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Published in: Journal of Interventional Cardiac Electrophysiology 2/2018

01-03-2018

Point-by-point versus multisite electrode mapping in VT ablation: does freedom from VT recurrences depend on mapping catheter? An observational study

Authors: Petra Maagh, Arnd Christoph, Markus Sebastian Müller, Henning Dopp, Gunnar Plehn, Axel Meissner

Published in: Journal of Interventional Cardiac Electrophysiology | Issue 2/2018

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Abstract

Purpose

This study was conducted with the purpose of determining whether or not the potential technical advantages of multi-electrode mapping catheters in catheter ablation (CA) of ventricular tachycardia (VT) result in any relevant clinical benefit for VT patients.

Methods

A single-center VT study, having taken place from 2012 to 2014 using a standard 3.5-mm catheter (Thermocool SF® group 1) and from 2014 to 2016 using a 1-mm multi-electrode-mapping catheter (PentaRay® group 2), was conducted. The endpoint was the complete elimination of late potentials (LPs), local abnormal ventricular activities (LAVA), and VT non-inducibility. Follow-up consisted of device interrogation to monitor for VT recurrence.

Results

Out of 74 VT patients aged 64.5 ± 12.0 years (66 male [89.2%], 56 with ICM [75.7%], and 18 with NICM [24.3%)]), 48 patients (64.9%) were investigated in group 1 and 26 (35.1%) in group 2. Using the multi-point acquisition approach, a tendency to require less mapping time (group 1 65.2 ± 37.6 min, group 2 55.6 ± 34.4 min, p ns) was determined. During 12-month follow-up, 57 patients had freedom from VT recurrences (79.2%). The result was insignificant between the groups (38 patients (79.2%) in group 1 and 19 patients (73.1%) in group 2).

Conclusions

In a single-center observational study, both conventional and high-density mapping approaches in VT patients are comparable in terms of procedure duration and outcome. Mapping time when using a multi-electrode catheter seems to have the tendency of being shorter. We should be encouraged to recruit more patients comparing the benefit of different catheter types.
Literature
1.
go back to reference Aliot EM, Stevenson WG, Almendral-Garrote JM, Bogun F, Calkins CH, Delacretaz E, Della Bella P, Hindricks G, Jaïs P, Josephson ME, Kautzner J, Kay GN, Kuck KH, Lerman BB, Marchlinski F, Reddy V, Schalij MJ, Schilling R, Soejima K, Wilber D, European Heart Rhythm Association (EHRA) Registered Branch of the European Society of Cardiology (ESC),Heart Rhythm Society (HRS), American College of Cardiology (ACC), American Heart Association (AHA) EHRA/HRS expert consensus on catheter ablation of ventricular arrhythmias: developed in a partnership with the European heart rhythm association (EHRA), a registered branch of the European Society of Cardiology (ESC), and the Heart Rhythm Society (HRS); in collaboration with the American College of Cardiology (ACC) and the American Heart Association (AHA). Heart Rhythm 2009;6:886–933, 6, https://doi.org/10.1016/j.hrthm.2009.04.030. Aliot EM, Stevenson WG, Almendral-Garrote JM, Bogun F, Calkins CH, Delacretaz E, Della Bella P, Hindricks G, Jaïs P, Josephson ME, Kautzner J, Kay GN, Kuck KH, Lerman BB, Marchlinski F, Reddy V, Schalij MJ, Schilling R, Soejima K, Wilber D, European Heart Rhythm Association (EHRA) Registered Branch of the European Society of Cardiology (ESC),Heart Rhythm Society (HRS), American College of Cardiology (ACC), American Heart Association (AHA) EHRA/HRS expert consensus on catheter ablation of ventricular arrhythmias: developed in a partnership with the European heart rhythm association (EHRA), a registered branch of the European Society of Cardiology (ESC), and the Heart Rhythm Society (HRS); in collaboration with the American College of Cardiology (ACC) and the American Heart Association (AHA). Heart Rhythm 2009;6:886–933, 6, https://​doi.​org/​10.​1016/​j.​hrthm.​2009.​04.​030.
2.
go back to reference Haris M. Haqqani, Francis E. Marchlinski, Electrophysiologic substrate underlying postinfarction ventricular tachycardia: characterization and role in catheter ablation. Heart Rhythm, 2009Vol 6, No 8S, August Supplement . Haris M. Haqqani, Francis E. Marchlinski, Electrophysiologic substrate underlying postinfarction ventricular tachycardia: characterization and role in catheter ablation. Heart Rhythm, 2009Vol 6, No 8S, August Supplement .
4.
go back to reference Kottkamp H, Wetzel U, Schirdewahn P, Dorszewski A, Gerds-Li JH, Carbucicchio C, et al. Catheter ablation of ventricular tachycardia in remote myocardial infarction: substrate description guiding placement of individual linear lesions targeting noninducibility. J Cardiovasc Electrophysiol. 2003;14(7):675–81. https://doi.org/10.1046/j.1540-8167.2003.02541.x. Kottkamp H, Wetzel U, Schirdewahn P, Dorszewski A, Gerds-Li JH, Carbucicchio C, et al. Catheter ablation of ventricular tachycardia in remote myocardial infarction: substrate description guiding placement of individual linear lesions targeting noninducibility. J Cardiovasc Electrophysiol. 2003;14(7):675–81. https://​doi.​org/​10.​1046/​j.​1540-8167.​2003.​02541.​x.
9.
go back to reference Soejima K, Suzuki M, Maisel WH, Brunckhorst CB, Delacretaz E, Blier L, et al. Catheter ablation in patients with multiple and unstable ventricular tachycardias after myocardial infarction: short ablation lines guided by reentry circuit isthmuses and sinus rhythm mapping. Circulation. 2001;104(6):664–9. https://doi.org/10.1161/hc3101.093764. Soejima K, Suzuki M, Maisel WH, Brunckhorst CB, Delacretaz E, Blier L, et al. Catheter ablation in patients with multiple and unstable ventricular tachycardias after myocardial infarction: short ablation lines guided by reentry circuit isthmuses and sinus rhythm mapping. Circulation. 2001;104(6):664–9. https://​doi.​org/​10.​1161/​hc3101.​093764.
10.
go back to reference Stevenson WG, Wilber DJ, Natale A, Jackman WM, Marchlinski FE, Talbert T, et al. Multicenter Thermocool VT Ablation Trial Investigators. Irrigated radiofrequency catheter ablation guided by electroanatomic mapping for recurrent ventricular tachycardia after myocardial infarction: the multicenter thermocool ventricular tachycardia ablation trial. Circulation. 2008;118(25):2773–82. Stevenson WG, Wilber DJ, Natale A, Jackman WM, Marchlinski FE, Talbert T, et al. Multicenter Thermocool VT Ablation Trial Investigators. Irrigated radiofrequency catheter ablation guided by electroanatomic mapping for recurrent ventricular tachycardia after myocardial infarction: the multicenter thermocool ventricular tachycardia ablation trial. Circulation. 2008;118(25):2773–82.
11.
go back to reference Tung R, Vaseghi M, Frankel DS, Vergara P, di Biase L, Nagashima K, et al. Freedom from recurrent ventricular tachycardia after catheter ablation is associated with improved survival in patients with structural heart disease: an international VT ablation center collaborative group study FHRS. Heart Rhythm. 2015;12(9):1997–2007. https://doi.org/10.1016/j.hrthm.2015.05.036. Tung R, Vaseghi M, Frankel DS, Vergara P, di Biase L, Nagashima K, et al. Freedom from recurrent ventricular tachycardia after catheter ablation is associated with improved survival in patients with structural heart disease: an international VT ablation center collaborative group study FHRS. Heart Rhythm. 2015;12(9):1997–2007. https://​doi.​org/​10.​1016/​j.​hrthm.​2015.​05.​036.
14.
go back to reference Yamashita S, Cochet H, Sacher F, et al. Impact of New Technologies and Approaches for Post-Myocardial Infarction Ventricular Tachycardia Ablation During Long-Term Follow-Up. Circ Arrhythm Electrophysiol. 2016;9(7):e003901.CrossRefPubMed Yamashita S, Cochet H, Sacher F, et al. Impact of New Technologies and Approaches for Post-Myocardial Infarction Ventricular Tachycardia Ablation During Long-Term Follow-Up. Circ Arrhythm Electrophysiol. 2016;9(7):e003901.CrossRefPubMed
21.
go back to reference Kapa S, Desjardins B, Callans DJ, Marchlinski FE, Dixit S. Contact electroanatomic mapping derived voltage criteria for characterizing left atrial scar in patients undergoing ablation for atrial fibrillation. J Cardiovasc Electrophysiol201425(10):1044–-1052. https://doi.org/10.1111/jce.12452. Epub 2014 Jun 11. Kapa S, Desjardins B, Callans DJ, Marchlinski FE, Dixit S. Contact electroanatomic mapping derived voltage criteria for characterizing left atrial scar in patients undergoing ablation for atrial fibrillation. J Cardiovasc Electrophysiol201425(10):1044–-1052. https://​doi.​org/​10.​1111/​jce.​12452. Epub 2014 Jun 11.
23.
go back to reference Spragg DD, Khurram I, Zimmerman SL, Yarmohammadi H, Barcelon B, Needleman M, et al. Initial experience with magnetic resonance imaging of atrial scar and co-registration with electroanatomic voltage mapping during atrial fibrillation: success and limitations. Heart Rhythm. 2012;9(12):2003–9. https://doi.org/10.1016/j.hrthm.2012.08.039. Spragg DD, Khurram I, Zimmerman SL, Yarmohammadi H, Barcelon B, Needleman M, et al. Initial experience with magnetic resonance imaging of atrial scar and co-registration with electroanatomic voltage mapping during atrial fibrillation: success and limitations. Heart Rhythm. 2012;9(12):2003–9. https://​doi.​org/​10.​1016/​j.​hrthm.​2012.​08.​039.
24.
go back to reference Squara F, Frankel DS, Schaller R, Kapa S, Chik WW, Callans DJ, et al. Voltage mapping for delineating inexcitable dense scar in patients undergoing atrial fibrillation ablation: a new end point for enhancing pulmonary vein isolation. Heart Rhythm. 2014;11(11):1904–11. https://doi.org/10.1016/j.hrthm.2014.07.027. Squara F, Frankel DS, Schaller R, Kapa S, Chik WW, Callans DJ, et al. Voltage mapping for delineating inexcitable dense scar in patients undergoing atrial fibrillation ablation: a new end point for enhancing pulmonary vein isolation. Heart Rhythm. 2014;11(11):1904–11. https://​doi.​org/​10.​1016/​j.​hrthm.​2014.​07.​027.
25.
go back to reference Liang JJ, Elafros MA, Muser D, Pathak RK, Santangeli P, Supple GE, et al. Comparison of left atrial bipolar voltage and scar using multielectrode fast automated mapping versus point-by-point contact Electroanatomic mapping in patients with atrial fibrillation undergoing repeat ablation. J Cardiovasc Electrophysiol. 2017 Mar;28(3):280–8. https://doi.org/10.1111/jce.13151. Epub 2017 Jan 10 Liang JJ, Elafros MA, Muser D, Pathak RK, Santangeli P, Supple GE, et al. Comparison of left atrial bipolar voltage and scar using multielectrode fast automated mapping versus point-by-point contact Electroanatomic mapping in patients with atrial fibrillation undergoing repeat ablation. J Cardiovasc Electrophysiol. 2017 Mar;28(3):280–8. https://​doi.​org/​10.​1111/​jce.​13151. Epub 2017 Jan 10
27.
go back to reference Hutchinson MD, Gerstenfeld EP, Desjardins B, Bala R, Riley MP, Garcia FC, et al. Endocardial unipolar voltagemapping to detect epicardial ventricular tachycardia substrate in patients with nonischemic left ventricular cardiomyopathy. Circ Arrhythm Electrophysiol. 2011;4(1):49–55. https://doi.org/10.1161/CIRCEP.110.959957. Hutchinson MD, Gerstenfeld EP, Desjardins B, Bala R, Riley MP, Garcia FC, et al. Endocardial unipolar voltagemapping to detect epicardial ventricular tachycardia substrate in patients with nonischemic left ventricular cardiomyopathy. Circ Arrhythm Electrophysiol. 2011;4(1):49–55. https://​doi.​org/​10.​1161/​CIRCEP.​110.​959957.
29.
go back to reference Marra MP, Leoni L, Bauce B, Corbetti F, Zorzi A, Migliore F, et al. Imaging study of ventricular scar in arrhythmogenic right ventricular cardiomyopathy: comparison of 3D standard electroanatomical voltagemapping and contrast-enhanced cardiac magnetic resonance. Circ Arrhythm Electrophysiol. 2012;5(1):91–100. https://doi.org/10.1161/CIRCEP.111.964635. Marra MP, Leoni L, Bauce B, Corbetti F, Zorzi A, Migliore F, et al. Imaging study of ventricular scar in arrhythmogenic right ventricular cardiomyopathy: comparison of 3D standard electroanatomical voltagemapping and contrast-enhanced cardiac magnetic resonance. Circ Arrhythm Electrophysiol. 2012;5(1):91–100. https://​doi.​org/​10.​1161/​CIRCEP.​111.​964635.
31.
go back to reference Perin EC, Silva GV, Sarmento-Leite R, Sousa AL, Howell M, Muthupillai R, et al. Assessing myocardial viability and infarct transmurality with left ventricular electromechanical mapping in patients with stable coronary artery disease: validation by delayed-enhancement magnetic resonance imaging. Circulation. 2002;106(8):957–61. https://doi.org/10.1161/01.CIR.0000026394.01888.18. Perin EC, Silva GV, Sarmento-Leite R, Sousa AL, Howell M, Muthupillai R, et al. Assessing myocardial viability and infarct transmurality with left ventricular electromechanical mapping in patients with stable coronary artery disease: validation by delayed-enhancement magnetic resonance imaging. Circulation. 2002;106(8):957–61. https://​doi.​org/​10.​1161/​01.​CIR.​0000026394.​01888.​18.
Metadata
Title
Point-by-point versus multisite electrode mapping in VT ablation: does freedom from VT recurrences depend on mapping catheter? An observational study
Authors
Petra Maagh
Arnd Christoph
Markus Sebastian Müller
Henning Dopp
Gunnar Plehn
Axel Meissner
Publication date
01-03-2018
Publisher
Springer US
Published in
Journal of Interventional Cardiac Electrophysiology / Issue 2/2018
Print ISSN: 1383-875X
Electronic ISSN: 1572-8595
DOI
https://doi.org/10.1007/s10840-018-0311-9

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