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The electrical circuit of a hemodynamically unstable and recurrent ventricular tachycardia diagnosed in 35 s with the Rhythmia mapping system.

ABSTRACT: Herein, we report a 47-year-old woman with ischemic cardiomyopathy who underwent ablation therapy due to an electrical storm without any triggers. The voltage mapping in sinus rhythm with the Rhythmia system and Orion catheter displayed several LAVAs in and around the anteroapical scar area. Although the patient did not tolerate the induced clinical ventricular tachycardia, which was reproductively induced, 35-second-mapping in the scar zone with the Orion catheter demonstrated the VT circuit with the critical isthmus. This report shows the possibility of the new ultra-high density mapping system in a specific ischemic VT patient.

SUBMITTER: Takigawa M

PROVIDER: S-EPMC5634715 | biostudies-literature | 2017 Oct

REPOSITORIES: biostudies-literature

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The electrical circuit of a hemodynamically unstable and recurrent ventricular tachycardia diagnosed in 35 s with the Rhythmia mapping system.

Takigawa Masateru M Frontera Antonio A Thompson Nathaniel N Capellino Stefano S Jais Pierre P Sacher Frederic F

Journal of arrhythmia 20170802 5

Herein, we report a 47-year-old woman with ischemic cardiomyopathy who underwent ablation therapy due to an electrical storm without any triggers. The voltage mapping in sinus rhythm with the Rhythmia system and Orion catheter displayed several LAVAs in and around the anteroapical scar area. Although the patient did not tolerate the induced clinical ventricular tachycardia, which was reproductively induced, 35-second-mapping in the scar zone with the Orion catheter demonstrated the VT circuit wi ...[more]

PMID: 29021859

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Project description:Infarct border zone (IBZ) geometry likely affects inducibility and characteristics of postinfarction reentrant ventricular tachycardia, but the connection has not been established.The purpose of this study was to determine characteristics of postinfarction ventricular tachycardia in the IBZ.A geometric model describing the relationship between IBZ geometry and wavefront propagation in reentrant circuits was developed. Based on the formulation, slow conduction and block were expected to coincide with areas where IBZ thickness (T) is minimal and the local spatial gradient in thickness (DeltaT) is maximal, so that the degree of wavefront curvature rho proportional, variant DeltaT/T is maximal. Regions of fastest conduction velocity were predicted to coincide with areas of minimum DeltaT. In seven arrhythmogenic postinfarction canine heart experiments, tachycardia was induced by programmed stimulation, and activation maps were constructed from multichannel recordings. IBZ thickness was measured in excised hearts from histologic analysis or magnetic resonance imaging. Reentrant circuit properties were predicted from IBZ geometry and compared with ventricular activation maps after tachycardia induction.Mean IBZ thickness was 231 +/- 140 microm at the reentry isthmus and 1440 +/- 770 microm in the outer pathway (P <0.001). Mean curvature rho was 1.63 +/- 0.45 mm(-1) at functional block line locations, 0.71 +/- 0.18 mm(-1) at isthmus entrance-exit points, and 0.33 +/- 0.13 mm(-1) in the outer reentrant circuit pathway. The mean conduction velocity about the circuit during reentrant tachycardia was 0.32 +/- 0.04 mm/ms at entrance-exit points, 0.42 +/- 0.13 mm/ms for the entire outer pathway, and 0.64 +/- 0.16 mm/ms at outer pathway regions with minimum DeltaT. Model sensitivity and specificity to detect isthmus location was 75.0% and 97.2%.Reentrant circuit features as determined by activation mapping can be predicted on the basis of IBZ geometrical relationships.

Dataset Information

The electrical circuit of a hemodynamically unstable and recurrent ventricular tachycardia diagnosed in 35 s with the Rhythmia mapping system.

Publications

The electrical circuit of a hemodynamically unstable and recurrent ventricular tachycardia diagnosed in 35 s with the Rhythmia mapping system.

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