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Published on: July 29, 2011
Centrifugal Wave Front Propagation Speed for Localizing the Origin of Ventricular Arrhythmias: Investigation Using a
Masaharu Masuda1, Mitsutoshi Asai1, Osamu Iida1
1Kansai Rosai Hospital Cardiovascular Center, Amagasaki, Japan.
Insights
Slow wave front propagation speed on right ventricular maps can identify the origin of outflow tract ventricular arrhythmias (VAs). This finding aids in pinpointing ventricular arrhythmias originating from the right ventricular outflow tract (RVOT).
Area of Science:
- Electrophysiology
- Cardiac Mapping
- Arrhythmia Mechanisms
Background:
- Ventricular arrhythmias (VAs) with right ventricular outflow tract (RVOT) activation can originate from within the RVOT or from elsewhere.
- Differentiating the origin of these VAs is crucial for effective treatment.
Purpose of the Study:
- To evaluate the utility of wave front propagation speed on right ventricular electroanatomic maps.
- To determine if this metric can accurately identify the earliest activation site as the origin of outflow tract VAs.
Main Methods:
- Prospective observational study of 23 patients with idiopathic outflow tract VAs.
- Utilized an ultra-high-resolution electroanatomic mapping system for RVOT mapping.
- Estimated wave front propagation speed by measuring the area of activation at specific time points (5, 10, 15, 20 ms).
Main Results:
- Significantly smaller areas of wave front propagation were observed in VAs of RVOT origin compared to non-RVOT origins at all measured time points.
- A propagated area <5.0 cm² at 15 ms demonstrated high accuracy (91%) in predicting RVOT VAs, with 87% sensitivity and 100% specificity.
Conclusions:
- Slow wave front propagation speed on right ventricular maps is indicative of an RVOT origin for VAs.
- This mapping technique offers a valuable tool for localizing the source of outflow tract ventricular arrhythmias.
Objectives:
The aim of this study was to assess the use of wave front propagation speed on a right ventricular map for determining the earliest activation site as the origin of outflow tract ventricular arrhythmias (VAs).
Background:
VAs with centrifugal right ventricular outflow tract (RVOT) activation can be from an RVOT focus or a focus outside the RVOT.
Methods:
This prospective observational study included 23 patients with idiopathic outflow tract VAs. Mapping of the RVOT was performed using a new ultra-high-resolution electroanatomic mapping system. The wave front propagation speed was estimated from the area surrounded by a propagated wave front at 5, 10, 15, and 20 ms after the earliest activation.
Results:
VAs disappeared following ablations in the RVOT in 15 patients (RVOT origin). The remaining 8 patients had VAs of non-RVOT origin determined by ablation success at another site or ablation failure. The areas surrounded by a propagated wave front were significantly smaller in VAs of RVOT origin than non-RVOT VAs at 5 ms (1.0 [0.7 to 1.1] cm2 vs. 2.2 [1.6 to 4.4] cm2), 10 ms (1.9 [1.4 to 2.2] cm2 vs. 4.5 [3.2 to 5.8] cm2), 15 ms (3.2 [2.3 to 4.4] cm2 vs. 7.1 [6.3 to 9.8] cm2), and 20 ms (5.0 [3.0 to 6.6] cm2 vs. 9.8 [9.3 to 14.8] cm2). A propagated area of <5.0 cm2 at 15 ms predicted RVOT VAs with 87% sensitivity, 100% specificity, and 91% predictive accuracy.
Conclusions:
VAs with slow wave front propagation speed on the right ventricular map indicate an RVOT origin.
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