TY - JOUR
T1 - Exit sites on the epicardium rarely subtend critical diastolic path of ischemic VT on the endocardium
T2 - Implications for noninvasive ablation
AU - Bhaskaran, Abhishek
AU - Nayyar, Sachin
AU - Porta-Sánchez, Andreu
AU - Haldar, Shouvik
AU - Bokhari, Mahmoud
AU - Massé, Stéphane
AU - Liang, Timothy
AU - Zehra, Nawazish
AU - Farid, Talha
AU - Downar, Eugene
AU - Nanthakumar, Kumaraswamy
N1 - Publisher Copyright:
© 2019 Wiley Periodicals, Inc.
PY - 2019/4
Y1 - 2019/4
N2 - Background: Noninvasive electrocardiographic mapping of ventricular tachycardia (VT) and ablation using stereotactic radiotherapy was recently reported. This strategy does not directly evaluate the critical diastolic components and assumes that the epicardial exit site of VT subtends closely over the endocardial mid-diastolic isthmus. Objective: To determine if the epicardial exit site of VT spatially corresponds to the critical diastolic components of ischemic scar-related VT. Materials and methods: Intraoperative simultaneous endocardial and epicardial mapping were performed during VT using a 112-bipole endocardial balloon and 112-bipole epicardial sock array. In eight patients, nine VTs having entire diastolic circuit mapped were included in the study. The diastolic path and VT-exit sites (epicardial and endocardial) were determined. Results: The diastolic path was mapped in the endocardium for all nine VTs (median length, 50; interquartile range [IQR], 28 mm). The tachycardia cycle length ranged from 210-500 ms. The VT-exit site was early in the endocardium for six VTs and on the epicardium for three VTs. The mid-diastolic isthmus and endocardial exit site of the six endocardial VTs were spatially distant from their epicardial exit site by a median distance of 32 and 27 mm, respectively. For the three VTs with an early epicardial exit, the isthmus and endocardial exit sites were distant from the epicardial exit site by a median distance of 34 and 38 mm, respectively. Conclusion: The epicardial exit site and the mid-diastolic isthmus sites were spatially distant and discrepant. Surface electrocardiography (ECG)-derived strategy in identifying epicardial exit site to select noninvasive ablation targets is prone to identify epicardial exit sites and may not identify critical targets in ischemic scar VT.
AB - Background: Noninvasive electrocardiographic mapping of ventricular tachycardia (VT) and ablation using stereotactic radiotherapy was recently reported. This strategy does not directly evaluate the critical diastolic components and assumes that the epicardial exit site of VT subtends closely over the endocardial mid-diastolic isthmus. Objective: To determine if the epicardial exit site of VT spatially corresponds to the critical diastolic components of ischemic scar-related VT. Materials and methods: Intraoperative simultaneous endocardial and epicardial mapping were performed during VT using a 112-bipole endocardial balloon and 112-bipole epicardial sock array. In eight patients, nine VTs having entire diastolic circuit mapped were included in the study. The diastolic path and VT-exit sites (epicardial and endocardial) were determined. Results: The diastolic path was mapped in the endocardium for all nine VTs (median length, 50; interquartile range [IQR], 28 mm). The tachycardia cycle length ranged from 210-500 ms. The VT-exit site was early in the endocardium for six VTs and on the epicardium for three VTs. The mid-diastolic isthmus and endocardial exit site of the six endocardial VTs were spatially distant from their epicardial exit site by a median distance of 32 and 27 mm, respectively. For the three VTs with an early epicardial exit, the isthmus and endocardial exit sites were distant from the epicardial exit site by a median distance of 34 and 38 mm, respectively. Conclusion: The epicardial exit site and the mid-diastolic isthmus sites were spatially distant and discrepant. Surface electrocardiography (ECG)-derived strategy in identifying epicardial exit site to select noninvasive ablation targets is prone to identify epicardial exit sites and may not identify critical targets in ischemic scar VT.
KW - body surface mapping
KW - catheter ablation
KW - epicardial ablation
KW - ischemic cardiomyopathy
KW - noninvasive mapping
KW - ventricular tachycardia
UR - http://www.scopus.com/inward/record.url?scp=85060160740&partnerID=8YFLogxK
U2 - 10.1111/jce.13843
DO - 10.1111/jce.13843
M3 - Article
C2 - 30614114
AN - SCOPUS:85060160740
SN - 1045-3873
VL - 30
SP - 520
EP - 527
JO - Journal of Cardiovascular Electrophysiology
JF - Journal of Cardiovascular Electrophysiology
IS - 4
ER -