Abstract
Background
Substrate mapping-based identification of all ventricular tachycardia (VT) circuits
(diastolic activation), including partial and complete diastolic circuits in clinical
and non-clinical VT, could be beneficial in guiding VT ablation to prevent VT recurrence.
The utility of extrasystole induced late potentials has not been compared to late
potentials in sinus rhythm and RV pacing.
Methods
Intraoperative simultaneous panoramic endocardial mapping of 21 VTs in 16 ischemic
heart disease patients was performed using a 112-bipole endocardial balloon. The decrement
of near field EGM later than surface QRS during extrasystole (eLP) was studied.
Results
Patients were predominantly male (75%) with a mean age of 52 ± 9 yrs. The mean sensitivity
of eLP (0.75[95% CI:0.72-0.78]) to detect VT circuits was better than SR (0.33[95%
CI:0.30-0.36] p<0.001) and RVp (0.36[95% CI:0.33-0.39] p<0.001) without significant
differences in specificity, eLP (0.77[95% CI:0.74-0.81], SR (0.82[95% CI:0.80- 0.84]
p=0.23), and RV pacing (0.81[95% CI:0.78-0.83] p=0.11). Both NPV and PPV were significantly
better for eLP mapping. The mean NPV was 0.77(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(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 (AUC) was significantly better for eLP (0.85[95% CI:0.80-0.90] compared
to SR (0.63[95% CI:0.56-0.72] p<0.001) or RVp (0.61[95% CI:0.52-0.74] p<0.001).
Conclusion
Evoked late potential mapping is a better tool to detect comprehensive diastolic circuits
activated during ventricular tachycardia, compared to late potential mapping in sinus
rhythm or RV pacing.
Graphical abstract
Graphical Abstract
Key Words
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Article info
Publication history
Accepted:
February 21,
2023
Received in revised form:
January 28,
2023
Received:
July 4,
2022
Publication stage
In Press Journal Pre-ProofFootnotes
No disclosures
What’s new?
•Comprehensive evaluation of ventricular tachycardia diastolic circuits including the complete circuit (isthmus) and all partial diastolic circuits of all clinical and non-clinical VTs, has not been reported before.
•Evoked late potential (eLP) mapping has more predictive value than conventional mapping in sinus rhythm or RV pacing to identify late potentials that co-localize with both complete and partial diastolic VT circuits.
•Identification of eLP simplifies the substrate mapping obviating the need for intricate measurements of decrement of local electrogram after the introduction of extrasystole.
Identification
Copyright
© 2023 Published by Elsevier Inc. on behalf of the Canadian Cardiovascular Society.
