Electroanatomical Voltage and Morphology Characteristics in Postinfarction Patients Undergoing Ventricular Tachycardia Ablation

Dimitris Tsiachris, John Silberbauer, Giuseppe Maccabelli, Teresa Oloriz, Francesca Baratto, Hiroya Mizuno, Caterina Bisceglia, Pasquale Vergara, Alessandra Marzi, Nicoleta Sora, Fabrizio Guarracini, Andrea Radinovic, Manuela Cireddu, Simone Sala, Simone Gulletta, Gabriele Paglino, Patrizio Mazzone, Nicola Trevisi, Paolo Della Bella

Research output: Contribution to journalArticle

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Abstract

Background - Catheter ablation is an important therapeutic option in postmyocardial infarction patients with ventricular tachycardia (VT). We analyzed the endo-epicardial electroanatomical mapping (EAM) voltage and morphology characteristics, their association with clinical data and their prognostic value in a large cohort of postmyocardial infarction patients. Methods and Results - We performed total and segmental analysis of voltage (bipolar dense scar [DS] and low voltage areas, unipolar low voltage and penumbra areas) and morphology characteristics (presence of abnormal late potentials [LPs] and early potentials [EPs]) in 100 postmyocardial infarction patients undergoing electroanatomical mapping-based VT ablation (26 endo-epicardial procedures) from 2010-2012. All patients had unipolar low voltage areas, whereas 18% had no identifiable endocardial bipolar DS areas. Endocardial bipolar DS area >22.5 cm 2 best predicted scar transmurality. Endo-epicardial LPs were recorded in 2/3 patients, more frequently in nonseptal myocardial segments and were abolished in 51%. Endocardial bipolar DS area >7 cm 2 and endocardial bipolar scar density >0.35 predicted epicardial LPs. Isolated LPs are located mainly epicardially and EPs endocardially. As a primary strategy, LPs and VT-mapping ablation occurred in 48%, only VT-mapping ablation in 27%, only LPs ablation in 17%, and EPs ablation in 6%. Endocardial LP abolition was associated with reduced VT recurrence and increased unipolar penumbra area predicted cardiac death. Conclusions - Endocardial scar extension and density predict scar transmurality and endo-epicardial presence of LPs, although DS is not always identified in postmyocardial infarction patients. LPs, most frequently located in nonseptal myocardial segments, were abolished in 51% resulting in improved outcome.

Original languageEnglish
Pages (from-to)863-873
Number of pages11
JournalCirculation: Arrhythmia and Electrophysiology
Volume8
Issue number4
DOIs
Publication statusPublished - Aug 22 2015

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Ventricular Tachycardia
Cicatrix
Infarction
Epicardial Mapping
Catheter Ablation
Recurrence

Keywords

  • catheter ablation
  • endocardium
  • myocardial infarction
  • myocardium
  • tachycardia
  • ventricular

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Physiology (medical)
  • Medicine(all)

Cite this

Electroanatomical Voltage and Morphology Characteristics in Postinfarction Patients Undergoing Ventricular Tachycardia Ablation. / Tsiachris, Dimitris; Silberbauer, John; Maccabelli, Giuseppe; Oloriz, Teresa; Baratto, Francesca; Mizuno, Hiroya; Bisceglia, Caterina; Vergara, Pasquale; Marzi, Alessandra; Sora, Nicoleta; Guarracini, Fabrizio; Radinovic, Andrea; Cireddu, Manuela; Sala, Simone; Gulletta, Simone; Paglino, Gabriele; Mazzone, Patrizio; Trevisi, Nicola; Della Bella, Paolo.

In: Circulation: Arrhythmia and Electrophysiology, Vol. 8, No. 4, 22.08.2015, p. 863-873.

Research output: Contribution to journalArticle

Tsiachris, D, Silberbauer, J, Maccabelli, G, Oloriz, T, Baratto, F, Mizuno, H, Bisceglia, C, Vergara, P, Marzi, A, Sora, N, Guarracini, F, Radinovic, A, Cireddu, M, Sala, S, Gulletta, S, Paglino, G, Mazzone, P, Trevisi, N & Della Bella, P 2015, 'Electroanatomical Voltage and Morphology Characteristics in Postinfarction Patients Undergoing Ventricular Tachycardia Ablation', Circulation: Arrhythmia and Electrophysiology, vol. 8, no. 4, pp. 863-873. https://doi.org/10.1161/CIRCEP.114.002551
Tsiachris, Dimitris ; Silberbauer, John ; Maccabelli, Giuseppe ; Oloriz, Teresa ; Baratto, Francesca ; Mizuno, Hiroya ; Bisceglia, Caterina ; Vergara, Pasquale ; Marzi, Alessandra ; Sora, Nicoleta ; Guarracini, Fabrizio ; Radinovic, Andrea ; Cireddu, Manuela ; Sala, Simone ; Gulletta, Simone ; Paglino, Gabriele ; Mazzone, Patrizio ; Trevisi, Nicola ; Della Bella, Paolo. / Electroanatomical Voltage and Morphology Characteristics in Postinfarction Patients Undergoing Ventricular Tachycardia Ablation. In: Circulation: Arrhythmia and Electrophysiology. 2015 ; Vol. 8, No. 4. pp. 863-873.
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T1 - Electroanatomical Voltage and Morphology Characteristics in Postinfarction Patients Undergoing Ventricular Tachycardia Ablation

AU - Tsiachris, Dimitris

AU - Silberbauer, John

AU - Maccabelli, Giuseppe

AU - Oloriz, Teresa

AU - Baratto, Francesca

AU - Mizuno, Hiroya

AU - Bisceglia, Caterina

AU - Vergara, Pasquale

AU - Marzi, Alessandra

AU - Sora, Nicoleta

AU - Guarracini, Fabrizio

AU - Radinovic, Andrea

AU - Cireddu, Manuela

AU - Sala, Simone

AU - Gulletta, Simone

AU - Paglino, Gabriele

AU - Mazzone, Patrizio

AU - Trevisi, Nicola

AU - Della Bella, Paolo

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N2 - Background - Catheter ablation is an important therapeutic option in postmyocardial infarction patients with ventricular tachycardia (VT). We analyzed the endo-epicardial electroanatomical mapping (EAM) voltage and morphology characteristics, their association with clinical data and their prognostic value in a large cohort of postmyocardial infarction patients. Methods and Results - We performed total and segmental analysis of voltage (bipolar dense scar [DS] and low voltage areas, unipolar low voltage and penumbra areas) and morphology characteristics (presence of abnormal late potentials [LPs] and early potentials [EPs]) in 100 postmyocardial infarction patients undergoing electroanatomical mapping-based VT ablation (26 endo-epicardial procedures) from 2010-2012. All patients had unipolar low voltage areas, whereas 18% had no identifiable endocardial bipolar DS areas. Endocardial bipolar DS area >22.5 cm 2 best predicted scar transmurality. Endo-epicardial LPs were recorded in 2/3 patients, more frequently in nonseptal myocardial segments and were abolished in 51%. Endocardial bipolar DS area >7 cm 2 and endocardial bipolar scar density >0.35 predicted epicardial LPs. Isolated LPs are located mainly epicardially and EPs endocardially. As a primary strategy, LPs and VT-mapping ablation occurred in 48%, only VT-mapping ablation in 27%, only LPs ablation in 17%, and EPs ablation in 6%. Endocardial LP abolition was associated with reduced VT recurrence and increased unipolar penumbra area predicted cardiac death. Conclusions - Endocardial scar extension and density predict scar transmurality and endo-epicardial presence of LPs, although DS is not always identified in postmyocardial infarction patients. LPs, most frequently located in nonseptal myocardial segments, were abolished in 51% resulting in improved outcome.

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KW - catheter ablation

KW - endocardium

KW - myocardial infarction

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KW - tachycardia

KW - ventricular

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