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Wavefront curvature analysis derived from preprocedural imaging can identify the critical isthmus in patients with postinfarcted ventricular tachycardia.
Ciaccio, Edward J; Cedilnik, Nicolas; Hsia, Henry H; Biviano, Angelo B; Garan, Hasan; Yarmohammadi, Hirad.
Afiliación
  • Ciaccio EJ; Department of Medicine, Division of Cardiology, College of Physicians and Surgeons, Columbia University, New York, New York. Electronic address: ciaccio@columbia.edu.
  • Cedilnik N; inHEART Medical, IHU Liryc, Hopital Xavier Arnozan, Pessac, France.
  • Hsia HH; Cardiac Electrophysiology and Arrhythmia Service, University of California San Francisco, San Francisco, California.
  • Biviano AB; Department of Medicine, Division of Cardiology, College of Physicians and Surgeons, Columbia University, New York, New York.
  • Garan H; Department of Medicine, Division of Cardiology, College of Physicians and Surgeons, Columbia University, New York, New York.
  • Yarmohammadi H; Department of Medicine, Division of Cardiology, College of Physicians and Surgeons, Columbia University, New York, New York.
Heart Rhythm ; 2024 Jun 05.
Article en En | MEDLINE | ID: mdl-38848858
ABSTRACT

BACKGROUND:

Where activation wavefront curvature is convexly shaped, functional conduction block can occur.

OBJECTIVE:

The purpose of this study was to determine whether left ventricular (LV) wall thickness determined from contrast-enhanced computed tomography (CT) is useful in localizing such areas in clinical postinfarction reentrant ventricular tachycardia (VT).

METHODS:

We evaluated data from 6 patients who underwent catheter ablation for postinfarction VT. CT imaging with inHEART processing was conducted 1-3 days before electrophysiological (EP) study to determine LV wall thickness (T). Activation wavefront curvature was approximated as ΔT/T, where ΔT represents wall thickness change. During EP study, bipolar LV VT electrograms were acquired using a high-density mapping catheter, and activation times were determined. Maps of T, ΔT/T, and VT activation were subsequently compared using statistical analyses.

RESULTS:

Two of 6 cases exhibited dual circuit morphologies, resulting in a total of 8 VT morphologies analyzed. The LV wall near the VT isthmus location tended to be thin, on the order of a few hundred micrometers. Regions of largest ΔT/T partially coincided with the lateral isthmus boundaries where electrical conduction block occurred during VT. ΔT/T at the boundaries, measured from imaging, was significantly larger compared to values at the isthmus midline and to the global LV mean value (P <.001).

CONCLUSION:

Wavefront curvature measured by ΔT/T and caused by source-sink mismatch is dependent on ventricular wall thickness. Areas of high wavefront curvature partly coincide with and may be helpful in locating the VT isthmus in infarct border zones using preprocedural imaging analysis.
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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Idioma: En Revista: Heart Rhythm 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 Idioma: En Revista: Heart Rhythm Año: 2024 Tipo del documento: Article Pais de publicación: Estados Unidos