Top

Journal of Interventional Cardiac Electrophysiology

Published in:

01-01-2018

Electrophysiologic features of protected channels in late postinfarction patients with and without spontaneous ventricular tachycardia

Authors: Sachin Nayyar, Lauren Wilson, Anand Ganesan, Thomas Sullivan, Pawel Kuklik, Glenn Young, Prashanthan Sanders, Kurt C. Roberts-Thomson

Published in: Journal of Interventional Cardiac Electrophysiology | Issue 1/2018

Abstract

Purpose

Protected channels of surviving myocytes in late postinfarction ventricular scar predispose to ventricular tachycardia (VT). However, only a few patients develop VT spontaneously. We studied differences in electric remodeling and protected channels in late postinfarction patients with and without spontaneous VT.

Methods

Patients with ischemic cardiomyopathy (ICM) with recurrent sustained monomorphic VT (n = 22) were compared with stable ICM patients without spontaneous VT (control group; n = 5). Left ventricular mapping was performed with a 20-pole catheter. Detailed pace mapping was used to identify channels of protected conduction, and confirmed, when feasible, by entrainment. Anatomical and electrophysiological properties of VT channels and non-VT channels in VT patients and channels in controls were evaluated.

Results

Seventy-three (median 3) VTs were inducible in VT patients compared to two (median 0) in controls. The VT channels in VT patients (n = 57, 3 ± 1 per patient) were lengthier (mean ± SEM 53 ± 5 vs. 33 ± 4 vs. 24 ± 8 mm), had longer S-QRS (73 ± 4 vs. 63 ± 3 vs. 44 ± 8 ms), longer conduction time (103 ± 13 vs. 33 ± 4 vs. 24 ± 8 ms), and slower conduction velocity (CV) (0.85 ± 0.21 vs. 1.39 ± 0.20 vs. 1.31 ± 0.41 m/s) than non-VT channels in VT patients (n = 183, 8 ± 6 per patient) (p ≤ 0.01) and channels in controls (n = 46, 9 ± 8 per patient) (p ≤ 0.01). Additionally, non-VT channels in VT patients had longer S-QRS (p = 0.02); however, they were similar in length, conduction time, and CV compared to channels in controls.

Conclusions

Channels supporting VT are lengthier, with longer conduction times and slower CV compared to channels in patients without spontaneous VT. These observations may explain why some ICM patients have spontaneous VT and others do not.

Wissner E, Stevenson WG, Kuck KH. Catheter ablation of ventricular tachycardia in ischaemic and non-ischaemic cardiomyopathy: where are we today? A clinical review. Eur Heart J. 2012;33(12):1440–50. https://doi.org/10.1093/eurheartj/ehs007.CrossRefPubMed

de Bakker JMT, van Capelle F, Janse M, Tasseron S, Vermeulen J, de Jonge N, et al. Slow conduction in the infarcted human heart. ‘Zigzag’ course of activation. Circulation. 1993;88(3):915–26. https://doi.org/10.1161/01.CIR.88.3.915.CrossRefPubMed

Cassidy D, Vassallo J, Miller J, Poll D, Buxton A, Marchlinski F, et al. Endocardial catheter mapping during sinus rhythm: relation of underlying heart disease and ventricular arrhythmia. Circulation. 1986;73(4):645–52. https://doi.org/10.1161/01.CIR.73.4.645.CrossRefPubMed

Haqqani HM, Kalman JM, Roberts-Thomson KC, Balasubramaniam RN, Rosso R, Snowdon RL, et al. Fundamental differences in electrophysiologic and electroanatomic substrate between ischemic cardiomyopathy patients with and without clinical ventricular tachycardia. J Am Coll Cardiol. 2009;54(2):166–73. https://doi.org/10.1016/j.jacc.2009.04.024.CrossRefPubMed

Nayyar S, Wilson L, Ganesan AN, Sullivan T, Kuklik P, Chapman D, et al. High-density mapping of ventricular scar: a comparison of ventricular tachycardia (VT) supporting channels with channels that do not support VT. Circ Arrhythm Electrophysiol. 2014;7(1):90–8. https://doi.org/10.1161/CIRCEP.113.000882.CrossRefPubMed

Epstein AE, Dimarco JP, Ellenbogen KA, Estes NA III, Freedman RA, Gettes LS, et al. ACC/AHA/HRS 2008 guidelines for device-based therapy of cardiac rhythm abnormalities: executive summary. Heart Rhythm. 2008;5(6):934–55. https://doi.org/10.1016/j.hrthm.2008.04.015.CrossRefPubMed

Josephson M. Clinical cardiac electrophysiology: techniques and interpretations. Philadelphia: Lippincott Williams & Wilkins; 2002. p. 425–610.

Marchlinski FE, Callans DJ, Gottlieb CD, Zado E. Linear ablation lesions for control of unmappable ventricular tachycardia in patients with ischemic and nonischemic cardiomyopathy. Circulation. 2000;101(11):1288–96. https://doi.org/10.1161/01.CIR.101.11.1288.CrossRefPubMed

Bogun F, Good E, Reich S, Elmouchi D, Igic P, Lemola K, et al. Isolated potentials during sinus rhythm and pace-mapping within scars as guides for ablation of post-infarction ventricular tachycardia. J Am Coll Cardiol. 2006;47(10):2013–9. https://doi.org/10.1016/j.jacc.2005.12.062.CrossRefPubMed

10.

Brunckhorst CB, Stevenson WG, Soejima K, Maisel WH, Delacretaz E, Friedman PL, et al. Relationship of slow conduction detected by pace-mapping to ventricular tachycardia re-entry circuit sites after infarction. J Am Coll Cardiol. 2003;41(5):802–9. https://doi.org/10.1016/S0735-1097(02)02932-7.CrossRefPubMed

11.

Stevenson WG, Sager PT, Natterson PD, Saxon LA, Middlekauff HR, Wiener I. Relation of pace mapping QRS configuration and conduction delay to ventricular tachycardia reentry circuits in human infarct scars. J Am Coll Cardiol. 1995;26(2):481–8. https://doi.org/10.1016/0735-1097(95)80026-D.CrossRefPubMed

12.

de Chillou C, Groben L, Magnin-Poull I, Andronache M, MagdiAbbas M, Zhang N, et al. Localizing the critical isthmus of postinfarct ventricular tachycardia: the value of pace-mapping during sinus rhythm. Heart Rhythm. 2014;11(2):175–81. https://doi.org/10.1016/j.hrthm.2013.10.042.CrossRefPubMed

13.

de Bakker J, van Capelle F, Janse M, Wilde A, Coronel R, Becker A, et al. Reentry as a cause of ventricular tachycardia in patients with chronic ischemic heart disease: electrophysiologic and anatomic correlation. Circulation. 1988;77(3):589–606. https://doi.org/10.1161/01.CIR.77.3.589.CrossRefPubMed

14.

de Bakker JM, Coronel R, Tasseron S, Wilde AA, Opthof T, Janse MJ, et al. Ventricular tachycardia in the infarcted, Langendorff-perfused human heart: role of the arrangement of surviving cardiac fibers. J Am Coll Cardiol. 1990;15(7):1594–607. https://doi.org/10.1016/0735-1097(90)92832-M.CrossRefPubMed

15.

Anter E, Tschabrunn CM, Buxton AE, Josephson ME. High-resolution mapping of postinfarction reentrant ventricular tachycardia: electrophysiological characterization of the circuit. Circulation. 2016;134(4):314–27. https://doi.org/10.1161/CIRCULATIONAHA.116.021955.CrossRefPubMedPubMedCentral

16.

Dillon SM, Allessie MA, Ursell PC, Wit AL. Influences of anisotropic tissue structure on reentrant circuits in the epicardial border zone of subacute canine infarcts. Circ Res. 1988;63(1):182–206. https://doi.org/10.1161/01.RES.63.1.182.CrossRefPubMed

17.

Ding C, Gepstein L, Nguyen DT, Wilson E, Hulley G, Beaser A, et al. High-resolution optical mapping of ventricular tachycardia in rats with chronic myocardial infarction. Pacing Clin Electrophysiol. 2010;33(6):687–95. https://doi.org/10.1111/j.1540-8159.2010.02704.x.CrossRefPubMed

18.

Hsia H, Lin D, Sauer W, Callans D, Marchlinski F. Anatomic characterization of endocardial substrate for hemodynamically stable reentrant ventricular tachycardia: identification of endocardial conducting channels. Heart Rhythm. 2006;3(5):503–12. https://doi.org/10.1016/j.hrthm.2006.01.015.CrossRefPubMed

19.

de Chillou C, Lacroix D, Klug D, Magnin-Poull I, Marquie C, Messier M, et al. Isthmus characteristics of reentrant ventricular tachycardia after myocardial infarction. Circulation. 2002;105(6):726–31. https://doi.org/10.1161/hc0602.103675.CrossRefPubMed

20.

Nayyar S, Kuklik P, Ganesan AN, Sullivan TR, Wilson L, Young GD, et al. Development of time- and voltage-domain mapping (V-T-mapping) to localize ventricular tachycardia channels during sinus rhythm. Circ Arrhythm Electrophysiol. 2016;9(12):e004050. https://doi.org/10.1161/CIRCEP.116.004050.CrossRefPubMed

21.

Brunckhorst CB, Delacretaz E, Soejima K, Maisel WH, Friedman PL, Stevenson WG. Identification of the ventricular tachycardia isthmus after infarction by pace mapping. Circulation. 2004;110(6):652–9. https://doi.org/10.1161/01.CIR.0000138107.11518.AF.CrossRefPubMed

22.

Wiener I, Mindich B, Pitchon R. Determinants of ventricular tachycardia in patients with ventricular aneurysms: results of intraoperative epicardial and endocardial mapping. Circulation. 1982;65(5):856–61. https://doi.org/10.1161/01.CIR.65.5.856.CrossRefPubMed

23.

Bogun F, Bahu M, Knight BP, Weiss R, Goyal R, Daoud E, et al. Response to pacing at sites of isolated diastolic potentials during ventricular tachycardia in patients with previous myocardial infarction. J Am Coll Cardiol. 1997;30(2):505–13. https://doi.org/10.1016/S0735-1097(97)00177-0.CrossRefPubMed

24.

Tschabrunn CM, Roujol S, Dorman NC, Nezafat R, Josephson ME, Anter E. High-resolution mapping of ventricular scar: comparison between single and multielectrode catheters. Circ Arrhythm Electrophysiol. 2016;9(6):e003841. https://doi.org/10.1161/CIRCEP.115.003841.CrossRefPubMed

25.

Cabo C, Pertsov AM, Baxter WT, Davidenko JM, Gray RA, Jalife J. Wave-front curvature as a cause of slow conduction and block in isolated cardiac muscle. Circ Res. 1994;75(6):1014–28. https://doi.org/10.1161/01.RES.75.6.1014.CrossRefPubMed

26.

Roy D, Marchand E, Theroux P, Waters DD, Pelletier GB, Cartier R, et al. Long-term reproducibility and significance of provokable ventricular arrhythmias after myocardial infarction. J Am Coll Cardiol. 1986;8(1):32–9. https://doi.org/10.1016/S0735-1097(86)80088-2.CrossRefPubMed

27.

Nayyar S, Kuklik P, Suszko A, Chauhan VS. Evoked intra-QRS and post-QRS potentials predict freedom from ventricular arrhythmias: a detailed body surface ECG analysis of cardiomyopathy patients. Heart Rhythm. 2017;14:s539.

28.

Stevenson WG, Soejima K. Catheter ablation for ventricular tachycardia. Circulation. 2007;115(21):2750–60. https://doi.org/10.1161/CIRCULATIONAHA.106.655720.CrossRefPubMed

29.

Leshem E, Tschabrunn CM, Jihye J, Whitaker J, Israel Z, Beeckler C, et al. High-resolution mapping of ventricular scar—evaluation of a novel integrated multielectrode mapping and ablation catheter. J Am Coll Cardiol EP. 2017;3:220–31.

Title: Electrophysiologic features of protected channels in late postinfarction patients with and without spontaneous ventricular tachycardia
Authors: Sachin Nayyar
Lauren Wilson
Anand Ganesan
Thomas Sullivan
Pawel Kuklik
Glenn Young
Prashanthan Sanders
Kurt C. Roberts-Thomson
Publication date: 01-01-2018
Publisher: Springer US
Published in: Journal of Interventional Cardiac Electrophysiology / Issue 1/2018
Print ISSN: 1383-875X
Electronic ISSN: 1572-8595
DOI: https://doi.org/10.1007/s10840-017-0299-6

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Electrophysiologic features of protected channels in late postinfarction patients with and without spontaneous ventricular tachycardia

Abstract

Purpose

Methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusions

Please log in to get access to this content

Other articles of this Issue 1/2018

Left ventricular outflow tract arrhythmias with divergent QRS morphology: mapping of different exits and ablation strategy

Can we implant left ventricle pacing lead in a patient with coronary sinus reducer?

Assessment of autonomic nervous system modulation after novel catheter ablation techniques for atrial fibrillation using multiple short-term electrocardiogram recordings

Pulmonary vein isolation combined with spironolactone or renal sympathetic denervation in patients with chronic kidney disease, uncontrolled hypertension, paroxysmal atrial fibrillation, and a pacemaker

Festina Lente—a curiously apt aphorism for Interventional Cardiac Electrophysiology in 2018

Conception and validation of a protocol for reuse of non-irrigated electrophysiology catheters in a Brazilian teaching hospital