Letter by Berruezo et al regarding article, "Impact of local ablation on interconnected channels within ventricular scar: mechanistic implications for substrate modification".
نویسندگان
چکیده
BACKGROUND The extent to which channels within scar are interconnected is not known. The objective of the study was to evaluate the impact of local ablation of late potentials (LPs) on adjacent and remote areas of slow conduction with simultaneous multipolar mapping. METHODS AND RESULTS Analysis was performed on consecutive patients referred for ablation of scar-mediated ventricular tachycardia with double ventricular access. Ablation was performed targeting the earliest of LPs visualized on the multipolar catheter, and the impact on later LPs was recorded. In 21 patients, a multipolar catheter placed within scar visualized spatially distinct LPs. Among 39 radiofrequency applications, ablation at earlier LPs had an effect on neighboring and remote LPs in 31 (80%), with delay in 8 (21%), partial elimination in 9 (23%), and complete elimination in 14 (36%). The mean distance where an ablation impact was detected was 17.6±14.7 mm (range, 2-50 mm). Among all patients, 9.7±7.8 radiofrequency applications were delivered to homogenize the targeted scar region with a mean number of 23±12 LPs targeted. CONCLUSIONS Ablation can eliminate neighboring and remote areas of slow conduction, suggesting that channels within scar are frequently interconnected. This is the first mechanistic demonstration to show that ablation can modify electrical activity in regions of scar outside of the known radius of an radiofrequency lesion. The targeting of relatively earlier LPs can expedite scar homogenization without the need for extensive ablation of all LPs.
منابع مشابه
Response to letter regarding "Impact of local ablation on inter-connected channels within ventricular scar: mechanistic implications for substrate modification".
متن کامل
Impact of Local Ablation on Inter-Connected Channels within Ventricular Scar: Mechanistic Implications for Substrate Modification
1 a c , T ar r rdi di di iac a a Arrhy y y yth hm mia C Cent ter r r, UCL CL CL CLA A A He eal lth Sy yste te te t m m m, D Dav v vid d d Ge ef ffen n n n Schoo oo ool of of Med d dic Abstract: Background-The extent to which channels within scar are interconnected is not known. The
متن کاملA Prospective Study of Ripple Mapping the Post-Infarct Ventricular Scar to Guide Substrate Ablation for Ventricular Tachycardia.
BACKGROUND Post-infarct ventricular tachycardia is associated with channels of surviving myocardium within scar characterized by fractionated and low-amplitude signals usually occurring late during sinus rhythm. Conventional automated algorithms for 3-dimensional electro-anatomic mapping cannot differentiate the delayed local signal of conduction within the scar from the initial far-field signa...
متن کاملPrognostic Value of Scar Imaging for€Substrate Ablation of Ventricular€Tachycardia
SEE PAGE 353 C atheter ablation for ventricular tachycardia (VT) in ischemic heart disease is considered standard therapy in patients with recurrent, sustained monomorphic ventricular tachycardia, usually after failed antiarrhythmic therapy. Many centers worldwide use pre-procedural imaging with cardiac magnetic resonance (CMR) to assess the “scar substrate” in patients with ischemic and non-is...
متن کاملScar dechanneling: new method for scar-related left ventricular tachycardia substrate ablation.
BACKGROUND Ventricular tachycardia (VT) substrate ablation usually requires extensive ablation. Scar dechanneling technique may limit the extent of ablation needed. METHODS AND RESULTS The study included 101 consecutive patients with left ventricular scar-related VT (75 ischemic patients; left ventricular ejection fraction, 36 ± 13%). Procedural end point was the elimination of all identified...
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ورودعنوان ژورنال:
- Circulation. Arrhythmia and electrophysiology
دوره 6 6 شماره
صفحات -
تاریخ انتشار 2013