Ventricular mapping during atrial and ventricular pacing. Relationship of multipotential electrograms to ventricular tachycardia reentry circuits after myocardial infarction

Aims Conduction through separated myocyte bundles causes multipotential electrograms and reentrant ventricular tachycardia. We hypothesized that without initiating tachycardia, the reentry region could be detected by analysing the change in multipotential electrograms during two different activation...

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Bibliographic Details
Published in:European heart journal 2002-07, Vol.23 (14), p.1131-1138
Main Authors: Brunckhorst, C.B., Stevenson, W.G., Jackman, W.M., Kuck, K.-H., Soejima, K., Nakagawa, H., Cappato, R., Ben-Haim, S.A.
Format: Article
Language:English
Subjects:
Aged
Biological and medical sciences
Cardiac dysrhythmias
Cardiac Pacing, Artificial
Cardiology. Vascular system
catheter ablation
Catheter Ablation - methods
Echocardiography
Electrocardiography
Electrophysiology
Heart
Humans
Male
Medical sciences
Middle Aged
myocardial infarction
Myocardial Infarction - complications
Myocardial Infarction - diagnosis
Prognosis
Prospective Studies
reentry
Risk Assessment
Sensitivity and Specificity
sinus rhythm
Tachycardia, Atrioventricular Nodal Reentry - etiology
Tachycardia, Atrioventricular Nodal Reentry - physiopathology
Tachycardia, Ventricular - diagnosis
Tachycardia, Ventricular - etiology
Tachycardia, Ventricular - therapy
Treatment Outcome
Ventricular tachycardia
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Summary:Aims Conduction through separated myocyte bundles causes multipotential electrograms and reentrant ventricular tachycardia. We hypothesized that without initiating tachycardia, the reentry region could be detected by analysing the change in multipotential electrograms during two different activation sequences. Methods and Results During catheter mapping and ablation in 16 patients with ventricular tachycardia late after infarction ventricular electrograms were recorded from 1072 sites during atrial and right ventricular paced ventricular activation. Multipotential electrograms were present during both activation sequences at 285 (27%) sites, during atrial pacing only at 159 (15%) sites and during right ventricular pacing only at 152 (14%) sites. Sites with multipotential electrograms during both activation sequences were more often related to a ventricular tachycardia circuit isthmus (43%) as compared to sites where such electrograms were present during one activation sequence (20%). Multipotential electrograms with >2 low amplitude deflections and a >100ms difference in duration between the two activation sequences were infrequent but highly predictive of the reentry circuit. Conclusion Regions with fixed multipotentials consistent with conduction block might be useful guides for ablation approaches that target large regions of the infarct, but are not sufficiently specific to be the sole guide for focal ablation approaches. Copyright 2002 The European Society of Cardiology. Published by Elsevier Science Ltd. All rights reserved.
ISSN:0195-668X
1522-9645
DOI:10.1053/euhj.2001.3110