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- Title
Spatial Resolution of Defibrillator Electrograms to Detect Distinct Exit Sites of Scar-Related Ventricular Tachycardia.
- Authors
SANTANGELI, PASQUALE; ALCALDE, OSCAR; ZADO, ERICA S.; CALLANS, DAVID J.; MARCHLINSKI, FRANCIS E.
- Abstract
Background Analysis of implantable cardioverter-defibrillator electrograms (IEGMs) with pacing along the scar edge is often used to approximate distinct exit sites of scar-related ventricular tachycardia (VT). We evaluated the spatial resolution of IEGMs in identifying distinct exit sites of scar-related VT. Methods and Results Seventeen patients with scar-related VT were included. Threshold pacing (500-ms cycle length) was performed at sites spaced 10 mm apart along the scar border, as defined by high-density bipolar voltage mapping. Twelve-lead electrocardiogram and near-field and far-field IEGMs were recorded at each pacing site and assessed for morphology. The average scar size was 60 ± 30 cm2 and the scar border perimeter measured 28 ± 9 cm. A median of 18 pacing sites per patient were collected, spaced 14 ± 11 mm apart. The mean spatial resolution for the near-field, far-field, and combination of both was 82.7 ± 76 mm, 62.7 ± 53.6 mm, and 56.7 ± 50 mm (P for trend < 0.001). In all cases, IEGM analysis failed to identify distinct VT exit sites spaced <2 cm apart. Conclusions Analysis of IEGM morphology with pacing around the edge of the scar is unable to distinguish distinct VT exit sites spaced <2 cm apart, with an average spatial resolution of 5 cm. Given the wide range of values observed, detailed pace mapping over a perimeter of 10-15 cm along the scar edge appears crucial to define the boundaries of a linear ablation strategy to target the VT exit site based on IEGM pace match alone.
- Subjects
PENNSYLVANIA; ACADEMIC medical centers; ANALYSIS of variance; CATHETER ablation; CONFIDENCE intervals; ELECTROCARDIOGRAPHY; ELECTROPHYSIOLOGY; FISHER exact test; IMPLANTABLE cardioverter-defibrillators; RESEARCH funding; SCARS; T-test (Statistics); DATA analysis software; VENTRICULAR tachycardia; DESCRIPTIVE statistics; MANN Whitney U Test; THERAPEUTICS
- Publication
Pacing & Clinical Electrophysiology, 2014, Vol 37, Issue 10, p1256
- ISSN
0147-8389
- Publication type
Article
- DOI
10.1111/pace.12444