woestijne ◽  
J W Roos-Hesselink ◽  
...  
Keyword(s):  
Congenital Heart ◽  
Volume Overload ◽  
Right Atrial ◽  
Conduction Time ◽  
Epicardial Mapping ◽  
Mapping Study ◽  
Crista Terminalis ◽  
Atrial Tachyarrhythmias ◽  
Conduction Disorders ◽  
Arrhythmogenic Substrate

Abstract Background Various atrial regions may contribute to the arrhythmogenic substrate for atrial tachyarrhythmias, including atrial fibrillation (AF), in patients with right atrial (RA) volume overload in congenital heart disease (CHD). It is widely recognized that structural and electrical remodelling of the RA occurs, but a previous endovascular mapping study showed that the left atrium (LA) was also affected in patients with atrial septal defect (ASD). The role of Bachmann's bundle (BB) and posterior left atrium (PLA) is yet unknown. Purpose To quantify and compare prevalence and severity of conduction disorders during sinus rhythm between atrial regions in patients with CHD and RA volume overload, using intraoperative high-resolution epicardial mapping. Methods Thirty-one patients (female: n=18, age: 48.5±13.8 years, history of AF: n=5) undergoing cardiac surgery for secundum ASD (n=18), sinus venosus defect (n=11) or isolated partial abnormal pulmonary venous return (n=2) were included. Intra-operative epicardial mapping (N=128/192 electrodes, interelectrode distance: 2mm) of the RA, BB, LA and PLA was performed during sinus rhythm. Conduction delay (CD) and block (CB) were quantified per region as proportion (%), length of lines (mm) and maximum conduction time (Δ local activation time between two adjacent electrodes). Results Proportion of CD on BB was 3.9% (2.3–4.9), RA 3.1% (1.9–3.8), PLA 2.4% (1.2–3.6) and LA 2.3% (1–3) and was higher on BB compared to PLA (p=0.002) and LA (p<0.001) but not RA (p=0.063). Proportion of CB on BB was 2.1% (1.2–5.4), RA 2.2% (1.1–3.4), PLA 0.8% (0.1–2.4) and LA 0.8% (0.3–1.6) and was smaller on LA compared to BB (p=0.001) and RA (p=0.004). There were no significant differences in length of CD/CB lines between regions, except that length of the longest CB line per patient was longer in the RA compared to LA (p=0.008). Maximum conduction time was highest in the RA (median 40ms) as opposed to BB (31ms), LA (21ms) and PLA (18ms; all p<0.0083 with Bonferroni correction), suggesting conduction disorders were more severe in the RA. For sub analysis, the RA surface was divided into 1) the crista terminalis region and 2) the lateral RA wall. In the crista terminalis region, proportions of CD and CB were higher, CD/CB lines were longer and maximum conduction times were higher (all p<0.05). Differences between patients with and without AF were solely observed on BB: patients with AF had a higher proportion and longer lines of CB (p<0.05), though outcomes should be interpreted with caution due to the small number of patients with AF. Conclusions In adult patients with CHD and RA volume overload, both RA and BB were affected by conduction disorders. More specifically, conduction disorders in the RA were mainly concentrated in the crista terminalis region. These findings suggest that not only the RA but also BB may be involved in the arrhythmogenic substrate for atrial tachyarrhythmias in these patients. Acknowledgement/Funding Dutch Heart Foundation [no 2012T0046]; LSH-Impulse [no 40-43100-98-008]; CVON [no 914728] and VIDI [no 91717339] to N.M.S. de Groot.

Abstract 1357: Mobility of Epicardial Rotors During Human Ventricular Fibrillation

Circulation ◽  
2007 ◽  
Vol 116 (suppl_16) ◽  
Author(s):  
Martyn P Nash ◽  
Ayman Mourad ◽  
Chris P Bradley ◽  
David J Paterson ◽  
Peter M Sutton ◽  
...  
Keyword(s):  
Coronary Artery Disease ◽  
Cardiac Surgery ◽  
Aortic Valve Disease ◽  
Singularity Analysis ◽  
Epicardial Mapping ◽  
Voltage Versus ◽  
Phase Singularity ◽  
The Mean ◽  
Artery Disease ◽  
Contact Electrodes

Introduction: Stability of reentry during VF may depend on the dynamics of rotor cores. We determined the mobility of rotors during human VF using global epicardial mapping and phase singularity analysis. Methods: In 10 patients undergoing cardiac surgery (6 with coronary artery disease; 4 with aortic valve disease), VF was induced by burst pacing prior to (n=7) or immediately following (n=3) the onset of cardiopulmonary bypass. For each subject, a 20 – 40 s episode of fibrillatory activity was sampled at 1 kHz using an epicardial sock containing 256 unipolar contact electrodes connected to a UnEmap system. Trajectories of persistent epicardial rotors (singularities of phase maps, based on de-trended voltage versus its Hilbert transform, lasting for > 1000 ms) were tracked. The mean core location was determined across the lifetime of each persistent rotor. The rotor was classified as stationary if its core remained within 15 mm of the mean location for more than 90% of its duration. Results: Using the above criteria, the numbers of mobile and stationary rotors varied from patient-to-patient (see figure ). In all but one patient, there were more mobile than stationary rotors. Over all patients, the mean ± SD number of mobile rotors (32 ± 21) was significantly greater than stationary rotors (7 ± 6, P<0.01). Conclusions: At least one stationary rotor was always present during human VF, but it is predominantly characterised by a small number of persistent mobile rotors.

scholarly journals The limitations of epicardial mapping as a guide to the surgical therapy of ventricular tachycardia.

Circulation ◽  
1978 ◽  
Vol 57 (4) ◽  
pp. 666-670 ◽  
Author(s):  
S R Spielman ◽  
E L Michelson ◽  
L N Horowitz ◽  
J F Spear ◽  
E N Moore
Keyword(s):  
Ventricular Tachycardia ◽  
Surgical Therapy ◽  
Epicardial Mapping

Epicardial mapping and surgical treatment in Wolff-Parkinson-White syndrome Type A

2000 ◽  
pp. 87-98
Author(s):  
Hein J. J. Wellens ◽  
Michiel J. Janse ◽  
Rudolf Th. Dam ◽  
Frans J. L. Capelle ◽  
Nico G. Meijne ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Type A ◽  
Syndrome Type ◽  
Epicardial Mapping ◽  
White Syndrome ◽  
Wolff Parkinson White Syndrome

Endocardial and Epicardial Mapping for Ischemic Ventricular Tachycardia

2009 ◽  
pp. 210-213
Author(s):  
Tamer S. Fahmy ◽  
Oussama M. Wazni ◽  
Moataz Ali ◽  
Robert A. Schweikert ◽  
Andrea Natale
Keyword(s):  
Ventricular Tachycardia ◽  
Epicardial Mapping

scholarly journals First-in-human high-density endo-epicardial mapping and ablation through left minithoracotomy in a patient with unstable ventricular tachycardia requiring ECMO

2020 ◽  
Vol 6 (7) ◽  
pp. 427-430
Author(s):  
Sergio Conti ◽  
Michele Pilato ◽  
Antonio Arcadipane ◽  
Marco Morsolini ◽  
Marco Turrisi ◽  
...  
Keyword(s):  
Ventricular Tachycardia ◽  
High Density ◽  
Epicardial Mapping

Ventricular fibrillation in myopathic human hearts: mechanistic insights from in vivo global endocardial and epicardial mapping

2007 ◽  
Vol 292 (6) ◽  
pp. H2589-H2597 ◽  
Author(s):  
Stéphane Massé ◽  
Eugene Downar ◽  
Vijay Chauhan ◽  
Elias Sevaptsidis ◽  
Kumaraswamy Nanthakumar
Keyword(s):  
Ventricular Fibrillation ◽  
Electrical Activity ◽  
Conduction Block ◽  
Left Ventricular ◽  
Ventricular Cardiomyopathy ◽  
Epicardial Mapping ◽  
Border Regions ◽  
Number Of Cycles ◽  
The Hilbert Transform

Ventricular fibrillation (VF) is an important cause of sudden cardiac death and cardiovascular mortality in patients with cardiomyopathy. Although it was generally believed that chaotic reentrant wavefronts underlie VF in humans, there is emerging evidence of spatiotemporal organization during early VF. The mechanism of this organization of electrical activity in early VF is unknown in myopathic hearts. We studied early VF in vivo, intraoperatively in five cardiomyopathic patients. Simultaneous electrograms were obtained from the epicardium and endocardium in left ventricular cardiomyopathy and from the endocardium in right ventricular myopathy. The Hilbert transform was used to derive the phase of the electrograms. Rotors were identified by isolating phase singularity points. Rotors were present in all of the myopathic hearts studied during VF and cumulatively lasted a mean of 3.2 ± 2.0 s of the 7.0 ± 4.0 s of the VF segments analyzed. For each surface mapped, 3.6 ± 2.9 rotors were identified for the duration mapped. The average number of cycles completed by these rotors was 4.9 ± 4.9. The longest rotor lasted 10.2 ± 6.2 rotations and lasted 2.0 ± 1.2 s. The rotors on the endocardium had a cycle length of 192 ± 33 ms compared with 220 ± 15 ms on the epicardium ( P = 0.08). There is centrifugal activation of electrical activity from these rotors, and they give rise to domains that activate at faster rates with evidence of conduction block at the border with slower domains. These rotors frequently localized to border regions of myocardium with bipolar electrogram amplitude of <0.5 mV. The organization of electrical activity during early VF in myopathic human hearts is characterized by wavefronts emanating from a few rotors.

scholarly journals Mapping and Surgical Ablation of Focal Epicardial Left Ventricular Tachycardia

2011 ◽  
Vol 2011 ◽  
pp. 1-5 ◽  
Author(s):  
Arif Elvan ◽  
Hauw T. Sie ◽  
Anand R. Ramdat Misier ◽  
Andre C. Linnenbank ◽  
Peter Paul H. M. Delnoy ◽  
...  
Keyword(s):  
Ventricular Tachycardia ◽  
Minimal Invasive ◽  
Left Ventricular ◽  
Lv Function ◽  
Ventricular Ectopy ◽  
Rf Ablation ◽  
Epicardial Mapping ◽  
Epicardial Ablation ◽  
Surgical Ablation ◽  
Technical Challenge

We describe a technical challenge in a 17-year-old patient with incessant epicardial focal ventricular arrhythmia and diminished LV function. Failure of ablation at the earliest activated endocardial site during ectopy suggested an epicardial origin, which was supported by specific electrocardiographic criteria. Epicardial ablation was not possible due to the localization of the origin of the ventricular tachycardia adjacent to the phrenic nerve. Minimal invasive surgical multielectrode high-density epicardial mapping was performed to localize the arrhythmia focus. Epicardial surgical RF ablation resulted in the termination of ventricular ectopy. After 2 years, the patient is still free from arrhythmias.

scholarly journals Impact of Ischemic and Valvular Heart Disease on Atrial Excitation:A High‐Resolution Epicardial Mapping Study

2018 ◽  
Vol 7 (6) ◽  
Author(s):  
Elisabeth M. J. P. Mouws ◽  
Eva A. H. Lanters ◽  
Christophe P. Teuwen ◽  
Lisette J. M. E. van der Does ◽  
Charles Kik ◽  
...  
Keyword(s):  
Heart Disease ◽  
High Resolution ◽  
Valvular Heart Disease ◽  
Epicardial Mapping ◽  
Mapping Study
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