Role of the notched unipolar electrogram in guiding catheter ablation of frequent premature ventricular contractions originating from the ventricular outflow tract

Objective To investigate the value of a notched unipolar electrogram (N-uniEGM) in confirming the origin of premature ventricular contractions originating from the ventricular outflow tract (VOT-PVC) during mapping and ablation procedures. Methods This retrospective study enrolled consecutive patients with symptomatic idiopathic frequent VOT-PVCs that underwent radiofrequency ablation. The characteristics of the uniEGM of the successful ablation targets were analysed. N-uniEGM was defined as the uniEGM presenting a QS morphology with ≥1 steep notches on the downstroke deflection. All patients were followed-up for 3 months post-ablation. Results The study enrolled 190 patients with a mean ± SD age of 49.0 ± 15.3 years. N-uniEGMs were recorded in 124 of 190 (65.3%) patients. The N-uniEGM distribution area was limited to a mean ± SD of 0.8 ± 0.4 cm2. N-uniEGM showed consistency with the outcomes of activation mapping and pace mapping. Patients with an N-uniEGM had an ablation success rate of 98.4% (122 of 124) and their ablation times were significantly shorter than those without an N-uniEGM (7.6 ± 3.8 s versus 15.8 ± 8.8 s, respectively). The sensitivity and specificity of N-uniEGM in predicting successful ablation of VOT-PVCs were 72.6% and 91.7%, respectively. Conclusion N-uniEGM was a highly specific and moderately sensitive predictor of successful radiofrequency ablation in patients with VOT-PVCs.

The Effects of Valvular Heart Disease on Atrial Conduction During Sinus Rhythm

Different arrhythmogenic substrates for atrial fibrillation (AF) may underlie aortic valve (AV) and mitral valve (MV) disease. We located conduction disorders during sinus rhythm by high-resolution epicardial mapping in patients undergoing AV (n = 85) or MV (n = 54) surgery. Extent and distribution of conduction delay (CD) and block (CD) across the entire right and left atrial surface was determined from circa 1880 unipolar electrogram recordings per patient. CD and CB were most pronounced at the superior intercaval area (2.5% of surface, maximal degree 6.6%/cm2). MV patients had a higher maximal degree of CD at the lateral left atrium than AV patients (4.2 vs 2.3%/cm2, p = 0.001). A history of AF was most strongly correlated to CD/CB at Bachmann’s bundle and age. Although MV patients have more conduction disorders at the lateral left atrium, disturbed conduction at Bachmann’s bundle during sinus rhythm indicates the presence of atrial remodeling which is related to AF episodes.