Detailed analysis of electrogram peak frequency to guide ventricular tachycardia substrate mapping.

Autor:	Mayer J; Department of Cardiology, University Hospital Coventry and Warwickshire NHS Trust, CV2 2DX Coventry, UK.; Department of Cardiology, Royal Stoke University Hospital, Stoke-on-Trent, UK., Al-Sheikhli J; Department of Cardiology, University Hospital Coventry and Warwickshire NHS Trust, CV2 2DX Coventry, UK.; Heart Rhythm Research Group, Division of Biomedical Sciences, Warwick Medical School, Clinical Sciences Research Laboratory, CV2 2DX Coventry, UK., Niespialowska-Steuden M; Department of Cardiology, University Hospital Coventry and Warwickshire NHS Trust, CV2 2DX Coventry, UK., Patchett I; Department of Cardiology, University Hospital Coventry and Warwickshire NHS Trust, CV2 2DX Coventry, UK., Winter J; Electrophysiology Division, Abbott Laboratories, Solihull, UK., Siang R; Department of Cardiology, University Hospital Coventry and Warwickshire NHS Trust, CV2 2DX Coventry, UK.; Heart Rhythm Research Group, Division of Biomedical Sciences, Warwick Medical School, Clinical Sciences Research Laboratory, CV2 2DX Coventry, UK., Lellouche N; Department of Cardiology, Hopital Henri Mondor Albert Chenevier, Inserm U955, Paris, France., Manoharan K; Sussex Cardiac Centre, Royal Sussex County Hospital, Brighton, UK., Phan TT; Department of Cardiology, Royal Stoke University Hospital, Stoke-on-Trent, UK., Calvo JJ; Sussex Cardiac Centre, Royal Sussex County Hospital, Brighton, UK., Porta-Sánchez A; Arrhythmia Unit, Hospital Clínic de Barcelona, Barcelona, Spain., Luque IR; Arrhythmia Unit, Hospital Clínic de Barcelona, Barcelona, Spain., Silberbauer J; Sussex Cardiac Centre, Royal Sussex County Hospital, Brighton, UK., Dhanjal T; Department of Cardiology, University Hospital Coventry and Warwickshire NHS Trust, CV2 2DX Coventry, UK.; Heart Rhythm Research Group, Division of Biomedical Sciences, Warwick Medical School, Clinical Sciences Research Laboratory, CV2 2DX Coventry, UK.
Jazyk:	angličtina
Zdroj:	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 [Europace] 2024 Oct 03; Vol. 26 (10).
DOI:	10.1093/europace/euae253
Abstrakt:	Aims: Differentiating near-field (NF) and far-field (FF) electrograms (EGMs) is crucial in identifying critical arrhythmogenic substrate during ventricular tachycardia (VT) ablation. A novel algorithm annotates NF-fractionated signals enabling EGM peak frequency (PF) determination using wavelet transformation. This study evaluated the algorithms' effectiveness in identifying critical components of the VT circuit during substrate mapping. Methods and Results: A multicentre, international cohort undergoing VT ablation was investigated. VT activation maps were used to demarcate the isthmus zone (IZ). Offline analysis was performed to evaluate the diagnostic performance of low-voltage area (LVA) PF substrate mapping. A total of 30 patients encompassing 198 935 EGMs were included. The IZ PF was significantly higher in sinus rhythm (SR) compared to right ventricular paced (RVp) substrate maps (234 Hz (195-294) vs. 197 Hz (166-220); P = 0.010). Compared to LVA PF, the IZ PF was significantly higher in both SR and RVp substrate maps (area under curve, AUC: 0.74 and 0.70, respectively). The LVA PF threshold of ≥200 Hz was optimal in SR maps (sensitivity 69%; specificity 64%) and RVp maps (sensitivity 60%; specificity 64%) in identifying the VT isthmus. In amiodarone-treated patients (n = 20), the SR substrate map IZ PF was significantly lower (222 Hz (186-257) vs. 303 Hz (244-375), P = 0.009) compared to amiodarone-naïve patients (n = 10). The ≥200 Hz LVA PF threshold resulted in an 80% freedom from VT with a trend towards reduced ablation lesions and radiofrequency times. Conclusion: LVA PF substrate mapping identifies critical components of the VT circuit with an optimal threshold of ≥200 Hz. Isthmus PF is influenced by chronic amiodarone therapy with lower values observed during RV pacing. Competing Interests: Conflict of interest: JS, IRL, NL, and TD receive research grants from Abbott Medical. (© The Author(s) 2024. Published by Oxford University Press on behalf of the European Society of Cardiology.)
Databáze:	MEDLINE
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