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Related Experiment Videos

The N + 1 difference: a new measure for entrainment mapping.

K Soejima1, W G Stevenson, W H Maisel

  • 1Department of Internal Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts 02115, USA.

Journal of the American College of Cardiology
|April 13, 2001
PubMed
Summary

A new measurement, the N + 1 difference, enhances entrainment mapping for identifying re-entry circuit sites. This method proves effective even when standard assessments are challenging.

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Area of Science:

  • Cardiology
  • Electrophysiology
  • Medical Devices

Background:

  • Entrainment mapping identifies re-entry circuits but faces challenges.
  • Difficulties include assessing fusion (QRS/P-wave changes) and postpacing interval (PPI) at stimulation sites.

Purpose of the Study:

  • To develop and validate a novel entrainment mapping measurement: the N + 1 difference.
  • To assess its utility in identifying re-entry circuit sites.

Main Methods:

  • The N + 1 difference was defined in computer simulations as the interval from a tachycardia-resetting stimulus to the second post-stimulus beat.
  • This was compared to the postpacing interval-tachycardia cycle length (PPI-TCL) difference.
  • Validation occurred in simulations and in 110 patients with ventricular tachycardia or atrial flutter.

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Main Results:

  • The N + 1 difference equaled the PPI-TCL difference in simulations.
  • Strong correlation (r >= 0.91) between N + 1 difference and PPI-TCL difference in patients.
  • High sensitivity (>= 86%) and specificity (>= 90%) for identifying re-entry circuit sites, with similar accuracy using surface ECG or intracardiac electrograms.

Conclusions:

  • The N + 1 difference is a reliable new measurement for entrainment mapping.
  • It overcomes limitations of traditional methods, especially when intracardiac electrograms or surface ECG fusion are difficult to interpret.