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Ventricular substrate identification using close-coupled paced electrogram feature analysis.

Mohammad Hassan Shariat1, Divyanshu Gupta1, Enes E Gul1

  • 1Heart Rhythm Service, Queen's University, Armstrong 3, Kingston Health Sciences Centre, 76 Stuart Street, Kingston, Ontario, Canada.

Europace : European Pacing, Arrhythmias, and Cardiac Electrophysiology : Journal of the Working Groups on Cardiac Pacing, Arrhythmias, and Cardiac Cellular Electrophysiology of the European Society of Cardiology
|November 28, 2018
PubMed
Summary
This summary is machine-generated.

Analyzing paced electrogram features helps identify ventricular tachycardia (VT) substrates. Targeting abnormal electrogram duration and latency reduced VT inducibility, suggesting a role in scar-related VT ablation.

Keywords:
AblationClose-coupled pacingElectroanatomic mappingElectrogramLatencyPaced electrogram feature analysisVentricular tachycardia

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Area of Science:

  • Cardiology
  • Electrophysiology
  • Medical Device Technology

Background:

  • Substrate-based catheter ablation is a common treatment for scar-related ventricular tachycardia (VT).
  • Intracardiac electrograms (EGMs) from close-coupled paced extrastimuli provide insights into myocardial electrical properties.
  • Characterizing EGM responses to varying coupling intervals is crucial for understanding VT substrates.

Purpose of the Study:

  • To analyze intracardiac electrograms (EGMs) from close-coupled paced extrastimuli.
  • To characterize ventricular myocardium EGM responses to varying coupling intervals from the right ventricular apex (RVA).
  • To differentiate between healthy individuals and patients with VT for catheter ablation.

Main Methods:

  • EGMs were recorded using high-density mapping catheters from the left ventricle after RVA extrastimuli delivery.
  • Data from 14 patients with ischemic VT and 5 controls were analyzed using MATLAB.
  • Observational data informed an interventional strategy in 10 additional VT patients.

Main Results:

  • Significant differences in EGM duration (ED) and latency (LT) were observed between VT patients and controls at all coupling intervals.
  • Increased ED and LT were noted at VT isthmuses with decreased RVA coupling intervals.
  • Targeting sites with abnormal LT and ED significantly reduced VT inducibility from 5/14 to 0/10 (P=0.03).

Conclusions:

  • Paced electrogram feature analysis is a novel method for characterizing ischemic VT substrates.
  • Abnormal EGM responses correlate with VT isthmuses.
  • This approach shows potential for substrate ablation in ischemic VT.