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Heart Rhythm. 2015 Jan;12(1):95-103. doi: 10.1016/j.hrthm.2014.10.002. Epub 2014 Oct 5.

Use of a novel fragmentation map to identify the substrate for ventricular tachycardia in postinfarction cardiomyopathy.

Author information

1
Electrophysiology Section, Department of Cardiology, Hospital Universitari Arnau de Vilanova, Lleida, Spain.
2
Electrophysiology Section, Cardiovascular Division, Department of Medicine, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania.
3
Electrophysiology Section, Cardiovascular Division, Department of Medicine, University of California San Francisco; San Francisco California. Electronic address: egerstenfeld@medicine.ucsf.edu.

Abstract

BACKGROUND:

Substrate ablation is commonly performed in patients with postinfarction cardiomyopathy and ventricular tachycardia (VT). Recognition of fragmented and late potentials during sinus rhythm is a tedious process subject to operator fatigue.

OBJECTIVE:

The purpose of this study was to assess the value of automated analysis to quantify electrogram fragmentation and to determine the relationship of fragmented regions to the VT isthmus.

METHODS:

Detailed left ventricular (LV) mapping was performed in 2 groups: (1) 14 patients with previous myocardial infarction and tolerated VT and (2) 14 controls with structurally normal hearts. In patients with VT, mid-isthmus sites were identified using entrainment mapping. Sinus rhythm endocardial LV electrograms underwent time- and frequency-domain analysis and were displayed as fragmentation or frequency maps. The region of fractionated electrograms and their relation to the VT isthmus sites were determined.

RESULTS:

Cutoffs for abnormal electrogram fragmentation were ventricular fractionation index ≥ 7 and fast Fourier transform ratio ≥ 14%, respectively. In the time domain, LV surface area with fractionated electrograms was significantly smaller than the total scar surface area (27.3% ± 7.1% vs 42.1% ± 12.3%, P <.001), yet contained 100% of VT isthmus sites. In the frequency domain, areas of abnormal fractionation occupied 9.7% ± 6.9% of total LV surface area and included only 60% of the VT isthmus sites.

CONCLUSION:

Automated electrogram fractionation analysis represents an objective tool to rapidly quantify electrogram fragmentation and guide substrate-based ablation of VT. Empiric ablation of these regions may be a new strategy for substrate-guided VT ablation.

KEYWORDS:

Ablation; Cardiomyopathy; Fourier transform; Fragmentation; Mapping; Ventricular tachycardia

PMID:
25285645
DOI:
10.1016/j.hrthm.2014.10.002
[Indexed for MEDLINE]
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