Document Detail

Functional pace-mapping responses for identification of targets for catheter ablation of scar-mediated ventricular tachycardia.
MedLine Citation:
PMID:  22333344     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: Myocardial scars harbor areas of slow conduction and display abnormal electrograms. Pace-mapping at these sites can generate a 12-lead ECG morphological match to a targeted ventricular tachycardia (VT), and in some instances, multiple exit morphologies can result. At times, this can also result in the initiation of VT, termed pace-mapped induction (PMI). We hypothesized that in patients undergoing catheter ablation of VT, scar substrates with multiple exit sites (MES) identified during pace-mapping have improved freedom from recurrent VT, and PMI of VT predicts successful sites of termination during ablation.
METHODS AND RESULTS: High-density mapping was performed in all subjects to delineate scar (0.5-1.5 mV). Sites with abnormal electrograms were tagged, stimulated (bipolar 10 mA at 2 ms), and targeted for ablation. MES was defined as >1 QRS morphology from a single pacing site. PMI was defined as initiation of VT during pace-mapping (400-600 ms). In a 2-year period, 44 consecutive patients with scar-mediated VT underwent mapping and ablation. MES were observed during pace-mapping in 25 patients (57%). At 9 months, 74% of patients who exhibited MES during pace-mapping had no recurrence of VT compared with 42% of those without MES observed (P=0.024), with an overall freedom from VT of 61%. Thirteen patients (30%) demonstrated PMI, and termination of VT was seen in 95% (18/19) of sites where ablation was performed.
CONCLUSIONS: During pace-mapping, electrograms that exhibit MES and PMI may be specific for sites critical to reentry. These functional responses hold promise for identifying important sites for catheter ablation of VT.
Roderick Tung; Nilesh Mathuria; Yoav Michowitz; Ricky Yu; Eric Buch; Jason Bradfield; Ravi Mandapati; Isaac Wiener; Noel Boyle; Kalyanam Shivkumar
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Publication Detail:
Type:  Journal Article; Research Support, N.I.H., Extramural     Date:  2012-02-14
Journal Detail:
Title:  Circulation. Arrhythmia and electrophysiology     Volume:  5     ISSN:  1941-3084     ISO Abbreviation:  Circ Arrhythm Electrophysiol     Publication Date:  2012 Apr 
Date Detail:
Created Date:  2012-04-18     Completed Date:  2012-06-12     Revised Date:  2012-12-13    
Medline Journal Info:
Nlm Unique ID:  101474365     Medline TA:  Circ Arrhythm Electrophysiol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  264-72     Citation Subset:  IM    
UCLA Cardiac Arrhythmia Center, UCLA Health System, David Geffen School of Medicine at UCLA, Los Angeles, CA 90095-1679, USA.
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MeSH Terms
Catheter Ablation*
Cicatrix / complications*
Cohort Studies
Heart Conduction System / physiopathology*
Middle Aged
Predictive Value of Tests
Retrospective Studies
Tachycardia, Ventricular / etiology*,  physiopathology,  surgery*
Treatment Outcome
Grant Support
Comment In:
Circ Arrhythm Electrophysiol. 2012 Oct;5(5):e100; author reply e101   [PMID:  23074326 ]

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