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Targeting Wavefront Discontinuity Lines for Scar-Related Ventricular Tachycardia Ablation: A Novel Functional Substrate Ablation Approach.
Maher, Timothy R; Freedman, Benjamin L; Yang, Shu; Locke, Andrew H; D'Angelo, Robert; Galvao, Madison; Buxton, Alfred E; Waks, Jonathan W; d'Avila, Andre.
Afiliación
  • Maher TR; Harvard-Thorndike Electrophysiology Institute and Arrhythmia Service, Division of Cardiovascular Diseases, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA. Electronic address: Tmaher@bidmc.harvard.edu.
  • Freedman BL; CardioVascular Center, Tufts Medical Center, Tufts University Medical School, Boston, Massachusetts, USA.
  • Yang S; Harvard-Thorndike Electrophysiology Institute and Arrhythmia Service, Division of Cardiovascular Diseases, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA.
  • Locke AH; Harvard-Thorndike Electrophysiology Institute and Arrhythmia Service, Division of Cardiovascular Diseases, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA.
  • D'Angelo R; Harvard-Thorndike Electrophysiology Institute and Arrhythmia Service, Division of Cardiovascular Diseases, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA.
  • Galvao M; Biosense Webster, Inc, Irvine, California, USA.
  • Buxton AE; Harvard-Thorndike Electrophysiology Institute and Arrhythmia Service, Division of Cardiovascular Diseases, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA.
  • Waks JW; Harvard-Thorndike Electrophysiology Institute and Arrhythmia Service, Division of Cardiovascular Diseases, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA.
  • d'Avila A; Harvard-Thorndike Electrophysiology Institute and Arrhythmia Service, Division of Cardiovascular Diseases, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA.
JACC Clin Electrophysiol ; 10(7 Pt 1): 1255-1270, 2024 Jul.
Article en En | MEDLINE | ID: mdl-38819346
ABSTRACT

BACKGROUND:

The boundaries of critical isthmuses for re-entrant ventricular tachycardia (VT) are formed by wavefront discontinuities (fixed lines of block, slow propagation, and rotational propagation) seen during baseline rhythm. It is unknown whether wavefront discontinuities can be automatically identified and targeted for ablation using electroanatomic mapping systems.

OBJECTIVES:

The purpose of this study was to assess the electrophysiologic characteristics of automatically projected wavefront discontinuity lines (WADLs) and outcomes of an ablation strategy targeting WADLs in a mixed cohort of VT patients.

METHODS:

Late activation substrate maps were analyzed from 1 or more baseline rhythm wavefronts. WADLs were identified using the Carto Extended Early Meets Late module. Number, total length, and distance to critical VT sites were measured. VT recurrence and VT-free survival were followed.

RESULTS:

In total, 49 patients underwent 52 ablations with 71 unique substrate maps analyzed (18.8% epicardial; 62.0% right ventricular paced, 28.2% sinus rhythm, 9.9% left ventricular paced). A total of 28 VT critical sites were identified in 24 patients. WADLs were present in 49 of 71 (69.0%) maps. WADLs were present regardless of cardiomyopathy etiology, mapping wavefront, or surface. At a WADL threshold of 30%, 73.9% of critical VT sites were in close proximity (≤15 mm) to a WADL. VT-free survival was 62% at 1 year, with a competing risk model estimating a 1-year risk of VT recurrence of 23%.

CONCLUSIONS:

WADLs can be automatically projected in a majority of patients in a mixed cohort of cardiomyopathy etiology, mapped wavefronts, and myocardial surfaces mapped. Targeting WADLs results in low rate of VT recurrence at 1 year.
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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Cicatriz / Taquicardia Ventricular / Ablación por Catéter / Técnicas Electrofisiológicas Cardíacas Límite: Aged / Female / Humans / Male / Middle aged Idioma: En Revista: JACC Clin Electrophysiol Año: 2024 Tipo del documento: Article Pais de publicación: Estados Unidos
Texto completo
Añadir a Mi BVS
Imprimir
XML
PubMed Links
Buscar en Google

Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Cicatriz / Taquicardia Ventricular / Ablación por Catéter / Técnicas Electrofisiológicas Cardíacas Límite: Aged / Female / Humans / Male / Middle aged Idioma: En Revista: JACC Clin Electrophysiol Año: 2024 Tipo del documento: Article Pais de publicación: Estados Unidos