| Functional pace-mapping responses for identification of targets for catheter ablation of scar-mediated ventricular tachycardia. | |
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MedLine Citation:
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PMID: 22333344 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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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. |
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Authors:
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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:
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Type: Journal Article; Research Support, N.I.H., Extramural Date: 2012-02-14 |
Journal Detail:
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Title: Circulation. Arrhythmia and electrophysiology Volume: 5 ISSN: 1941-3084 ISO Abbreviation: Circ Arrhythm Electrophysiol Publication Date: 2012 Apr |
Date Detail:
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Created Date: 2012-04-18 Completed Date: 2012-06-12 Revised Date: 2012-12-13 |
Medline Journal Info:
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Nlm Unique ID: 101474365 Medline TA: Circ Arrhythm Electrophysiol Country: United States |
Other Details:
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Languages: eng Pagination: 264-72 Citation Subset: IM |
Affiliation:
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UCLA Cardiac Arrhythmia Center, UCLA Health System, David Geffen School of Medicine at UCLA, Los Angeles, CA 90095-1679, USA. rtung@mednet.ucla.edu |
Export Citation:
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| MeSH Terms | |
Descriptor/Qualifier:
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Aged Catheter Ablation* Cicatrix / complications* Cohort Studies Electrocardiography Female Heart Conduction System / physiopathology* Humans Male Middle Aged Predictive Value of Tests Recurrence Retrospective Studies Tachycardia, Ventricular / etiology*, physiopathology, surgery* Treatment Outcome |
| Grant Support | |
ID/Acronym/Agency:
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R01HL084261/HL/NHLBI NIH HHS |
| Comments/Corrections | |
Comment In:
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Circ Arrhythm Electrophysiol. 2012 Oct;5(5):e100; author reply e101
[PMID:
23074326
]
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From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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