Document Detail


Use of a Novel Fragmentation Map to Identify the Substrate for Ventricular Tachycardia in Post Infarction Cardiomyopathy.
MedLine Citation:
PMID:  25285645     Owner:  NLM     Status:  Publisher    
Abstract/OtherAbstract:
BACKGROUND: Substrate ablation is commonly performed in patients with post-infarction cardiomyopathy and ventricular tachycardia (VT). Recognition of fragmented and late potentials during sinus rhythm is a tedious process subject to operator fatigue.
OBJECTIVES: The purpose of this study was to assess the value of automated analysis to quantify electrogram fragmentation and to determine the relationship of fragmented regions to the VT isthmus.
METHODS: Detailed left ventricular (LV) mapping was performed in 2 groups: 1) 14 patients with previous myocardial infarction and tolerated VT and 2) 14 controls with structurally normal hearts. In patients with VT, mid-isthmus sites were identified using entrainment mapping. Sinus rhythm endocardial LV electrograms underwent time and frequency domain analysis and were displayed as fragmentation or frequency maps. The region of fractionated electrograms and their relation to the VT isthmus sites was determined.
RESULTS: Cutoffs for abnormal electrogram fragmentation were ventricular fractionation index (VFl) ≥7 and FFT ratio ≥14%, respectively. In the time domain, the left ventricular surface area with fractionated electrograms was significantly smaller than the total scar surface area (27.3 ± 7.1% vs. 42.1±12.3%, p<0.001), yet contained 100% of VT isthmus sites. In the frequency domain, areas of abnormal fractionation occupied 9.7 ± 6.9% of total LV surface area and included only 60% of the VT isthmus sites.
CONCLUSION: Automated electrogram fractionation analysis represent an objective tool to rapidly quantify electrogram fragmentation and guide substrate based ablation of VT. Empiric ablation of these regions may be a new strategy for substrate guided VT ablation.
Authors:
Bieito Campos; Miguel E Jauregui; Francis E Marchlinski; Sanjay Dixit; Edward P Gerstenfeld
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Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2014-10-3
Journal Detail:
Title:  Heart rhythm : the official journal of the Heart Rhythm Society     Volume:  -     ISSN:  1556-3871     ISO Abbreviation:  Heart Rhythm     Publication Date:  2014 Oct 
Date Detail:
Created Date:  2014-10-6     Completed Date:  -     Revised Date:  2014-10-7    
Medline Journal Info:
Nlm Unique ID:  101200317     Medline TA:  Heart Rhythm     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
Copyright Information:
Copyright © 2014. Published by Elsevier Inc.
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From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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