Sinus rhythm detection of conducting channels and ventricular tachycardia isthmus in arrhythmogenic right ventricular cardiomyopathy
Background The identification of conducting channels (CCs) based on its relative high voltage or the presence of electrograms with delayed components has been proposed for substrate-guided scar-related ventricular tachycardia (VT) ablation. The relationship of these channels with the VT isthmuses re...
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| creator | Fernández-Armenta, Juan, MD Andreu, David, Msc, PhD Penela, Diego, MD Trucco, Emilce, MD Cipolletta, Laura, MD Arbelo, Elena, MD, PhD Berne, Paola, MD María Tolosana, Jose, MD Pedrote, Alonso, MD, PhD Brugada, Josep, MD, PhD Mont, Lluis, MD, PhD Berruezo, Antonio, MD, PhD |
| description | Background The identification of conducting channels (CCs) based on its relative high voltage or the presence of electrograms with delayed components has been proposed for substrate-guided scar-related ventricular tachycardia (VT) ablation. The relationship of these channels with the VT isthmuses remains unclear. Objective To assess the link between CCs identified during sinus rhythm (SR) and VT isthmuses in patients with arrhythmogenic right ventricular cardiomyopathy (ARVC). Methods Twenty-two consecutive patients with ARVC undergoing substrate-guided VT ablation (scar dechanneling technique) were analyzed. High-density endocardial and epicardial electroanatomic maps were obtained during SR. Standard bipolar cutoff values (0.5–1.5 and |
| doi_str_mv | 10.1016/j.hrthm.2014.02.016 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_1518243943</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><els_id>1_s2_0_S1547527114001684</els_id><sourcerecordid>1518243943</sourcerecordid><originalsourceid>FETCH-LOGICAL-c480t-d44864d93ca56f654cc692b9d65febfc65f58bc5385709b8eace406619d3f2d83</originalsourceid><addsrcrecordid>eNqFkk1v1DAQhiMEoqXwC5CQj1wS7PhjkwNIqAJaqRKHwtlyxpONl8Re7KRS7v3hON2CBBdOY4_meUd6NEXxmtGKUabeHaohzsNU1ZSJitZV7j0pzpmUquTNjj3d3mJXynrHzooXKR0orVtF-fPirBZSMSbb8-L-1vklkTisOYpYnBFmFzwJPYHg7ZJ_fk9gMN7jmIjxltyhn6ODZTSRzAaGFUy0zhCXckTOcp6YeAoMe_QOSHT7Yf6Le0DCtIajmYf1ZfGsN2PCV4_1ovj--dO3y6vy5uuX68uPNyWIhs6lFaJRwrYcjFS9kgJAtXXXWiV77HrIRTYdSN7IHW27Bg2goEqx1vK-tg2_KN6eco8x_FwwzXpyCXAcjcewJM0ka2rBW8HzKD-NQgwpRez1MbrJxFUzqjf9-qAf9OtNv6a1zr1MvXlcsHQT2j_Mb9954P1pIMvEO4dRJ3DoAa2L2by2wf1nwYd_eBhdVmzGH7hiOoQl-mxQM50yoG-3C9gOgAma8UbwXwd-sK8</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>1518243943</pqid></control><display><type>article</type><title>Sinus rhythm detection of conducting channels and ventricular tachycardia isthmus in arrhythmogenic right ventricular cardiomyopathy</title><source>MEDLINE</source><source>Elsevier ScienceDirect Journals</source><creator>Fernández-Armenta, Juan, MD ; Andreu, David, Msc, PhD ; Penela, Diego, MD ; Trucco, Emilce, MD ; Cipolletta, Laura, MD ; Arbelo, Elena, MD, PhD ; Berne, Paola, MD ; María Tolosana, Jose, MD ; Pedrote, Alonso, MD, PhD ; Brugada, Josep, MD, PhD ; Mont, Lluis, MD, PhD ; Berruezo, Antonio, MD, PhD</creator><creatorcontrib>Fernández-Armenta, Juan, MD ; Andreu, David, Msc, PhD ; Penela, Diego, MD ; Trucco, Emilce, MD ; Cipolletta, Laura, MD ; Arbelo, Elena, MD, PhD ; Berne, Paola, MD ; María Tolosana, Jose, MD ; Pedrote, Alonso, MD, PhD ; Brugada, Josep, MD, PhD ; Mont, Lluis, MD, PhD ; Berruezo, Antonio, MD, PhD</creatorcontrib><description>Background The identification of conducting channels (CCs) based on its relative high voltage or the presence of electrograms with delayed components has been proposed for substrate-guided scar-related ventricular tachycardia (VT) ablation. The relationship of these channels with the VT isthmuses remains unclear. Objective To assess the link between CCs identified during sinus rhythm (SR) and VT isthmuses in patients with arrhythmogenic right ventricular cardiomyopathy (ARVC). Methods Twenty-two consecutive patients with ARVC undergoing substrate-guided VT ablation (scar dechanneling technique) were analyzed. High-density endocardial and epicardial electroanatomic maps were obtained during SR. Standard bipolar cutoff values (0.5–1.5 and <0.5 mV) were used to define border zone and dense scar. The CCs were identified by voltage threshold adjustment (voltage channels) or by tagging the electrograms with delayed components that are sequentially activated (late potential channels). Results A total of 87 CCs were identified; 65 (74.7%) of them on the epicardial surface. Twenty-four (27.6%) CCs were voltage channels, and compared with late potential CCs, these had a higher bipolar voltage (0.96 [0.48–1.29] mV vs 0.39 [0.26–0.50] mV; P < .001] and required more radiofrequency applications (5 [4–7] vs 3 [2–5]; P = .048]. Eighteen (90%) of 20 identified VT isthmuses were located on the epicardium. Only 8 (40%) VT isthmuses were related to a voltage CC. The remaining 12 (60%) VT isthmuses were linked to a late potential CC. Conclusion Late potential CCs more frequently act as the VT substrate in ARVC and therefore should also be considered to guide SR substrate-guided ablation.</description><identifier>ISSN: 1547-5271</identifier><identifier>EISSN: 1556-3871</identifier><identifier>DOI: 10.1016/j.hrthm.2014.02.016</identifier><identifier>PMID: 24561159</identifier><language>eng</language><publisher>United States: Elsevier Inc</publisher><subject>Adult ; Arrhythmogenic right ventricular cardiomyopathy ; Arrhythmogenic Right Ventricular Dysplasia - diagnosis ; Arrhythmogenic Right Ventricular Dysplasia - physiopathology ; Arrhythmogenic Right Ventricular Dysplasia - surgery ; Body Surface Potential Mapping - methods ; Cardiovascular ; Catheter Ablation ; Conducting channels ; Electrocardiography ; Epicardial ablation ; Female ; Heart Conduction System - physiopathology ; Heart Conduction System - surgery ; Heart Rate - physiology ; Humans ; Imaging, Three-Dimensional ; Male ; Radiofrequency ablation ; Substrate-guided ablation ; Tachycardia, Ventricular - diagnosis ; Tachycardia, Ventricular - physiopathology ; Tachycardia, Ventricular - surgery ; Treatment Outcome ; Ventricular tachycardia</subject><ispartof>Heart rhythm, 2014-05, Vol.11 (5), p.747-754</ispartof><rights>Heart Rhythm Society</rights><rights>2014 Heart Rhythm Society</rights><rights>Copyright © 2014 Heart Rhythm Society. Published by Elsevier Inc. All rights reserved.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c480t-d44864d93ca56f654cc692b9d65febfc65f58bc5385709b8eace406619d3f2d83</citedby><cites>FETCH-LOGICAL-c480t-d44864d93ca56f654cc692b9d65febfc65f58bc5385709b8eace406619d3f2d83</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://www.sciencedirect.com/science/article/pii/S1547527114001684$$EHTML$$P50$$Gelsevier$$H</linktohtml><link.rule.ids>314,776,780,3537,27901,27902,65306</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/24561159$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Fernández-Armenta, Juan, MD</creatorcontrib><creatorcontrib>Andreu, David, Msc, PhD</creatorcontrib><creatorcontrib>Penela, Diego, MD</creatorcontrib><creatorcontrib>Trucco, Emilce, MD</creatorcontrib><creatorcontrib>Cipolletta, Laura, MD</creatorcontrib><creatorcontrib>Arbelo, Elena, MD, PhD</creatorcontrib><creatorcontrib>Berne, Paola, MD</creatorcontrib><creatorcontrib>María Tolosana, Jose, MD</creatorcontrib><creatorcontrib>Pedrote, Alonso, MD, PhD</creatorcontrib><creatorcontrib>Brugada, Josep, MD, PhD</creatorcontrib><creatorcontrib>Mont, Lluis, MD, PhD</creatorcontrib><creatorcontrib>Berruezo, Antonio, MD, PhD</creatorcontrib><title>Sinus rhythm detection of conducting channels and ventricular tachycardia isthmus in arrhythmogenic right ventricular cardiomyopathy</title><title>Heart rhythm</title><addtitle>Heart Rhythm</addtitle><description>Background The identification of conducting channels (CCs) based on its relative high voltage or the presence of electrograms with delayed components has been proposed for substrate-guided scar-related ventricular tachycardia (VT) ablation. The relationship of these channels with the VT isthmuses remains unclear. Objective To assess the link between CCs identified during sinus rhythm (SR) and VT isthmuses in patients with arrhythmogenic right ventricular cardiomyopathy (ARVC). Methods Twenty-two consecutive patients with ARVC undergoing substrate-guided VT ablation (scar dechanneling technique) were analyzed. High-density endocardial and epicardial electroanatomic maps were obtained during SR. Standard bipolar cutoff values (0.5–1.5 and <0.5 mV) were used to define border zone and dense scar. The CCs were identified by voltage threshold adjustment (voltage channels) or by tagging the electrograms with delayed components that are sequentially activated (late potential channels). Results A total of 87 CCs were identified; 65 (74.7%) of them on the epicardial surface. Twenty-four (27.6%) CCs were voltage channels, and compared with late potential CCs, these had a higher bipolar voltage (0.96 [0.48–1.29] mV vs 0.39 [0.26–0.50] mV; P < .001] and required more radiofrequency applications (5 [4–7] vs 3 [2–5]; P = .048]. Eighteen (90%) of 20 identified VT isthmuses were located on the epicardium. Only 8 (40%) VT isthmuses were related to a voltage CC. The remaining 12 (60%) VT isthmuses were linked to a late potential CC. Conclusion Late potential CCs more frequently act as the VT substrate in ARVC and therefore should also be considered to guide SR substrate-guided ablation.</description><subject>Adult</subject><subject>Arrhythmogenic right ventricular cardiomyopathy</subject><subject>Arrhythmogenic Right Ventricular Dysplasia - diagnosis</subject><subject>Arrhythmogenic Right Ventricular Dysplasia - physiopathology</subject><subject>Arrhythmogenic Right Ventricular Dysplasia - surgery</subject><subject>Body Surface Potential Mapping - methods</subject><subject>Cardiovascular</subject><subject>Catheter Ablation</subject><subject>Conducting channels</subject><subject>Electrocardiography</subject><subject>Epicardial ablation</subject><subject>Female</subject><subject>Heart Conduction System - physiopathology</subject><subject>Heart Conduction System - surgery</subject><subject>Heart Rate - physiology</subject><subject>Humans</subject><subject>Imaging, Three-Dimensional</subject><subject>Male</subject><subject>Radiofrequency ablation</subject><subject>Substrate-guided ablation</subject><subject>Tachycardia, Ventricular - diagnosis</subject><subject>Tachycardia, Ventricular - physiopathology</subject><subject>Tachycardia, Ventricular - surgery</subject><subject>Treatment Outcome</subject><subject>Ventricular tachycardia</subject><issn>1547-5271</issn><issn>1556-3871</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2014</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNqFkk1v1DAQhiMEoqXwC5CQj1wS7PhjkwNIqAJaqRKHwtlyxpONl8Re7KRS7v3hON2CBBdOY4_meUd6NEXxmtGKUabeHaohzsNU1ZSJitZV7j0pzpmUquTNjj3d3mJXynrHzooXKR0orVtF-fPirBZSMSbb8-L-1vklkTisOYpYnBFmFzwJPYHg7ZJ_fk9gMN7jmIjxltyhn6ODZTSRzAaGFUy0zhCXckTOcp6YeAoMe_QOSHT7Yf6Le0DCtIajmYf1ZfGsN2PCV4_1ovj--dO3y6vy5uuX68uPNyWIhs6lFaJRwrYcjFS9kgJAtXXXWiV77HrIRTYdSN7IHW27Bg2goEqx1vK-tg2_KN6eco8x_FwwzXpyCXAcjcewJM0ka2rBW8HzKD-NQgwpRez1MbrJxFUzqjf9-qAf9OtNv6a1zr1MvXlcsHQT2j_Mb9954P1pIMvEO4dRJ3DoAa2L2by2wf1nwYd_eBhdVmzGH7hiOoQl-mxQM50yoG-3C9gOgAma8UbwXwd-sK8</recordid><startdate>20140501</startdate><enddate>20140501</enddate><creator>Fernández-Armenta, Juan, MD</creator><creator>Andreu, David, Msc, PhD</creator><creator>Penela, Diego, MD</creator><creator>Trucco, Emilce, MD</creator><creator>Cipolletta, Laura, MD</creator><creator>Arbelo, Elena, MD, PhD</creator><creator>Berne, Paola, MD</creator><creator>María Tolosana, Jose, MD</creator><creator>Pedrote, Alonso, MD, PhD</creator><creator>Brugada, Josep, MD, PhD</creator><creator>Mont, Lluis, MD, PhD</creator><creator>Berruezo, Antonio, MD, PhD</creator><general>Elsevier Inc</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>7X8</scope></search><sort><creationdate>20140501</creationdate><title>Sinus rhythm detection of conducting channels and ventricular tachycardia isthmus in arrhythmogenic right ventricular cardiomyopathy</title><author>Fernández-Armenta, Juan, MD ; Andreu, David, Msc, PhD ; Penela, Diego, MD ; Trucco, Emilce, MD ; Cipolletta, Laura, MD ; Arbelo, Elena, MD, PhD ; Berne, Paola, MD ; María Tolosana, Jose, MD ; Pedrote, Alonso, MD, PhD ; Brugada, Josep, MD, PhD ; Mont, Lluis, MD, PhD ; Berruezo, Antonio, MD, PhD</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c480t-d44864d93ca56f654cc692b9d65febfc65f58bc5385709b8eace406619d3f2d83</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2014</creationdate><topic>Adult</topic><topic>Arrhythmogenic right ventricular cardiomyopathy</topic><topic>Arrhythmogenic Right Ventricular Dysplasia - diagnosis</topic><topic>Arrhythmogenic Right Ventricular Dysplasia - physiopathology</topic><topic>Arrhythmogenic Right Ventricular Dysplasia - surgery</topic><topic>Body Surface Potential Mapping - methods</topic><topic>Cardiovascular</topic><topic>Catheter Ablation</topic><topic>Conducting channels</topic><topic>Electrocardiography</topic><topic>Epicardial ablation</topic><topic>Female</topic><topic>Heart Conduction System - physiopathology</topic><topic>Heart Conduction System - surgery</topic><topic>Heart Rate - physiology</topic><topic>Humans</topic><topic>Imaging, Three-Dimensional</topic><topic>Male</topic><topic>Radiofrequency ablation</topic><topic>Substrate-guided ablation</topic><topic>Tachycardia, Ventricular - diagnosis</topic><topic>Tachycardia, Ventricular - physiopathology</topic><topic>Tachycardia, Ventricular - surgery</topic><topic>Treatment Outcome</topic><topic>Ventricular tachycardia</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Fernández-Armenta, Juan, MD</creatorcontrib><creatorcontrib>Andreu, David, Msc, PhD</creatorcontrib><creatorcontrib>Penela, Diego, MD</creatorcontrib><creatorcontrib>Trucco, Emilce, MD</creatorcontrib><creatorcontrib>Cipolletta, Laura, MD</creatorcontrib><creatorcontrib>Arbelo, Elena, MD, PhD</creatorcontrib><creatorcontrib>Berne, Paola, MD</creatorcontrib><creatorcontrib>María Tolosana, Jose, MD</creatorcontrib><creatorcontrib>Pedrote, Alonso, MD, PhD</creatorcontrib><creatorcontrib>Brugada, Josep, MD, PhD</creatorcontrib><creatorcontrib>Mont, Lluis, MD, PhD</creatorcontrib><creatorcontrib>Berruezo, Antonio, MD, PhD</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Heart rhythm</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Fernández-Armenta, Juan, MD</au><au>Andreu, David, Msc, PhD</au><au>Penela, Diego, MD</au><au>Trucco, Emilce, MD</au><au>Cipolletta, Laura, MD</au><au>Arbelo, Elena, MD, PhD</au><au>Berne, Paola, MD</au><au>María Tolosana, Jose, MD</au><au>Pedrote, Alonso, MD, PhD</au><au>Brugada, Josep, MD, PhD</au><au>Mont, Lluis, MD, PhD</au><au>Berruezo, Antonio, MD, PhD</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Sinus rhythm detection of conducting channels and ventricular tachycardia isthmus in arrhythmogenic right ventricular cardiomyopathy</atitle><jtitle>Heart rhythm</jtitle><addtitle>Heart Rhythm</addtitle><date>2014-05-01</date><risdate>2014</risdate><volume>11</volume><issue>5</issue><spage>747</spage><epage>754</epage><pages>747-754</pages><issn>1547-5271</issn><eissn>1556-3871</eissn><abstract>Background The identification of conducting channels (CCs) based on its relative high voltage or the presence of electrograms with delayed components has been proposed for substrate-guided scar-related ventricular tachycardia (VT) ablation. The relationship of these channels with the VT isthmuses remains unclear. Objective To assess the link between CCs identified during sinus rhythm (SR) and VT isthmuses in patients with arrhythmogenic right ventricular cardiomyopathy (ARVC). Methods Twenty-two consecutive patients with ARVC undergoing substrate-guided VT ablation (scar dechanneling technique) were analyzed. High-density endocardial and epicardial electroanatomic maps were obtained during SR. Standard bipolar cutoff values (0.5–1.5 and <0.5 mV) were used to define border zone and dense scar. The CCs were identified by voltage threshold adjustment (voltage channels) or by tagging the electrograms with delayed components that are sequentially activated (late potential channels). Results A total of 87 CCs were identified; 65 (74.7%) of them on the epicardial surface. Twenty-four (27.6%) CCs were voltage channels, and compared with late potential CCs, these had a higher bipolar voltage (0.96 [0.48–1.29] mV vs 0.39 [0.26–0.50] mV; P < .001] and required more radiofrequency applications (5 [4–7] vs 3 [2–5]; P = .048]. Eighteen (90%) of 20 identified VT isthmuses were located on the epicardium. Only 8 (40%) VT isthmuses were related to a voltage CC. The remaining 12 (60%) VT isthmuses were linked to a late potential CC. Conclusion Late potential CCs more frequently act as the VT substrate in ARVC and therefore should also be considered to guide SR substrate-guided ablation.</abstract><cop>United States</cop><pub>Elsevier Inc</pub><pmid>24561159</pmid><doi>10.1016/j.hrthm.2014.02.016</doi><tpages>8</tpages></addata></record> |
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| subjects | Adult Arrhythmogenic right ventricular cardiomyopathy Arrhythmogenic Right Ventricular Dysplasia - diagnosis Arrhythmogenic Right Ventricular Dysplasia - physiopathology Arrhythmogenic Right Ventricular Dysplasia - surgery Body Surface Potential Mapping - methods Cardiovascular Catheter Ablation Conducting channels Electrocardiography Epicardial ablation Female Heart Conduction System - physiopathology Heart Conduction System - surgery Heart Rate - physiology Humans Imaging, Three-Dimensional Male Radiofrequency ablation Substrate-guided ablation Tachycardia, Ventricular - diagnosis Tachycardia, Ventricular - physiopathology Tachycardia, Ventricular - surgery Treatment Outcome Ventricular tachycardia |
| title | Sinus rhythm detection of conducting channels and ventricular tachycardia isthmus in arrhythmogenic right ventricular cardiomyopathy |
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