Signature signal strategy: electrogram-based ventricular tachycardia mapping

Nayyar, Sachin, Downar, Eugene, Bhaskaran, Abhishek P., Masse, Stephane, and Nanthakumar, Kumaraswamy (2020) Signature signal strategy: electrogram-based ventricular tachycardia mapping. Heart Rhythm, 17 (11). pp. 2000-2009.

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Abstract

Multiple decades of work have recognized complexities of substrates responsible for ventricular tachycardia (VT). There is sufficient evidence that 3 critical components of a re-entrant VT circuit, namely, region of slow conduction, zone of unidirectional block, and exit site, are located in spatial vicinity to each other in the ventricular scar. Each of these components expresses characteristic electrograms in sinus rhythm, at initiation of VT, and during VT, respectively. Despite this, abnormal electrograms are widely targeted without appreciation of these signature electrograms during contemporary VT ablation. Our aim is to stimulate physiology-based VT mapping and a targeted ablation of VT. In this article, we focus on these 3 underappreciated aspects of the physiology of ischemic scar-related VT circuits that have practical applications during a VT ablation procedure. We explore the anatomic and functional elements underlying these distinctive bipolar electro-grams, specifically the contribution of tissue branching, conduction restitution, and wave curvature to the substrate, as they pertain to initiation and maintenance of VT. We propose a VT ablation approach based on these 3 electrogram features that can be a potential practical means to recognize critical elements of a VT circuit and target ablation.

Item ID: 66193
Item Type: Article (Research - C1)
ISSN: 1556-3871
Keywords: Branching, Conduction, Electrogram mapping, Ventricular tachycardia, Wave curvature
Copyright Information: Copyright © 2020 Heart Rhythm Society.
Funders: Townsville Hospital and Health Service (THHS)
Projects and Grants: THHS SERTA Grant (2019_03)
Date Deposited: 25 Nov 2020 08:19
FoR Codes: 32 BIOMEDICAL AND CLINICAL SCIENCES > 3201 Cardiovascular medicine and haematology > 320101 Cardiology (incl. cardiovascular diseases) @ 100%
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