The Different Substrate Characteristics of Arrhythmogenic Triggers in Idiopathic Right Ventricular Outflow Tract Tachycardia and Arrhythmogenic Right Ventricular Dysplasia: New Insight from Noncontact Mapping
The aim of this study was to investigate the different substrate characteristics of repetitive premature ventricular complexed (PVC) trigger sites by the non-contact mapping (NCM). Thirty-five consecutive patients, including 14 with arrhythmogenic right ventricular cardiomyopathy/dysplasia (ARVC) an...
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| Veröffentlicht in: | PloS one 2015-10, Vol.10 (10), p.e0140167-e0140167 |
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| creator | Do, Van Buu Dan Tsai, Wen-Chin Lin, Yenn-Jiang Higa, Satoshi Yagi, Nobumori Chang, Shih-Lin Lo, Li-Wei Chung, Fa-Po Liao, Jo-Nan Huang, Yen-Chang Chan, Chao-Shun Huang, Hung-Kai Hu, Yu-Feng Tsao, Hsuan-Ming Chen, Shih-Ann |
| description | The aim of this study was to investigate the different substrate characteristics of repetitive premature ventricular complexed (PVC) trigger sites by the non-contact mapping (NCM).
Thirty-five consecutive patients, including 14 with arrhythmogenic right ventricular cardiomyopathy/dysplasia (ARVC) and 21 with idiopathic right ventricular outflow tract tachycardia (RVOT VT), were enrolled for electrophysiological study and catheter ablation guided by the NCM. Substrate and electrogram (Eg) characteristics of the earliest activation (EA) and breakout (BO) sites of PVCs were investigated, and these were confirmed by successful PVC elimination.
Overall 35 dominant focal PVCs were identified. PVCs arose from the focal origins with preferential conduction, breakout, and spread to the whole right ventricle. The conduction time and distance from EA to BO site were both longer in the ARVC than the RVOT group. The conduction velocity was similar between the 2 groups. The negative deflection of local unipolar Eg at the EA site (EA slope3,5,10ms values) was steeper in the RVOT, compared to ARVC patients. The PVCs of ARVC occurred in the diseased substrate in the ARVC patients. More radiofrequency applications were required to eliminate the triggers in ARVC patients.
The substrate characteristics of PVC trigger may help to differentiate between idiopathic RVOT VT and ARVC. The slowing and slurred QS unipolar electrograms and longer distance from EA to BO in RVOT endocardium suggest that the triggers of ARVC may originate from mid- or sub-epicardial myocardium. More extensive ablation to the trigger site was required in order to create deeper lesions for a successful outcome. |
| doi_str_mv | 10.1371/journal.pone.0140167 |
| format | Article |
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Thirty-five consecutive patients, including 14 with arrhythmogenic right ventricular cardiomyopathy/dysplasia (ARVC) and 21 with idiopathic right ventricular outflow tract tachycardia (RVOT VT), were enrolled for electrophysiological study and catheter ablation guided by the NCM. Substrate and electrogram (Eg) characteristics of the earliest activation (EA) and breakout (BO) sites of PVCs were investigated, and these were confirmed by successful PVC elimination.
Overall 35 dominant focal PVCs were identified. PVCs arose from the focal origins with preferential conduction, breakout, and spread to the whole right ventricle. The conduction time and distance from EA to BO site were both longer in the ARVC than the RVOT group. The conduction velocity was similar between the 2 groups. The negative deflection of local unipolar Eg at the EA site (EA slope3,5,10ms values) was steeper in the RVOT, compared to ARVC patients. The PVCs of ARVC occurred in the diseased substrate in the ARVC patients. More radiofrequency applications were required to eliminate the triggers in ARVC patients.
The substrate characteristics of PVC trigger may help to differentiate between idiopathic RVOT VT and ARVC. The slowing and slurred QS unipolar electrograms and longer distance from EA to BO in RVOT endocardium suggest that the triggers of ARVC may originate from mid- or sub-epicardial myocardium. More extensive ablation to the trigger site was required in order to create deeper lesions for a successful outcome.</description><identifier>ISSN: 1932-6203</identifier><identifier>EISSN: 1932-6203</identifier><identifier>DOI: 10.1371/journal.pone.0140167</identifier><identifier>PMID: 26488594</identifier><language>eng</language><publisher>United States: Public Library of Science</publisher><subject>Ablation ; Adult ; Arrhythmias, Cardiac - diagnosis ; Arrhythmias, Cardiac - physiopathology ; Arrhythmias, Cardiac - surgery ; Arrhythmogenic Right Ventricular Dysplasia - diagnosis ; Arrhythmogenic Right Ventricular Dysplasia - physiopathology ; Arrhythmogenic Right Ventricular Dysplasia - surgery ; Cardiac arrhythmia ; Cardiology ; Cardiomyopathy ; Care and treatment ; Catheter Ablation ; Catheters ; Clinical medicine ; Complications and side effects ; Conduction ; Disease ; Dysplasia ; Electrocardiography ; Electrophysiologic Techniques, Cardiac - methods ; Electrophysiological recording ; Endocardium - physiopathology ; Female ; Follow-Up Studies ; Health aspects ; Heart ; Heart Conduction System - physiopathology ; Heart Ventricles - physiopathology ; Hospitals ; Humans ; Laboratories ; Lesions ; Male ; Mapping ; Medical instruments ; Medicine ; Middle Aged ; Myocardium ; Patients ; Pulmonary arteries ; Radio frequency ; Radiofrequency ablation ; Right ventricular dysplasia ; Risk factors ; Substrates ; Tachycardia ; Tachycardia, Ventricular - diagnosis ; Tachycardia, Ventricular - physiopathology ; Tachycardia, Ventricular - surgery ; Treatment Outcome ; Ventricle ; Ventricular dysplasia</subject><ispartof>PloS one, 2015-10, Vol.10 (10), p.e0140167-e0140167</ispartof><rights>COPYRIGHT 2015 Public Library of Science</rights><rights>2015 Do et al. This is an open access article distributed under the terms of the Creative Commons Attribution License: http://creativecommons.org/licenses/by/4.0/ (the “License”), which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.</rights><rights>2015 Do et al 2015 Do et al</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c692t-f849632c6b8d70e54451399a43e293e914aad2b50f9453ed82e48ba9212aaa743</citedby><cites>FETCH-LOGICAL-c692t-f849632c6b8d70e54451399a43e293e914aad2b50f9453ed82e48ba9212aaa743</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC4619190/pdf/$$EPDF$$P50$$Gpubmedcentral$$Hfree_for_read</linktopdf><linktohtml>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC4619190/$$EHTML$$P50$$Gpubmedcentral$$Hfree_for_read</linktohtml><link.rule.ids>230,314,723,776,780,860,881,2096,2915,23845,27901,27902,53766,53768,79343,79344</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/26488594$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Do, Van Buu Dan</creatorcontrib><creatorcontrib>Tsai, Wen-Chin</creatorcontrib><creatorcontrib>Lin, Yenn-Jiang</creatorcontrib><creatorcontrib>Higa, Satoshi</creatorcontrib><creatorcontrib>Yagi, Nobumori</creatorcontrib><creatorcontrib>Chang, Shih-Lin</creatorcontrib><creatorcontrib>Lo, Li-Wei</creatorcontrib><creatorcontrib>Chung, Fa-Po</creatorcontrib><creatorcontrib>Liao, Jo-Nan</creatorcontrib><creatorcontrib>Huang, Yen-Chang</creatorcontrib><creatorcontrib>Chan, Chao-Shun</creatorcontrib><creatorcontrib>Huang, Hung-Kai</creatorcontrib><creatorcontrib>Hu, Yu-Feng</creatorcontrib><creatorcontrib>Tsao, Hsuan-Ming</creatorcontrib><creatorcontrib>Chen, Shih-Ann</creatorcontrib><title>The Different Substrate Characteristics of Arrhythmogenic Triggers in Idiopathic Right Ventricular Outflow Tract Tachycardia and Arrhythmogenic Right Ventricular Dysplasia: New Insight from Noncontact Mapping</title><title>PloS one</title><addtitle>PLoS One</addtitle><description>The aim of this study was to investigate the different substrate characteristics of repetitive premature ventricular complexed (PVC) trigger sites by the non-contact mapping (NCM).
Thirty-five consecutive patients, including 14 with arrhythmogenic right ventricular cardiomyopathy/dysplasia (ARVC) and 21 with idiopathic right ventricular outflow tract tachycardia (RVOT VT), were enrolled for electrophysiological study and catheter ablation guided by the NCM. Substrate and electrogram (Eg) characteristics of the earliest activation (EA) and breakout (BO) sites of PVCs were investigated, and these were confirmed by successful PVC elimination.
Overall 35 dominant focal PVCs were identified. PVCs arose from the focal origins with preferential conduction, breakout, and spread to the whole right ventricle. The conduction time and distance from EA to BO site were both longer in the ARVC than the RVOT group. The conduction velocity was similar between the 2 groups. The negative deflection of local unipolar Eg at the EA site (EA slope3,5,10ms values) was steeper in the RVOT, compared to ARVC patients. The PVCs of ARVC occurred in the diseased substrate in the ARVC patients. More radiofrequency applications were required to eliminate the triggers in ARVC patients.
The substrate characteristics of PVC trigger may help to differentiate between idiopathic RVOT VT and ARVC. The slowing and slurred QS unipolar electrograms and longer distance from EA to BO in RVOT endocardium suggest that the triggers of ARVC may originate from mid- or sub-epicardial myocardium. More extensive ablation to the trigger site was required in order to create deeper lesions for a successful outcome.</description><subject>Ablation</subject><subject>Adult</subject><subject>Arrhythmias, Cardiac - diagnosis</subject><subject>Arrhythmias, Cardiac - physiopathology</subject><subject>Arrhythmias, Cardiac - surgery</subject><subject>Arrhythmogenic Right Ventricular Dysplasia - diagnosis</subject><subject>Arrhythmogenic Right Ventricular Dysplasia - physiopathology</subject><subject>Arrhythmogenic Right Ventricular Dysplasia - surgery</subject><subject>Cardiac arrhythmia</subject><subject>Cardiology</subject><subject>Cardiomyopathy</subject><subject>Care and treatment</subject><subject>Catheter Ablation</subject><subject>Catheters</subject><subject>Clinical medicine</subject><subject>Complications and side effects</subject><subject>Conduction</subject><subject>Disease</subject><subject>Dysplasia</subject><subject>Electrocardiography</subject><subject>Electrophysiologic Techniques, Cardiac - methods</subject><subject>Electrophysiological recording</subject><subject>Endocardium - physiopathology</subject><subject>Female</subject><subject>Follow-Up Studies</subject><subject>Health aspects</subject><subject>Heart</subject><subject>Heart Conduction System - physiopathology</subject><subject>Heart Ventricles - physiopathology</subject><subject>Hospitals</subject><subject>Humans</subject><subject>Laboratories</subject><subject>Lesions</subject><subject>Male</subject><subject>Mapping</subject><subject>Medical instruments</subject><subject>Medicine</subject><subject>Middle Aged</subject><subject>Myocardium</subject><subject>Patients</subject><subject>Pulmonary arteries</subject><subject>Radio frequency</subject><subject>Radiofrequency ablation</subject><subject>Right ventricular dysplasia</subject><subject>Risk factors</subject><subject>Substrates</subject><subject>Tachycardia</subject><subject>Tachycardia, Ventricular - diagnosis</subject><subject>Tachycardia, Ventricular - physiopathology</subject><subject>Tachycardia, Ventricular - surgery</subject><subject>Treatment Outcome</subject><subject>Ventricle</subject><subject>Ventricular dysplasia</subject><issn>1932-6203</issn><issn>1932-6203</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2015</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>BENPR</sourceid><sourceid>DOA</sourceid><recordid>eNqNk89u1DAQxiMEoqXwBggsISE47BI7dhJzQKpa_qxUWqlderUmziRxlY0X26HsW_JIeNtt1S09IB9iTX7fN54ZTZK8pOmUZgX9cGFHN0A_XdoBpynlKc2LR8kulRmb5CzNHt-57yTPvL9IU5GVef402WE5L0sh-W7yZ94hOTRNgw6HQM7GygcHAclBBw50QGd8MNoT25B957pV6Ba2xcFoMnembdF5YgYyq41dQuhi-NS0XSDn0c0ZPfbgyMkYmt5eRkE0JHPQ3UqDqw0QGOr7rv_KD1d-2YM38JEc4yWZDf4KaZxdkGM7aDuEte93WC7N0D5PnjTQe3yx-e4lP758nh98mxydfJ0d7B9NdC5ZmDQll3nGdF6VdZGi4FzQTErgGTKZoaQcoGaVSBvJRYZ1yZCXFUhGGQAUPNtLXl_7Lnvr1WYYXtGCiZSWqRSRmF0TtYULtXRmAW6lLBh1FbCuVeBib3tUPD5ACMSa1gWnBZUQs2GT66pimWBV9Pq0yTZWC6z1uj3Qb5lu_xlMp1r7S_GcSirTaPBuY-DszxF9UAvjNfY9DGjHq3fHogohWETf3EMfrm5DtRALMENjY169NlX7PGOMCcqLSE0foOKpcWHi5LAxMb4leL8lWE8Xf4cWRu_V7Oz0_9mT82327R22Q-hD520_BmMHvw3ya1A7673D5rbJNFXrxbvphlovntosXpS9ujugW9HNpmV_AQYqLP0</recordid><startdate>20151021</startdate><enddate>20151021</enddate><creator>Do, Van Buu Dan</creator><creator>Tsai, Wen-Chin</creator><creator>Lin, Yenn-Jiang</creator><creator>Higa, Satoshi</creator><creator>Yagi, Nobumori</creator><creator>Chang, Shih-Lin</creator><creator>Lo, Li-Wei</creator><creator>Chung, Fa-Po</creator><creator>Liao, Jo-Nan</creator><creator>Huang, Yen-Chang</creator><creator>Chan, Chao-Shun</creator><creator>Huang, Hung-Kai</creator><creator>Hu, Yu-Feng</creator><creator>Tsao, Hsuan-Ming</creator><creator>Chen, Shih-Ann</creator><general>Public Library of Science</general><general>Public Library of Science (PLoS)</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>IOV</scope><scope>ISR</scope><scope>3V.</scope><scope>7QG</scope><scope>7QL</scope><scope>7QO</scope><scope>7RV</scope><scope>7SN</scope><scope>7SS</scope><scope>7T5</scope><scope>7TG</scope><scope>7TM</scope><scope>7U9</scope><scope>7X2</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8AO</scope><scope>8C1</scope><scope>8FD</scope><scope>8FE</scope><scope>8FG</scope><scope>8FH</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABJCF</scope><scope>ABUWG</scope><scope>AEUYN</scope><scope>AFKRA</scope><scope>ARAPS</scope><scope>ATCPS</scope><scope>AZQEC</scope><scope>BBNVY</scope><scope>BENPR</scope><scope>BGLVJ</scope><scope>BHPHI</scope><scope>C1K</scope><scope>CCPQU</scope><scope>D1I</scope><scope>DWQXO</scope><scope>FR3</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>GNUQQ</scope><scope>H94</scope><scope>HCIFZ</scope><scope>K9.</scope><scope>KB.</scope><scope>KB0</scope><scope>KL.</scope><scope>L6V</scope><scope>LK8</scope><scope>M0K</scope><scope>M0S</scope><scope>M1P</scope><scope>M7N</scope><scope>M7P</scope><scope>M7S</scope><scope>NAPCQ</scope><scope>P5Z</scope><scope>P62</scope><scope>P64</scope><scope>PATMY</scope><scope>PDBOC</scope><scope>PIMPY</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PTHSS</scope><scope>PYCSY</scope><scope>RC3</scope><scope>7X8</scope><scope>5PM</scope><scope>DOA</scope></search><sort><creationdate>20151021</creationdate><title>The Different Substrate Characteristics of Arrhythmogenic Triggers in Idiopathic Right Ventricular Outflow Tract Tachycardia and Arrhythmogenic Right Ventricular Dysplasia: New Insight from Noncontact Mapping</title><author>Do, Van Buu Dan ; Tsai, Wen-Chin ; Lin, Yenn-Jiang ; Higa, Satoshi ; Yagi, Nobumori ; Chang, Shih-Lin ; Lo, Li-Wei ; Chung, Fa-Po ; Liao, Jo-Nan ; Huang, Yen-Chang ; Chan, Chao-Shun ; Huang, Hung-Kai ; Hu, Yu-Feng ; Tsao, Hsuan-Ming ; Chen, Shih-Ann</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c692t-f849632c6b8d70e54451399a43e293e914aad2b50f9453ed82e48ba9212aaa743</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2015</creationdate><topic>Ablation</topic><topic>Adult</topic><topic>Arrhythmias, Cardiac - 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physiopathology</topic><topic>Hospitals</topic><topic>Humans</topic><topic>Laboratories</topic><topic>Lesions</topic><topic>Male</topic><topic>Mapping</topic><topic>Medical instruments</topic><topic>Medicine</topic><topic>Middle Aged</topic><topic>Myocardium</topic><topic>Patients</topic><topic>Pulmonary arteries</topic><topic>Radio frequency</topic><topic>Radiofrequency ablation</topic><topic>Right ventricular dysplasia</topic><topic>Risk factors</topic><topic>Substrates</topic><topic>Tachycardia</topic><topic>Tachycardia, Ventricular - diagnosis</topic><topic>Tachycardia, Ventricular - physiopathology</topic><topic>Tachycardia, Ventricular - surgery</topic><topic>Treatment Outcome</topic><topic>Ventricle</topic><topic>Ventricular dysplasia</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Do, Van Buu Dan</creatorcontrib><creatorcontrib>Tsai, Wen-Chin</creatorcontrib><creatorcontrib>Lin, Yenn-Jiang</creatorcontrib><creatorcontrib>Higa, Satoshi</creatorcontrib><creatorcontrib>Yagi, Nobumori</creatorcontrib><creatorcontrib>Chang, Shih-Lin</creatorcontrib><creatorcontrib>Lo, Li-Wei</creatorcontrib><creatorcontrib>Chung, Fa-Po</creatorcontrib><creatorcontrib>Liao, Jo-Nan</creatorcontrib><creatorcontrib>Huang, Yen-Chang</creatorcontrib><creatorcontrib>Chan, Chao-Shun</creatorcontrib><creatorcontrib>Huang, Hung-Kai</creatorcontrib><creatorcontrib>Hu, Yu-Feng</creatorcontrib><creatorcontrib>Tsao, Hsuan-Ming</creatorcontrib><creatorcontrib>Chen, Shih-Ann</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>Gale In Context: Opposing Viewpoints</collection><collection>Gale In Context: Science</collection><collection>ProQuest Central (Corporate)</collection><collection>Animal Behavior Abstracts</collection><collection>Bacteriology Abstracts (Microbiology B)</collection><collection>Biotechnology Research Abstracts</collection><collection>Nursing & Allied Health Database</collection><collection>Ecology Abstracts</collection><collection>Entomology Abstracts (Full archive)</collection><collection>Immunology Abstracts</collection><collection>Meteorological & Geoastrophysical Abstracts</collection><collection>Nucleic Acids Abstracts</collection><collection>Virology and AIDS Abstracts</collection><collection>Agricultural Science Collection</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>ProQuest Pharma Collection</collection><collection>Public Health Database</collection><collection>Technology Research Database</collection><collection>ProQuest SciTech Collection</collection><collection>ProQuest Technology Collection</collection><collection>ProQuest Natural Science Collection</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>Materials Science & Engineering Collection</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest One Sustainability</collection><collection>ProQuest Central UK/Ireland</collection><collection>Advanced Technologies & Aerospace Collection</collection><collection>Agricultural & Environmental Science Collection</collection><collection>ProQuest Central Essentials</collection><collection>Biological Science Collection</collection><collection>ProQuest Central</collection><collection>Technology Collection</collection><collection>Natural Science Collection</collection><collection>Environmental Sciences and Pollution Management</collection><collection>ProQuest One Community College</collection><collection>ProQuest Materials Science Collection</collection><collection>ProQuest Central Korea</collection><collection>Engineering Research Database</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Central Student</collection><collection>AIDS and Cancer Research Abstracts</collection><collection>SciTech Premium Collection</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Materials Science Database</collection><collection>Nursing & Allied Health Database (Alumni Edition)</collection><collection>Meteorological & Geoastrophysical Abstracts - 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Academic</collection><collection>PubMed Central (Full Participant titles)</collection><collection>DOAJ Directory of Open Access Journals</collection><jtitle>PloS one</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Do, Van Buu Dan</au><au>Tsai, Wen-Chin</au><au>Lin, Yenn-Jiang</au><au>Higa, Satoshi</au><au>Yagi, Nobumori</au><au>Chang, Shih-Lin</au><au>Lo, Li-Wei</au><au>Chung, Fa-Po</au><au>Liao, Jo-Nan</au><au>Huang, Yen-Chang</au><au>Chan, Chao-Shun</au><au>Huang, Hung-Kai</au><au>Hu, Yu-Feng</au><au>Tsao, Hsuan-Ming</au><au>Chen, Shih-Ann</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>The Different Substrate Characteristics of Arrhythmogenic Triggers in Idiopathic Right Ventricular Outflow Tract Tachycardia and Arrhythmogenic Right Ventricular Dysplasia: New Insight from Noncontact Mapping</atitle><jtitle>PloS one</jtitle><addtitle>PLoS One</addtitle><date>2015-10-21</date><risdate>2015</risdate><volume>10</volume><issue>10</issue><spage>e0140167</spage><epage>e0140167</epage><pages>e0140167-e0140167</pages><issn>1932-6203</issn><eissn>1932-6203</eissn><abstract>The aim of this study was to investigate the different substrate characteristics of repetitive premature ventricular complexed (PVC) trigger sites by the non-contact mapping (NCM).
Thirty-five consecutive patients, including 14 with arrhythmogenic right ventricular cardiomyopathy/dysplasia (ARVC) and 21 with idiopathic right ventricular outflow tract tachycardia (RVOT VT), were enrolled for electrophysiological study and catheter ablation guided by the NCM. Substrate and electrogram (Eg) characteristics of the earliest activation (EA) and breakout (BO) sites of PVCs were investigated, and these were confirmed by successful PVC elimination.
Overall 35 dominant focal PVCs were identified. PVCs arose from the focal origins with preferential conduction, breakout, and spread to the whole right ventricle. The conduction time and distance from EA to BO site were both longer in the ARVC than the RVOT group. The conduction velocity was similar between the 2 groups. The negative deflection of local unipolar Eg at the EA site (EA slope3,5,10ms values) was steeper in the RVOT, compared to ARVC patients. The PVCs of ARVC occurred in the diseased substrate in the ARVC patients. More radiofrequency applications were required to eliminate the triggers in ARVC patients.
The substrate characteristics of PVC trigger may help to differentiate between idiopathic RVOT VT and ARVC. The slowing and slurred QS unipolar electrograms and longer distance from EA to BO in RVOT endocardium suggest that the triggers of ARVC may originate from mid- or sub-epicardial myocardium. More extensive ablation to the trigger site was required in order to create deeper lesions for a successful outcome.</abstract><cop>United States</cop><pub>Public Library of Science</pub><pmid>26488594</pmid><doi>10.1371/journal.pone.0140167</doi><oa>free_for_read</oa></addata></record> |
| fulltext | fulltext |
| identifier | ISSN: 1932-6203 |
| ispartof | PloS one, 2015-10, Vol.10 (10), p.e0140167-e0140167 |
| issn | 1932-6203 1932-6203 |
| language | eng |
| recordid | cdi_plos_journals_1725018095 |
| source | MEDLINE; DOAJ Directory of Open Access Journals; EZB-FREE-00999 freely available EZB journals; PubMed Central; Free Full-Text Journals in Chemistry; Public Library of Science (PLoS) |
| subjects | Ablation Adult Arrhythmias, Cardiac - diagnosis Arrhythmias, Cardiac - physiopathology Arrhythmias, Cardiac - surgery Arrhythmogenic Right Ventricular Dysplasia - diagnosis Arrhythmogenic Right Ventricular Dysplasia - physiopathology Arrhythmogenic Right Ventricular Dysplasia - surgery Cardiac arrhythmia Cardiology Cardiomyopathy Care and treatment Catheter Ablation Catheters Clinical medicine Complications and side effects Conduction Disease Dysplasia Electrocardiography Electrophysiologic Techniques, Cardiac - methods Electrophysiological recording Endocardium - physiopathology Female Follow-Up Studies Health aspects Heart Heart Conduction System - physiopathology Heart Ventricles - physiopathology Hospitals Humans Laboratories Lesions Male Mapping Medical instruments Medicine Middle Aged Myocardium Patients Pulmonary arteries Radio frequency Radiofrequency ablation Right ventricular dysplasia Risk factors Substrates Tachycardia Tachycardia, Ventricular - diagnosis Tachycardia, Ventricular - physiopathology Tachycardia, Ventricular - surgery Treatment Outcome Ventricle Ventricular dysplasia |
| title | The Different Substrate Characteristics of Arrhythmogenic Triggers in Idiopathic Right Ventricular Outflow Tract Tachycardia and Arrhythmogenic Right Ventricular Dysplasia: New Insight from Noncontact Mapping |
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