Direct and indirect mapping of intramural space in ventricular tachycardia
| Autor: | Mahmoud M. Bokhari, Christian Jons, Kumaraswamy Nanthakumar, Andrew C.T. Ha, Prashant Aukhojee, Abhishek Bhaskaran, Roderick Tung, Sachin Nayyar, Karl Magtibay, Andreu Porta-Sánchez, Eugene Downar, Stéphane Massé |
|---|---|
| Jazyk: | angličtina |
| Rok vydání: | 2020 |
| Předmět: |
Epicardial Mapping
Male Tachycardia medicine.medical_specialty Heart Ventricles Diastole 030204 cardiovascular system & hematology Ventricular tachycardia 03 medical and health sciences 0302 clinical medicine Monitoring Intraoperative Physiology (medical) Internal medicine Explanted heart mapping medicine Humans 030212 general & internal medicine Cardiac Surgical Procedures Endocardium Ischemic cardiomyopathy business.industry Intramural needle mapping Intraoperative mapping medicine.disease Vt ablation Ventricular tachycardia mapping medicine.anatomical_structure Nonischemic cardiomyopathy Ventricle Tachycardia Ventricular Cardiology Female Intramural ventricular tachycardia medicine.symptom Cardiology and Cardiovascular Medicine business |
| Popis: | BACKGROUND: The ventricular tachycardia (VT) circuit is often assumed to be located in the endocardium or epicardium. The plateauing success rate of VT ablation warrants reevaluation of this mapping paradigm. OBJECTIVE: The purpose of this study was to resolve the intramural components of VT circuits by mapping in human hearts. METHODS: Panoramic simultaneous endocardial-epicardial mapping (SEEM) during intraoperative mapping (IOM) was performed in human subjects. In explanted hearts (EH), SEEM and intramural multielectrode plunge needle mapping (NM) of the left ventricle were performed. Overall, 37 VTs (26 ischemic cardiomyopathy [ICM], 11 nonischemic cardiomyopathy [NICM]) were studied in 32 patients. Intraoperative SEEM was performed in 16 patients (16 ICM). Additionally, 16 explanted myopathic human hearts (9 NICM, 7 ICM) were studied in a Langendorff setup. Predominant intramural location of the VT was imputed by the absence of significant endocardial-epicardial activation during IOM (using SEEM and no NM) or by the presence of intramural activation spanning the entire cycle length (including mid-diastole) in EH (SEEM and NM). RESULTS: By IOM (SEEM), predominant endocardial activation (entire tachycardia cycle length including mid-diastolic activation) was present in 10 of 18 VTs (55%). In 8 of 18 VTs (44%), the VT circuit was presumed to be intramural due to incomplete diastolic activation in endocardium and epicardium. In EH (SEEM and NM), VT location was predominantly intramural, endocardial, and epicardial in 8 of 19 (42%), 5 of 19 (26%), and 1 of 19 VTs (5%), respectively. CONCLUSION: In a significant proportion of both ischemic and nonischemic ventricular tachycardias, the predominant activation was located in the intramural space. This work was funded by CIHR MOP: 142272. Dr Bhaskaran is a Burnett fellow. Dr Nanthakumar is an investigator at TGHRI and HSF. Sí |
| Databáze: | OpenAIRE |
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