BACKGROUND: Abnormal ventricular signals(AVS) are the cornerstone of substrate-based ventricular tachycardia(VT) ablation in sinus rhythm. Signal characterization of AVS amongst ischaemic and non-ischaemic cardiomyopathies has never been performed. OBJECTIVE: To describe ventricular signal abnormalities in three different pathologies and study their association with the diastolic component of VT circuits. METHODS: 45{15 ischaemic(ICM),15 arrhythmogenic(ACM),15 dilated(DCM) cardiomyopathy}patients who underwent VT ablation with more than 50% of the diastolic pathway of the VT circuit recorded, were studied. AVS were classified into late potentials (LP) and continuous fractionated ventricular signals (CFVS) and their characteristics and correlation with the diastolic pathway of VT circuits analysed. RESULTS: 75 VT circuits were analysed. Bipolar scars were greatest in ICM endocardially (53cm(2)vs36cm(2)vs25cm(2) in ICM,ACM,DCM respectively,p=0.010) and in ACM epicardially (98cm(2)vs25cm(2) in ICM,24cm(2) in DCM,p=0.005). Location of VT diastolic interval coincided with AVS location in 54% of VTs in ICM,89% in ACM and 72% in DCM(p=0.036). There was a trend to greater association of diastolic intervals coinciding with LPs rather than CFVS(78%vs57%, p=0.052).[69% diastolic intervals in ICM coincided with LPs,33% with CFVS(p=0.063)]. 100% patients with CFVS in ACM had VT diastolic components arising from CFVS (33% ICM,64% DCM,p=0.049). Positive predictive value for LPs vs CFVS was 77.8%vs56.7% and sensitivity 67.3%vs32.7% respectively. CONCLUSIONS: The nature of abnormal signals in different cardiomyopathies reflect underlying pathology. LPs rather than continuous fractionated ventricular signals, appear to be more linked to diastolic components of VT circuits, especially in ICM. LPs have higher sensitivity and specificity for VT, however continuous fractionated ventricular signals may be of more relevance in ACM.
Significance of Abnormal and Late Ventricular Signatures in Ventricular Tachycardia Ablation of Ischaemic and Non-Ischaemic Cardiomyopathies / Zachariah, D.; Nakajima, K.; Limite, L. R.; Zweiker, D.; Spartalis, M.; Zirolia, D.; Musto, M.; D'Angelo, G.; Paglino, G.; Baratto, F.; Cireddu, M.; Bisceglia, C.; Radinovic, A.; Marzi, A.; Sala, S.; Peretto, G.; Vergara, P; Gulletta, S.; Mazzone, P.; Della Bella, P.; Frontera, A.. - In: HEART RHYTHM. - ISSN 1547-5271. - 19:(2022), pp. 2075-2083. [10.1016/j.hrthm.2022.08.008]
Significance of Abnormal and Late Ventricular Signatures in Ventricular Tachycardia Ablation of Ischaemic and Non-Ischaemic Cardiomyopathies
VERGARA P;
2022
Abstract
BACKGROUND: Abnormal ventricular signals(AVS) are the cornerstone of substrate-based ventricular tachycardia(VT) ablation in sinus rhythm. Signal characterization of AVS amongst ischaemic and non-ischaemic cardiomyopathies has never been performed. OBJECTIVE: To describe ventricular signal abnormalities in three different pathologies and study their association with the diastolic component of VT circuits. METHODS: 45{15 ischaemic(ICM),15 arrhythmogenic(ACM),15 dilated(DCM) cardiomyopathy}patients who underwent VT ablation with more than 50% of the diastolic pathway of the VT circuit recorded, were studied. AVS were classified into late potentials (LP) and continuous fractionated ventricular signals (CFVS) and their characteristics and correlation with the diastolic pathway of VT circuits analysed. RESULTS: 75 VT circuits were analysed. Bipolar scars were greatest in ICM endocardially (53cm(2)vs36cm(2)vs25cm(2) in ICM,ACM,DCM respectively,p=0.010) and in ACM epicardially (98cm(2)vs25cm(2) in ICM,24cm(2) in DCM,p=0.005). Location of VT diastolic interval coincided with AVS location in 54% of VTs in ICM,89% in ACM and 72% in DCM(p=0.036). There was a trend to greater association of diastolic intervals coinciding with LPs rather than CFVS(78%vs57%, p=0.052).[69% diastolic intervals in ICM coincided with LPs,33% with CFVS(p=0.063)]. 100% patients with CFVS in ACM had VT diastolic components arising from CFVS (33% ICM,64% DCM,p=0.049). Positive predictive value for LPs vs CFVS was 77.8%vs56.7% and sensitivity 67.3%vs32.7% respectively. CONCLUSIONS: The nature of abnormal signals in different cardiomyopathies reflect underlying pathology. LPs rather than continuous fractionated ventricular signals, appear to be more linked to diastolic components of VT circuits, especially in ICM. LPs have higher sensitivity and specificity for VT, however continuous fractionated ventricular signals may be of more relevance in ACM.I documenti in IRIS sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.
