Research output: Contribution to journal › Article › peer-review
Michele Orini, Adam J. Graham, Neil T. Srinivasan, Fernando O. Campos, Ben M. Hanson, Anthony Chow, Ross J. Hunter, Richard J. Schilling, Malcolm Finlay, Mark J. Earley, Simon Sporton, Mehul Dhinoja, Martin Lowe, Bradley Porter, Nicholas Child, Christopher A. Rinaldi, Jaswinder Gill, Martin Bishop, Peter Taggart, Pier D. Lambiase
Original language | English |
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Journal | Heart Rhythm |
Early online date | 18 Nov 2019 |
DOIs | |
Accepted/In press | 13 Nov 2019 |
E-pub ahead of print | 18 Nov 2019 |
Evaluation of the Re-entry_ORINI_Publishedonline18November2019_GREEN AAM (CC BY-NC-ND)
Evaluation_of_the_Re_entry_ORINI_Publishedonline18November2019_GREEN_AAM_CC_BY_NC_ND_.pdf, 1.57 MB, application/pdf
Uploaded date:22 Nov 2019
Version:Accepted author manuscript
Licence:CC BY-NC-ND
Identifying arrhythmogenic sites to improve ventricular tachycardia (VT) ablation outcomes remains unresolved. The re-entry vulnerability index (RVI) combines activation and repolarization timings to identify sites critical for re-entrant arrhythmia initiation without inducing VT.
ObjectiveTo provide the first assessment of RVI’s capability to identify VT sites of origin using high-density contact mapping and comparison with other activation-repolarization markers of functional substrate.
Methods18 VT ablation patients (16M, 72% ischemic) were studied. Unipolar electrograms were recorded during ventricular pacing and analysed off-line. Activation time (AT), activation-recovery interval (ARI), repolarization time (RT) were measured. Vulnerability to re-entry was mapped based on RVI and spatial distribution of AT, ARI and RT. The distance from sites identified as vulnerable to re-entry to the VT site of origin was measured, with distances <10 mm and >20 mm indicating accurate and inaccurate localization, respectively.
ResultsThe origin of 18 VTs was identified (n=6 entrainment, n=12 pace-mapping). RVI maps included 1012, 408—2098 (median, 1st—3rd quartiles) points/patient. RVI accurately localized 72.2% VT sites of origin, with median distance equal to 5.1, 3.2—10.1 mm. Inaccurate localization was significantly less frequent for RVI than AT (5.6% vs 33.3%, OR=0.12, P=0.035). Compared to RVI, distance to VT sites of origin was significantly larger for sites showing prolonged RT and ARI, and non-significantly larger for sites showing highest AT and ARI gradients.
ConclusionRVI identifies vulnerable regions closest to VT sites of origin. Activation-repolarization metrics may improve VT substrate delineation and inform novel ablation strategies.
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