scholarly journals Functional Activation Mapping of Scar-Related Ventricular Tachycardia Substrate

2020 ◽  
Vol 33 (3) ◽  
pp. 176-182
Author(s):  
Carlos Volponi Lovatto ◽  
Fabricio Vassallo ◽  
Eduardo Serpa ◽  
Aloyr Simões Jr ◽  
Hermes Carloni ◽  
...  
Keyword(s):  
Ventricular Tachycardia ◽  
Sinus Rhythm ◽  
Optimal Method ◽  
Arrhythmogenic Substrate ◽  
Activation Mapping

The optimal method to identify the arrhythmogenic substrate of scar-related ventricular tachycardia (VT) is unknown. Sites of activation slowing during sinus rhythm (SR) often co-localize with the VT circuit. This is a report of two scar related VT substrate mapping using a strategy of voltage-independent approach.

Activation mapping in sinus rhythm in patients with ventricular tachycardia-relationship to cycle length and site of origin

1981 ◽  
Vol 47 ◽  
pp. 497 ◽  
Author(s):  
Scott R. Spielman ◽  
Leonard N. Horowitz ◽  
Allan M. Greenspan ◽  
William J. Untereker ◽  
Michael B. Simson ◽  
...  
Keyword(s):  
Ventricular Tachycardia ◽  
Sinus Rhythm ◽  
Cycle Length ◽  
Activation Mapping

scholarly journals Information theory to tachycardia therapy: electrogram entropy predicts diastolic microstructure of reentrant ventricular tachycardia

2019 ◽  
Vol 316 (1) ◽  
pp. H134-H144 ◽  
Author(s):  
Sachin Nayyar ◽  
Eugene Downar ◽  
Mohammadali Beheshti ◽  
Timothy Liang ◽  
Stéphane Massé ◽  
...  
Keyword(s):  
Mathematical Modeling ◽  
Ventricular Tachycardia ◽  
Sinus Rhythm ◽  
Main Channel ◽  
Single Individual ◽  
Minimum Entropy ◽  
Structural Representation ◽  
Scar Region ◽  
Low Entropy ◽  
Activation Mapping

There is no known strategy to differentiate which multicomponent electrograms in sinus rhythm maintain reentrant ventricular tachycardia (VT). Low entropy in the voltage breakdown of a multicomponent electrogram can localize conditions suitable for reentry but has not been validated against the classic VT activation mapping. We examined whether low entropy in a late and diversely activated ventricular scar region characterizes and differentiates the diastolic path of VT and represents protected tissue channels devoid of side branches. Intraoperative bipolar electrogram (BiEGM) activation and entropy maps were obtained during sinus rhythm in 17 patients with ischemic cardiomyopathy and compared with diastolic activation paths of VT (total of 39 VTs). Mathematical modeling of a zigzag main channel with side branches was also used to further validate structural representation of low entropy in the ventricular scar. A median of one region per patient (range: 1–2 regions) was identified in sinus rhythm, in which BiEGMwith the latest mean activation time and adjacent minimum entropy were assembled together in a high-activation dispersion region. These regions accurately recognized diastolic paths of 34 VTs, often to multiple inducible VTs within a single individual arrhythmogenic region. In mathematical modeling, side branching from the main channel had a strong influence on the BiEGMcomposition along the main channel. The BiEGMobtained from a long unbranched channel had the lowest entropy compared with those with multiple side branches. In conclusion, among a population of multicomponent sinus electrograms, those that demonstrate low entropy and are delayed colocalize to critical long-protected channels of VT. This information is pertinent for planning VT ablation in sinus rhythm.NEW & NOTEWORTHY Entropy is a measure to quantify breakdown in information. Electrograms from a protected tissue channel can only possess a few states in their voltage and thus less information. In contrast, current-load interactions from side branches in unprotected channels introduce a number of dissimilar voltage deflections and thus high information. We compare here a mapping approach based on entropy against a rigorous reference standard of activation mapping during VT and entropy was assessed in sinus rhythm.

P1125 Safety and efficacy of ventricular tachycardia ablation during sinus rhythm in patients with structural heart disease

EP Europace ◽  
2020 ◽  
Vol 22 (Supplement_1) ◽  
Author(s):  
J Fernandez-Armenta Pastor ◽  
E Silva ◽  
D Soto-Iglesias ◽  
D Penela ◽  
J Acosta ◽  
...  
Keyword(s):  
Heart Disease ◽  
Ventricular Tachycardia ◽  
Sinus Rhythm ◽  
Structural Heart Disease ◽  
Ventricular Assist Devices ◽  
Ventricular Assist ◽  
Arrhythmogenic Substrate ◽  
Vt Ablation ◽  
One Year ◽  
Multicenter Registry

Abstract Funding Acknowledgements Project “PI-0057-2017”, funded by Junta de Andalucía and co-funded by European Union (ERDF/ESF, “Invesing in your future”) Background The best strategy for scar related ventricular tachycardia (VT) ablation is not yet established. Recently, the use of ventricular assist devices is being proposed to allow ablation during unstable VT.  Purpose Analyze the results of a multicenter registry of substrate-guided VT ablation performed primarily during stable rhythm. Methods  This prospective multicenter registry included 433 VT ablation procedures performed in 372 consecutive patients with structural heart disease undergoing VT ablation. Substrate ablation (scar dechanneling technique) during sinus rhythm without initial VT induction was the standard protocol. Any episode of sustained VT or appropriate ICD therapy was considered VT recurrence.  Results  Myocardial infarction was the arrhythmogenic substrate in 64% of patients. 90.5% of patients were male, mean age 64 ± 13 years. Mean LVEF was 38 ± 13%.No ventricular assist device was used in any case. After substrate ablation no VT was inducible in 69% of cases. End-procedure non-inducibility was achieved in 73.1% of cases. Complication rate was 6.7 %. 30-days mortality was 1.9% (7 patients), including one procedure related death. At one year after first procedure 17 patients died (4.5%). Age, chronic obstructive pulmonary disease and renal failure were independent predictors of mortality. One-year freedom from VT recurrence was 84%.  Conclusion Substrate-guided VT ablation during stable rhythm as main approach for scar-related VT treatment is associated to low complication and recurrence rates in this prospective multicenter study.

scholarly journals Catheter Ablation of Ventricular Tachycardia in LMNA Cardiomyopathy: Out of Sight but not Out of Mind

2021 ◽  
Author(s):  
Ahmad Halawa ◽  
Paul Zei ◽  
Neal Lakdawala ◽  
William Sauer ◽  
Usha Tedrow ◽  
...  
Keyword(s):  
Ventricular Tachycardia ◽  
Catheter Ablation ◽  
Success Rate ◽  
Ventricular Arrhythmias ◽  
Cycle Length ◽  
Electrical Storm ◽  
Arrhythmogenic Substrate ◽  
Ablation Success ◽  
Endocardial Mapping ◽  
Activation Mapping

Lamin Cardiomyopathy (LC) is associated with refractory ventricular arrhythmias. Catheter ablation success rate is low due to presence of multiple circuits and intramural substrate. We present a LC case presented with electrical storm. During catheter ablation, arrhythmia was easily inducible but activation mapping, including full epicardial and endocardial mapping, failed to demonstrate the full tachycardia cycle length (70% only) suggesting intramural activation. Critical isthmus was not identified even with successful concealed entrainment on both Endo/epicardial surfaces. This case shows that even combined endocardial and epicardial catheter approach can be ineffective in identifying the full arrhythmogenic substrate in LC.

scholarly journals Flecainide How and When: A Practical Guide in Supraventricular Arrhythmias

2021 ◽  
Vol 10 (7) ◽  
pp. 1456
Author(s):  
Carlo Lavalle ◽  
Michele Magnocavallo ◽  
Martina Straito ◽  
Luca Santini ◽  
Giovanni Battista Forleo ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Ventricular Tachycardia ◽  
Drug Treatment ◽  
Sinus Rhythm ◽  
Antiarrhythmic Drug ◽  
Safety Profile ◽  
Patient Management ◽  
Clinical Use ◽  
Supraventricular Arrhythmias ◽  
Sinus Rhythm Maintenance

Transcatheter ablation was increasingly and successfully used to treat symptomatic drug refractory patients affected by supraventricular arrhythmias. Antiarrhythmic drug treatment still plays a major role in patient management, alone or combined with non-pharmacological therapies. Flecainide is an IC antiarrhythmic drug approved in 1984 from the Food and Drug Administration for the suppression of sustained ventricular tachycardia and later for acute cardioversion of atrial fibrillation and for sinus rhythm maintenance. Currently, flecainide is mostly used for sinus rhythm maintenance in atrial fibrillation (AF) patients without structural cardiomyopathy although recent studies enrolling different patient populations have demonstrated a good effectiveness and safety profile. How should we interpret the results of the CAST after the latest evidence? Is it possible to expand the indications of flecainide, and therefore, its use? This review aims to highlight the main characteristics of flecainide, as well as its optimal clinical use, delineating drug indications and contraindications and appropriate monitoring, based on the most recent evidence.

Ventricular tachycardia converts to sinus rhythm after administration of propofol: A case report

2021 ◽  
Author(s):  
Krysta Shannon ◽  
Daniel Saltzman ◽  
Irene Li ◽  
Robert Mokszycki ◽  
Gayle Galletta
Keyword(s):  
Ventricular Tachycardia ◽  
Case Report ◽  
Sinus Rhythm

scholarly journals Relationship Between Sinus Rhythm Late Activation Zones and Critical Sites for Scar-Related Ventricular Tachycardia

2015 ◽  
Vol 8 (2) ◽  
pp. 390-399 ◽  
Author(s):  
Tadanobu Irie ◽  
Ricky Yu ◽  
Jason S. Bradfield ◽  
Marmar Vaseghi ◽  
Eric F. Buch ◽  
...  
Keyword(s):  
Ventricular Tachycardia ◽  
Sinus Rhythm
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