Noninvasive Identification of Ventricular Tachycardia-Related Anatomical Isthmuses in Repaired Tetralogy of Fallot: What Is the Role of the 12-Lead Ventricular Tachycardia Electrocardiogram.

Autor: Brouwer C; Department of Cardiology, Leiden University Medical Centre, Leiden, the Netherlands., Kapel GFL; Department of Cardiology, Leiden University Medical Centre, Leiden, the Netherlands., Jongbloed MRM; Department of Cardiology, Leiden University Medical Centre, Leiden, the Netherlands., Schalij MJ; Department of Cardiology, Leiden University Medical Centre, Leiden, the Netherlands., de Riva Silva M; Department of Cardiology, Leiden University Medical Centre, Leiden, the Netherlands., Zeppenfeld K; Department of Cardiology, Leiden University Medical Centre, Leiden, the Netherlands. Electronic address: k.zeppenfeld@lumc.nl.
Jazyk: angličtina
Zdroj: JACC. Clinical electrophysiology [JACC Clin Electrophysiol] 2018 Oct; Vol. 4 (10), pp. 1308-1318. Date of Electronic Publication: 2018 Aug 29.
DOI: 10.1016/j.jacep.2018.06.017
Abstrakt: Objectives: This study sought to evaluate the relation between 12-lead ventricular tachycardia (VT) electrocardiography (ECG) and VT-related anatomical isthmuses (AIs) in repaired tetralogy of Fallot (rTOF).
Background: Slow-conducting AIs are the dominant VT substrate in rTOF. Whether an AI is considered critical relies on pace mapping (PM) guided by the VT ECG.
Methods: VT ECGs, electroanatomical mapping data and PM results were analyzed in 25 rTOF patients (group 1) (age 57 ± 13 years). Selection of PM and ablation sites was guided by VT ECG. In 7 patients (group 2) (age 33 ± 14 years), PM was systematically performed within all AIs, irrespective of the VT ECG.
Results: In group 1, all 35 induced VTs (median VT cycle length 270 [interquartile range: 240 to 310] ms) were AI related. All 11 right bundle branch block (RBBB) VTs were related to AI3 (right ventricular septum if positive concordant [7 of 7]), coronary cusp if V2 transition break [3 of 4]). Left bundle branch block (LBBB) VTs with transition Conclusions: In rTOF with only AI1 and AI3, RBBB VTs are due to clockwise and LBBB VTs to counterclockwise activation of AI3. Involvement of both AIs in the VT circuit limits the role of the 12-lead VT ECG and PM. AI3 can always be targeted irrespective of the 12-lead VT ECG.
(Copyright © 2018 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.)
Databáze: MEDLINE
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