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Related Experiment Video

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Ablation of Ischemic Ventricular Tachycardia Using a Multipolar Catheter and 3-dimensional Mapping System for High-density Electro-anatomical Reconstruction
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Noncentrifugal activation patterns in focal RVOT PVC/VT: New insights from high density multielectrode mapping.

Justin Ng1, Binita Chhachhi1, Paul Stobie1

  • 1Sir Charles Gairdner Hospital, Nedlands, Australia.

Journal of Cardiovascular Electrophysiology
|October 29, 2020
PubMed
Summary

Noncentrifugal activation patterns are common in patients with premature ventricular complex/ventricular tachycardia (PVC/VT) originating from the right ventricular outflow tract (RVOT). This finding suggests underlying preferential conduction or epicardial connections, challenging traditional activation theories.

Keywords:
RVOT PVC/VT ablationactivation mappinghigh density multielectrode mapping

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Area of Science:

  • Cardiology
  • Electrophysiology
  • Medical Imaging

Background:

  • Premature ventricular complex/ventricular tachycardia (PVC/VT) from the right ventricular outflow tract (RVOT) is typically associated with centrifugal activation.
  • However, preferential conduction and epicardial connections may lead to noncentrifugal wavefront propagation.

Purpose of the Study:

  • To investigate endocardial activation patterns in RVOT PVC/VT using high-resolution 3D activation mapping.
  • To determine the prevalence of noncentrifugal activation in this patient cohort.

Main Methods:

  • High-resolution 3D activation mapping was performed using a multielectrode catheter in patients with frequent idiopathic RVOT PVC/VT.
  • Noncentrifugal activation was defined as wavefront propagation not uniformly radiating from a single focus.

Main Results:

  • Noncentrifugal activation patterns were observed in 62% of the 16 studied patients.
  • Centrifugal activation was seen in 38% of patients.
  • Older age was associated with centrifugal activation, but no differences were found in gender, QRS duration, or RVOT origin sites.

Conclusions:

  • High-resolution mapping reveals noncentrifugal activation in a significant portion of idiopathic RVOT PVC/VT patients.
  • This suggests the presence of preferential conduction and/or epicardial/intramural connections within the RVOT.