Signature signal strategy: Electrogram-based ventricular tachycardia mapping.

Autor:	Nayyar S; The Hull Family Cardiac Fibrillation Management Laboratory, Toronto General Hospital, Toronto, Ontario, Canada; Division of Cardiology, Townsville University Hospital, Townsville, Queensland, Australia; Department of Medicine, James Cook University, Townsville, Queensland, Australia. Electronic address: sachin.nayyar@health.qld.gov.au., Downar E; The Hull Family Cardiac Fibrillation Management Laboratory, Toronto General Hospital, Toronto, Ontario, Canada., Bhaskaran AP; The Hull Family Cardiac Fibrillation Management Laboratory, Toronto General Hospital, Toronto, Ontario, Canada., Massé S; The Hull Family Cardiac Fibrillation Management Laboratory, Toronto General Hospital, Toronto, Ontario, Canada., Nanthakumar K; The Hull Family Cardiac Fibrillation Management Laboratory, Toronto General Hospital, Toronto, Ontario, Canada.
Jazyk:	angličtina
Zdroj:	Heart rhythm [Heart Rhythm] 2020 Nov; Vol. 17 (11), pp. 2000-2009. Date of Electronic Publication: 2020 Jun 24.
DOI:	10.1016/j.hrthm.2020.06.022
Abstrakt:	Multiple decades of work have recognized complexities of substrates responsible for ventricular tachycardia (VT). There is sufficient evidence that 3 critical components of a re-entrant VT circuit, namely, region of slow conduction, zone of unidirectional block, and exit site, are located in spatial vicinity to each other in the ventricular scar. Each of these components expresses characteristic electrograms in sinus rhythm, at initiation of VT, and during VT, respectively. Despite this, abnormal electrograms are widely targeted without appreciation of these signature electrograms during contemporary VT ablation. Our aim is to stimulate physiology-based VT mapping and a targeted ablation of VT. In this article, we focus on these 3 underappreciated aspects of the physiology of ischemic scar-related VT circuits that have practical applications during a VT ablation procedure. We explore the anatomic and functional elements underlying these distinctive bipolar electrograms, specifically the contribution of tissue branching, conduction restitution, and wave curvature to the substrate, as they pertain to initiation and maintenance of VT. We propose a VT ablation approach based on these 3 electrogram features that can be a potential practical means to recognize critical elements of a VT circuit and target ablation. (Copyright © 2020 Heart Rhythm Society. All rights reserved.)
Databáze:	MEDLINE
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