Abstract
Background
Substrate mapping–based identification of all ventricular tachycardia (VT) circuits
(diastolic activation), including partial and complete diastolic circuits in clinical
and nonclinical VT, could be beneficial in guiding VT ablation to prevent VT recurrence.
The utility of extrasystole induced late potentials has not been compared with late
potentials in sinus rhythm (SR) and right ventricular pacing (RVp).
Methods
Intraoperative simultaneous panoramic endocardial mapping of 21 VTs in 16 ischemic
heart disease patients was performed with the use of a 112-bipole endocardial balloon.
The decrement of near-field electrogram later than surface QRS during extrasystole
(eLP) was studied.
Results
Patients had a mean age of 52 ± 9 years and were predominantly (75%) male. The mean
sensitivity of eLP (0.75 [95% confidence interval [CI] 0.72-0.78]) to detect VT circuits
was better than SR (0.33 [0.30-0.36]; P < 0.001) and RVp (0.36 [0.33-0.39]; P < 0.001) without significant differences in specificity, eLP (0.77 [0.74-0.81], SR
(0.82 [0.80-0.84]; P = 0.23), and RVp (0.81 [0.78-0.83]; P = 0.11). Both negative (NPV) and positivie (PPV) predictive values were significantly
better for eLP mapping. The mean NPV was 0.77 (95% CI 0.74-0.81), 0.57 (0.55-0.59),
and 0.58 (0.55-0.61) for eLP, SR, and RVp, respectively (P < 0.0001). PPV was 0.75 (95% CI 0.72-0.78), 0.63 (0.59-0.67), and 0.63 (0.59-0.67)
for eLP, SR, and RVp, respectively (P < 0.001). Overall diagnostic performance (area under the receiver operating characteristic
curve) was significantly better for eLP (0.85 [95% CI 0.80-0.90] compared with SR
(0.63 [0.56-0.72]; P < 0.001) or RVp (0.61 [0.52-0.74]; P < 0.001).
Conclusions
Evoked late potential mapping is a better tool to detect comprehensive diastolic circuits
activated during VT, compared with eLP mapping in sinus rhythm or RV pacing.
Résumé
Contexte
L’identification de tous les circuits de tachycardie ventriculaire (activation diastolique),
y compris les circuits diastoliques partiels et complets dans les cas de tachycardie
ventriculaire (TV) clinique et non clinique, basée sur la cartographie des substrats,
pourrait être utile pour guider l’ablation du foyer de la tachycardie ventriculaire
afin d’en prévenir la récurrence. L’utilité des potentiels tardifs induits par l’extrasystole
n’a pas été comparée aux potentiels tardifs dans le cas d’un rythme sinusal et d’une
stimulation ventriculaire droite (SVD).
Méthodologie
Une cartographie endocardique panoramique simultanée peropératoire de 21 TV chez 16
patients atteints de cardiopathie ischémique a été réalisée à l’aide d’un ballon endocardique
à 112 dipôles. On a étudié la diminution de l’ECG en champ proche après le QRS de
surface pendant l’extrasystole (potentiels tardifs évoqués, ou PTe).
Résultats
Les patients étaient principalement des hommes (75 %) âgés en moyenne de 52 ± 9 ans.
La sensibilité moyenne des PTe (0,75 [intervalle de confiance (IC) à 95 %, 0,72-0,78])
pour détecter les circuits de TV était meilleure que pour un rythme sinusal (0,33
[IC à 95 %, 0,30-0,36]; P < 0,001) et la SVD (0,36 [IC à 95 %, 0,33-0,39]; P < 0.001) sans différence significative sur le plan de la spécificité : PTe (0,77
[IC à 95 %, 0,74-0,81]), rythme sinusal (0,82 [IC à 95 %, 0,80-0,84]; P = 0,23) et SVD (0,81 [IC à 95 %, 0.78-0.83]; P = 0,11). La valeur prédictive négative (VPN) et la valeur prédictive positive (VPP)
étaient significativement meilleures pour la cartographie des PTe. La VPN moyenne
était respectivement de 0,77 (IC à 95 %, 0,74-0,81), de 0,57 (IC à 95 %, 0,55-0,59)
et de 0,58 (IC à 95 %, 0,55-0,61) pour les PTe, le rythme sinusal et la SVD (P < 0,0001). La VPP était respectivement de 0,75 (IC à 95 %, 0,72-0,78), de 0,63 (IC à 95
%, 0,59-0,67) et de 0,63 (IC à 95 %, 0,59-0,67) pour les PTe, le rythme sinusal et
la SVD (P < 0,001). La performance diagnostique globale (aire sous la courbe) était significativement
meilleure pour les PTe (0,85 [IC à 95 %, 0,80-0,90]) que pour le rythme sinusal (0,63
[IC à 95 %, 0,56-0,72]; P < 0,001) ou la SVD (0,61 [IC à 95 %, 0,52-0,74]; P < 0,001).
Conclusions
En comparaison de la cartographie des potentiels tardifs dans le cas d’un rythme sinusal
ou d’une SVD, la cartographie des PTe est un meilleur outil pour détecter les circuits
diastoliques activés pendant la tachycardie ventriculaire.
Graphical abstract
Graphical Abstract
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Article info
Publication history
Published online: March 12, 2023
Accepted:
February 21,
2023
Received:
July 4,
2022
Publication stage
In Press Journal Pre-ProofFootnotes
See page 9 for disclosure information.
Identification
Copyright
© 2023 Canadian Cardiovascular Society. Published by Elsevier Inc. All rights reserved.
