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Surgery for ventricular tachyarrhythmias based on fragmentation mapping in sinus rhythm alone
J P Bourke1, R W Campbell, A Renzulli
1Cardiothoracic Centre, Freeman Hospital, Newcastle-upon-Tyne, UK.
Summary
Fragmentation mapping in sinus rhythm enables surgery for previously inoperable ventricular tachycardia. This new approach improves outcomes for patients with unstable or noninducible arrhythmias, expanding surgical options.
Area of Science:
- Cardiology
- Cardiac Surgery
- Electrophysiology
Background:
- Intraoperative arrhythmia activation mapping is successful for sustained uniform ventricular tachycardia.
- Unstable or noninducible arrhythmias are not amenable to activation mapping, limiting surgical options.
Purpose of the Study:
- To evaluate fragmentation mapping in sinus rhythm as a surgical strategy for ventricular tachycardia.
- To determine if fragmentation mapping can guide surgery for arrhythmias not treatable by activation mapping.
Main Methods:
- Fragmentation mapping in sinus rhythm was used to identify surgical targets.
- Endocardial resection was performed on areas with fragmented local electrograms (>100 ms duration).
- This technique was applied in patients where intraoperative arrhythmia mapping was not possible.
Main Results:
- Intraoperative mapping was impossible in 33% of patients due to non-inducibility or unstable morphology.
- Fragmentation mapping successfully guided surgery in these challenging cases.
- Postoperative outcomes showed manageable mortality and recurrence rates, with improved arrhythmia control on medication.
Conclusions:
- Fragmentation mapping in sinus rhythm extends surgical candidacy to previously inoperable ventricular tachycardia.
- This method provides a viable alternative for arrhythmias unsuitable for activation mapping.
- The approach offers comparable results to surgery guided by activation mapping.