Simultaneous Amplitude Frequency Electrogram Transformation (SAFE-T) Mapping to Identify Ventricular Tachycardia Arrhythmogenic Potentials in Sinus Rhythm

Chin Yu Lin, John Silberbauer, Yenn Jiang Lin, Men Tzung Lo, Chen Lin, Hsiang Chih Chang, Shih Lin Chang, Li Wei Lo, Yu Feng Hu, Fa Po Chung, Jo Nan Liao, Yun Yu Chen, Chun Wang Chiou, Shih Ann Chen, Paolo Della Bella

Research output: Contribution to journalArticlepeer-review

Abstract

Objectives This study sought to develop a novel automated technique, simultaneous amplitude frequency electrogram transformation (SAFE-T), to identify ventricular tachycardia (VT) isthmuses by analysis of sinus rhythm arrhythmogenic potentials (AP). Background Substrate ablation is useful for patients with scar-related hemodynamically unstable VT; however, the accuracy of different approaches remains inadequate, varying from targeting late potentials to full scar homogenization. Methods High-density ventricular mapping was performed in 3 groups: 1) 18 normal heart control subjects; 2) 10 ischemic patients; and 3) 8 nonischemic VT patients. In VT patients, isthmus sites were characterized using entrainment responses. Sinus rhythm right ventricle/left ventricle endocardial and epicardial electrograms underwent Hilbert-Huang spectral analysis and were displayed as 3-dimensional SAFE-T maps. AP and their relation to the VT isthmus sites were studied. Results AP were defined by a cutoff value of 3.08 Hz mV using normal heart control subjects. Receiver-operating characteristics showed that VT isthmus sites were best identified using SAFE-T mapping (p < 0.001) as compared with bipolar and unipolar scar and late potential mapping with an optimal cutoff value of 3.09 Hz mV, allowing identification of 100% of the 34 mapped VT isthmuses, compared with 68% using late potentials. There was no significant difference between sinus rhythm and paced SAFE-T values. Abnormal SAFE-T areas involved about one-quarter of the scar total area. Conclusions Automated electrogram analysis using 3-dimensional SAFE-T mapping allows rapid and objective identification of AP that reliably detect VT isthmuses. The results suggest that SAFE-T mapping is good alternative strategy to late potential mapping in identifying VT isthmuses and allows reduced ablation as compared to scar homogenization.

Original languageEnglish
Pages (from-to)459-470
Number of pages12
JournalJACC: Clinical Electrophysiology
Volume2
Issue number4
DOIs
Publication statusPublished - Aug 1 2016

Keywords

  • arrhythmogenic potentials
  • catheter ablation
  • Hilbert-Huang transform
  • isthmus
  • ventricular tachycardia

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Physiology (medical)

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