Temporal-component analysis of diastolic electrograms in ventricular tachycardia differentiates nonvulnerable regions...

Successful activation mapping of ventricular tachycardia (VT) is dependent on the identification of a region of diastolic conduction by use of point-by-point sequential mapping. It is important to identify the site of transition from diastolic conduction to systolic activation of healthy myocardium (exit site) and differentiate this from nonvulnerable regions of the circuit.

We sought to determine the temporal and component characteristics of exit-site electrograms using simultaneous multielectrode endocardial mapping and to differentiate them from bystander sites during activation mapping.

Sixteen VTs induced in 12 patients with ischemic cardiomyopathy who underwent multielectrode mapping during VT performed with a custom-made 112-bipolar-electrode endocardial array were analyzed retrospectively. The activation sequence in systole and diastole was annotated, and the timing at exit and bystander sites of the near-field component was characterized in relation to surface electrocardiogram activation and to the far-field component. Spectral content of bipolar electrograms recorded at these sites was additionally analyzed to identify the near-field to far-field interval.

The mean activation time at exit sites was 60.0 ± 31.5 ms (range 21-113 ms) ahead of surface QRS but was not significantly different from bystander sites (72.0 ± 55.0 ms, P = .63). However, the time delay from local to far-field activity was significantly lower at exit sites than at bystander sites (24.9 ± 15.6 vs. 86.6 ± 92.0 ms, P = .003), which was confirmed by spectral analysis (10.0 ± 13.1 vs. 89.0 ± 64.5 ms, P = .003).

Our analysis suggests that temporal-component analysis of diastolic electrograms during activation mapping of VT provides a practical method to differentiate nonvulnerable sites from the exit site without the need for pacing maneuvers.