Identification of an epicardial slow conduction channel using ripple mapping in ablation of postinfarct ventricular tachycardia

Abstract We report a case with Ebstein’s anomaly and pulmonary atresia with sustained monomorphic ventricular tachycardia in a patient without a ventriculotomy history. In the low voltage area between the atrialised right ventricle and hypoplastic right ventricle, there was a ventricular tachycardia substrate and slow conduction. The tachycardia circuit was eliminated by a point catheter ablation at the area with diastolic fractionated potentials.

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Pace Mapping of Postinfarction Scar to Detect Ventricular Tachycardia Exit Sites and Zones of Slow Conduction

Journal of Cardiovascular Electrophysiology ◽

10.1046/j.1540-8167.2001.00662.x ◽

2001 ◽

Vol 12 (6) ◽

pp. 662-670 ◽

Cited By ~ 8

Author(s):

PASCAL F.H.M. DESSEL ◽

JACQUES M. BAKKER ◽

NORBERT M. HEMEL ◽

ANDRE C. LINNENBANK ◽

EMILE R. JESSURUN ◽

...

Keyword(s):

Ventricular Tachycardia ◽

Slow Conduction ◽

Pace Mapping

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Gap Junctions, Slow Conduction, and Ventricular Tachycardia After Myocardial Infarction

Journal of the American College of Cardiology ◽

10.1016/j.jacc.2012.05.020 ◽

2012 ◽

Vol 60 (12) ◽

pp. 1111-1113 ◽

Cited By ~ 11

Author(s):

Jeffrey E. Saffitz ◽

André G. Kléber

Keyword(s):

Myocardial Infarction ◽

Ventricular Tachycardia ◽

Gap Junctions ◽

Slow Conduction

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Entrainment of idiopathic ventricular tachycardia of left ventricular origin with evidence for reentry with an area of slow conduction and effect of verapamil

The American Journal of Cardiology ◽

10.1016/0002-9149(88)91211-8 ◽

1988 ◽

Vol 62 (10) ◽

pp. 727-732 ◽

Cited By ~ 103

Author(s):

Ken Okumura ◽

Koshi Matsuyama ◽

Hiroo Miyagi ◽

Takeshi Tsuchiya ◽

Hirofumi Yasue

Keyword(s):

Ventricular Tachycardia ◽

Left Ventricular ◽

Idiopathic Ventricular Tachycardia ◽

Slow Conduction

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A novel ventricular map of electrograms duration as a method to identify areas of slow conduction during ablation of ventricular tachycardia

EP Europace ◽

10.1093/europace/euab116.358 ◽

2021 ◽

Vol 23 (Supplement_3) ◽

Author(s):

P Rossi ◽

FM Cauti ◽

M Polselli ◽

L Iaia ◽

V Fanti ◽

...

Keyword(s):

Ventricular Tachycardia ◽

Wave Front ◽

Conduction Delay ◽

Funding Sources ◽

Diastolic Phase ◽

Slow Conduction ◽

Reentry Circuit ◽

Background Wave ◽

Mean Time ◽

Funding Acknowledgements

Abstract Funding Acknowledgements Type of funding sources: None. Background – Wave front inhomogeneous propagation is crucial for reentry circuit generation. Bipolar EGM duration is indicative of local conduction delay and may identify areas of low conduction as a functional substrate. This study aimed to create a map of EGM duration during the VT (VEDUM Map) to identify the area of the slowest conduction and to verify if RF delivery at this area allows to rapidly interrupt the VT. Methods – 24 high-density VTs maps (21 patients) were analyzed. Activation maps and voltage maps during SR were performed. An offline remap confirmed with MathLab software was customized to visualize the longest duration electrogram during VT. Results – All of the VTs were interrupted during the first RF delivery (mean time 7,3 ± 5,4 sec (range 3-25 sec)) at the area with the longest EGM duration (212 ± 47 ms (range 113-330 ms)). . In 9 pts (37,5%) the longest EGM was located at the entrance or exit area of the activation maps while in 5 pts (21%) the EGM covered the full diastolic phase. Finally, in 10 pts the longest EGM occurred in the mid-exit-diastolic phase. Conclusions - A novel Ventricular map of Electrograms DUration (VEDUM Map) is highly accurate in defining a conductive vulnerable zone of the VT circuit. The longest EGM duration within the isthmus is highly predictive of rapid VT termination. Quantitative variablesQualitative variablesMeanMedianStandard DeviationAge71738.40BMI26.624.54.02LV EDV16315442.7LV EDD61.2629.9LV EF38.7369.74VT cycle lenght (TCL)35537556.4EGM max. duration in VT21220847EGM max dur / TCL58.260.512Maximum EGM duration localization in CLProto = 12.5%Meso = 33.3%Tele = 25%Full = 20.8%Myocardium voltage characteristics in VEDUM EGMHealthy = 25%Transition = 20.8%Scar = 41.7%Critical Isthmus area12.3107.3VT Interruption during RFYes = 79.2%No = 20.8%Time (seconds) to interruption765Access typeEndo = 58.3%Epi = 29.2%Clinical and procedural dataAbstract Figure.

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130Long-term outcomes of ventricular tachycardia substrate ablation incorporating hidden slow conduction analysis

EP Europace ◽

10.1093/europace/euaa162.098 ◽

2020 ◽

Vol 22 (Supplement_1) ◽

Author(s):

J Acosta Martinez ◽

D Soto-Iglesias ◽

B Jauregui-Garrido ◽

J Fernandez-Armenta ◽

D Penela ◽

...

Keyword(s):

Ventricular Tachycardia ◽

Border Zone ◽

Procedure Time ◽

Long Term Outcomes ◽

Free Survival ◽

Scar Area ◽

Slow Conduction ◽

Substrate Identification ◽

Short And Long Term

Abstract Introduction Ventricular tachycardia substrate ablation (VTSA) incorporating hidden slow conduction (HSC) analysis allows further arrhythmic substrate identification. This study evaluates whether the analysis and elimination of HSC electrograms (HSC-EGMs) during VTSA procedures result in better short and long-term outcomes. Methods Consecutive patients (n = 70, 63% ischaemic, 64 ± 14.6 years) undergoing VTSA were prospectively included. Bipolar EGMs with >3 deflections and duration <133 ms were considered as potential HSC-EGM, if located within/surrounding the scar area. Whenever a potential HSC-EGM was identified, a double ventricular extrastimulus was delivered. If a local potential showed up as a delayed component, it was annotated as HSC-EGM. The incidence of HSC-EGM in core, border-zone, and normal-voltage regions was determined. Ablation was delivered at conducting channel entrances and HSC-EGMs. Procedure time, radiofrequency time, VT inducibility after VTSA and VT recurrence at 12 months after the procedure were compared with data from a historic control group (n = 66, 70% ischaemic, 65.2 ± 12 years). Results 5076 EGMs were analyzed. 1029 (20.2%) qualified as potential HSC-EGM, and 453 of them were tagged as HSC-EGMs. Scars in patients with HSC-EGMs (n = 43, 61.4%) were smaller (39.66 ± 28.2 vs 69.4 ± 38.2 cm2; p = 0.005) and more heterogeneous (core/scar area ratio 0.24 ± 0.2 vs 0.43 ± 0.17; p = 0.03). 29.6% of HSC-EGMs were located in normal-voltage tissue; 83.5% were targeted for ablation. Patients undergoing VTSA incorporating HSC analysis needed less procedure time (213 ± 75 vs 242 ± 60 min; p = 0.018), less RF time (15.9 ± 10 vs 25 ± 12,7 minutes; p < 0.001), had a lower rate of VT inducibility (27.5% vs 51.5%; p = 0.005) and a higher 2-year VT/VF-free survival (82.8% vs 59.7%; log rank p = 0.047) after VTSA than the historic controls . Conclusion VTSA incorporating HSC analysis allowed further arrhythmic substrate identification (especially in normal-voltage areas) and resulted in increased VTSA efficiency and better short and long-term outcomes. Abstract Figure. VT Recurrence-Free Survival

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Ablation of the Slow-Conduction Area in Chronic Ventricular Tachycardia

Cardiology ◽

10.1159/000174605 ◽

1990 ◽

Vol 77 (3) ◽

pp. 240-258 ◽

Cited By ~ 3

Author(s):

G. Fontaine ◽

R. Frank ◽

A. Pavie ◽

J. Tonet ◽

G. Lascault ◽

...

Keyword(s):

Ventricular Tachycardia ◽

Slow Conduction

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New implications for the recurrence mechanism of an upper septal ventricular tachycardia: a case report

European Heart Journal - Case Reports ◽

10.1093/ehjcr/ytz079 ◽

2019 ◽

Vol 3 (2) ◽

Author(s):

Junji Yamaguchi ◽

Yasutoshi Nagata ◽

Yasuteru Yamauchi ◽

Kenzo Hirao

Keyword(s):

Ventricular Tachycardia ◽

Catheter Ablation ◽

Left Ventricular ◽

Common Type ◽

Idiopathic Left Ventricular Tachycardia ◽

Case Summary ◽

Slow Conduction ◽

Left Posterior ◽

Proximal Site ◽

The Us

Abstract Background Verapamil-sensitive fascicular ventricular tachycardia (VT) is the most common type of idiopathic left ventricular tachycardia, and it is divided into three types. Upper septal ventricular tachycardia (US-VT) is likely in patients with prior episodes of left posterior fascicular (LPF)-VT ablation, however, little is known about the recurrence mechanism of US-VT. Case summary A 53-year-old man had an US-VT after two catheter ablation sessions for a common idiopathic LPF-VT. The US-VT was successfully treated by ablating the proximal site of the LPF without making any further branch or fascicular block. This successful ablation point corresponded completely with the earliest pre-systolic potential (P2) site of the LPF-VT during the 1st session of catheter ablation. Discussion An US-VT recurrence could occur if a critical slow conduction is not affected by the catheter ablation. This recurrence might be the result of changing the re-entrant circuit after damage to the LPF. In order to eliminate the LPF-VT and prevent an US-VT recurrence, the earliest P2 site should be investigated carefully and ablated sufficiently.

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