Accuracy of standard bipolar amplitude voltage thresholds to identify late potential channels in ventricular tachycardia ablation.

Autor: Roca-Luque I; Department of Cardiology, Cardiovascular Clinical Institute, Arrythmia Unit, Hospital Clìnic, Universitat de Barcelona. C/Villarroel 170, 08036, Barcelona, Catalonia, Spain. iroca@clinic.cat.; Institut d'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), Barcelona, Catalonia, Spain. iroca@clinic.cat.; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain. iroca@clinic.cat., Zaraket F; Department of Cardiology, Cardiovascular Clinical Institute, Arrythmia Unit, Hospital Clìnic, Universitat de Barcelona. C/Villarroel 170, 08036, Barcelona, Catalonia, Spain.; Institut d'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), Barcelona, Catalonia, Spain., Garre P; Department of Cardiology, Cardiovascular Clinical Institute, Arrythmia Unit, Hospital Clìnic, Universitat de Barcelona. C/Villarroel 170, 08036, Barcelona, Catalonia, Spain.; Institut d'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), Barcelona, Catalonia, Spain., Sanchez-Somonte P; Department of Cardiology, Cardiovascular Clinical Institute, Arrythmia Unit, Hospital Clìnic, Universitat de Barcelona. C/Villarroel 170, 08036, Barcelona, Catalonia, Spain.; Institut d'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), Barcelona, Catalonia, Spain.; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain., Quinto L; Department of Cardiology, Cardiovascular Clinical Institute, Arrythmia Unit, Hospital Clìnic, Universitat de Barcelona. C/Villarroel 170, 08036, Barcelona, Catalonia, Spain.; Institut d'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), Barcelona, Catalonia, Spain., Borras R; Department of Cardiology, Cardiovascular Clinical Institute, Arrythmia Unit, Hospital Clìnic, Universitat de Barcelona. C/Villarroel 170, 08036, Barcelona, Catalonia, Spain.; Institut d'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), Barcelona, Catalonia, Spain., Guasch E; Department of Cardiology, Cardiovascular Clinical Institute, Arrythmia Unit, Hospital Clìnic, Universitat de Barcelona. C/Villarroel 170, 08036, Barcelona, Catalonia, Spain.; Institut d'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), Barcelona, Catalonia, Spain.; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain., Arbelo E; Department of Cardiology, Cardiovascular Clinical Institute, Arrythmia Unit, Hospital Clìnic, Universitat de Barcelona. C/Villarroel 170, 08036, Barcelona, Catalonia, Spain.; Institut d'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), Barcelona, Catalonia, Spain.; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain., Tolosana JM; Department of Cardiology, Cardiovascular Clinical Institute, Arrythmia Unit, Hospital Clìnic, Universitat de Barcelona. C/Villarroel 170, 08036, Barcelona, Catalonia, Spain.; Institut d'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), Barcelona, Catalonia, Spain.; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain., Brugada J; Department of Cardiology, Cardiovascular Clinical Institute, Arrythmia Unit, Hospital Clìnic, Universitat de Barcelona. C/Villarroel 170, 08036, Barcelona, Catalonia, Spain.; Institut d'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), Barcelona, Catalonia, Spain.; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain., Mont L; Department of Cardiology, Cardiovascular Clinical Institute, Arrythmia Unit, Hospital Clìnic, Universitat de Barcelona. C/Villarroel 170, 08036, Barcelona, Catalonia, Spain.; Institut d'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), Barcelona, Catalonia, Spain.; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain.
Jazyk: angličtina
Zdroj: Journal of interventional cardiac electrophysiology : an international journal of arrhythmias and pacing [J Interv Card Electrophysiol] 2023 Jan; Vol. 66 (1), pp. 15-25. Date of Electronic Publication: 2022 Feb 23.
DOI: 10.1007/s10840-022-01148-6
Abstrakt: Background: Ventricular tachycardia (VT) is caused by the presence of a slow conduction channel (CC) of border zone (BZ) tissue inside the scar-core tissue. Electroanatomic mapping can depict this tissue by voltage mapping. Areas of slow conduction can be detected as late potentials (LPs) and their abolition is the most accepted ablation endpoint. In the current guidelines, bipolar voltage thresholds for BZ and core scar are 1.5 and 0.5 mV respectively. The performance of these values is controversial. The aim of the study is to analyze the diagnostic yield of current amplitude thresholds in voltage map to define VT substrate in terms of CCs of LPs. Predictors of usefulness of current thresholds will be analyzed.
Methods: All patients with structural heart disease who underwent VT ablation in Hospital Clinic in 2016-2017 were included. Maps with delineation of CCs based on LPs were created with contact force sensor catheter. Thresholds were adjusted for every patient based on CCs. Diagnostic yield and predictors of performance of conventional thresholds were analyzed.
Results: During study period, 57 consecutive patients were included (age: 60.4 ± 8.5; 50.2% ischemic cardiomyopathy, LVEF 39.8 ± 13.5%). Cutoff voltages that better identified the scar and BZ according to the LP channels were 0.32 (0.02-2 mV) and 1.84 (0.3-6 mV) respectively. Current voltage thresholds identified correctly core and BZ in 87.7% and 42.1% of the patients respectively. Accuracy was worse in non-ischemic cardiomyopathy (NICM) especially for BZ (28.6% vs 55.2%, p = 0.042).
Conclusions: Accuracy of standard voltage thresholds for scar and BZ is poor in terms of LPs detection. Diagnostic yield is worse in NICM patients specially for border zone.
(© 2022. The Author(s).)
Databáze: MEDLINE
Externí odkaz: