OPTIMIZATION OF APPROACHES TO ENDOCARDIAL MAPPING OF SUBSTRATE OF IDIOPATHIC VENTRICULAR ARRHYTHMIAS IN PEDIATRIC PATIENTS

S. A. Termosesov; R. Sh. Garipov; Ya. Yu. Volkova; I. L. Ilyich; I. N. Skofenko; I. A. Khamnagadaev; I. A. Kovalev; M. A. Shkolnikova

OPTIMIZATION OF APPROACHES TO ENDOCARDIAL MAPPING OF SUBSTRATE OF IDIOPATHIC VENTRICULAR ARRHYTHMIAS IN PEDIATRIC PATIENTS

S. A. Termosesov, R. Sh. Garipov, Ya. Yu. Volkova, I. L. Ilyich, I. N. Skofenko, I. A. Khamnagadaev, I. A. Kovalev, M. A. Shkolnikova

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Abstract

To optimize an algorithm of endocardial mapping of idiopathic ventricular arrhythmias (VA) in pediatric patients by evaluating the data of invasive electrophysiological study (EPS) and to develop a method of prognosis of the VA substrate radiofrequency ablation (RFA) outcome, 337 patients, including 193 male (57.3%) and 144 female subjects (42.7%) were assessed and treated in 2003 2013. The patients aged 5 18 years (median: 14 years; IQR: 12 16 years). The study inclusion criteria were as follows: focal slow ventricular tachycardia (VT), fascicular tachycardia or monomorphic frequent ventricular premature contractions (VPC) associated with symptoms and/or arrhythmogenic myocardial dysfunction; frequent early VPC, and VPC provoked by exertion. The exclusion criteria were as follows: structural heart disease, polymorphic PVC or VT, number of monomorphic VPC less than 15,000 per day (according to the data of 24 hour Holter ECG monitoring), and the subject’s age under 5 years. To identify predictors to be used to localize the VA substrate, the data of activation (AM) and stimulation mapping (SM) were analyzed. According to the AM data, the “presystolic activity” was evaluated defined as an interval between the ventricular activation on endocardial bipolar electrogram and the onset of QRS complex on surface ECG at the background of ectopic activity. The SM results are given as presence of “identity” or “similarity” of paced and spontaneous QRS complexes at the background of ectopic activity. The statistically significant association between the results of AM and SM was found (r=-0.2; p<0.05). The SM results were statistically significantly associated with the effectiveness of RFA of the idiopathic VA substrate. There is a 2.6 times more pronounced likelihood of successful RFA in case of “identical” than in “similar” spontaneous and paced QRS complexes at the background of ectopic activity. In addition, the mathematic model analysis showed that irrespective of “identity” or “similarity” of spontaneous and paced QRS complexes at the background of ectopic activity, the success rate of RFA can be considered intermediate (0.75

Keywords

ventricular arrhythmias, electrophysiological study, activation mapping, stimulation mapping, radiofrequency catheter ablation

About the Authors

S. A. Termosesov

ОСП «Научно-исследовательский клинический институт педиатрии»; ГБОУ ВПО РНИМУ им. Н.И. Пирогова Минздрава России, Москва
Russian Federation

R. Sh. Garipov

Ya. Yu. Volkova

I. L. Ilyich

I. N. Skofenko

I. A. Khamnagadaev

I. A. Kovalev

M. A. Shkolnikova

References

1. Вайнштейн А.Б., Яшин С.М., Думпис Я.Ю., Шубик Ю.В. Электрокардиографическая топическая диагностика некоронарогенных правожелудочковых аритмий // Вестник аритмологии. - 2004. - No 34. - С. 11-17.

2. Ревишвили А.Ш., Рзаев Ф.Г., Снегур Р.Ю. Лабарткова Е.З. Алгоритм топической диагностики правожелудочковых аритмий // Вестник аритмологии, 2007. - С. Т. 46. - С. 5-11.

3. Ревишвили А.Ш., Носкова М.В., Рзаев Ф.Г., Артюхина Е.А. Неинвазивная топическая диагностика некоронарогенных желудочковых аритмий // Вестник аритмологии. - 2004. - № 35. - С. 5-15.

4. Ahmad A., Callans D., Hsia H. et al. Hads-On Ablation: The experts approach. 2013; 496 P.

5. Aliot E., Stevenson W., Almendral-Garrote J. 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: 6: 886-933.

6. Case C., Gillette P., Oslizlok P. et al. Radiofrequency catheter ablation of incessant, medically resistant supraventricular tachycardia in infants and small children // J. Am. Coll. Cardiol. 1992; 20: 1405-1410.

7. Deal B., Miller S., Scagliotti D. Ventricular tachycardia in a young population without overt heart disease // Circulation. 1986; 73: 1111-1118.

8. Dick M. Clinical Cardiac Electrophysiology in the Young. - Springer, 2006. - Т. 257.

9. Dixit S., Gerstenfeld E.P., Callans D.J., Marchlinski F.E. Electrocardiographic patterns of superior right ventricular outflow tract tachycardia: distinguishing septal and freewall sites of origin // J. Cardiovasc. Electrophisiol. - 2003. - V. 14. - P. 1-7.

10. El-Shalakany A., Hadjis T., Papageorgiou P., et al: Entrainment mapping criteria for the prediction of termination of ventricular tachycardia by single radiofrequency lesion in patients with coronary artery disease // Circulation 1999; 99: 2283-2289.

11. Jadonath R.L., Schwartzman D., Preminger M.W. et al. Utility of the 12-lead electrocardiogram in localizing the origin of right ventricular outflow tract tachycardia // Am. Heart J. - 1995. - V. 130. - P. 1107-1113.

12. Hulot J., Jouven X., Empana J. et al. Natural history and risk stratification of arrhythmogenic right ventricular dysplasia/cardiomyopathy // Circulation. 2004; 110: 1879-1884.

13. Issa Z., Miller J., Zipes D. Clinical arrhythmology and electrophysiology. Elsevier Science; 2009. 688;

14. Kamakura S., Shimizu W., Matsuo K., et al. Localization of optimal ablation site of idiopathic ventricular tachycardia from and left ventricular outflow tract by body surface EGG // Circulation. - 1998. - V. 98. - Р. 1525-1533.

15. Kuchar D.L., Ruskin J.N., Geran H. Electrocardiographic localization of the site of origin of ventricular tachycardia in patients with prior myocardial infarction // Int. J. Am. Coll. Cardiol. - 1989. - V. 13. - P. 893- 903.

16. Kugler J., Danford D., Deal B. Radifrequency catheter ablation for tachyarrhythmias in children and adolescents // N. Engl. J. Med. 1994; 26: 330: 21: 1481-1487.

17. Movsowitz C., Schwartzman D., Callans D. et al. Idiopathic right ventricular outflow tract tachycardia: Narrowing the anatomic location for successful ablation // Am. Heart J. 1996 May; 131: 5: 930-936.

18. Nagashima M., Matsishima M., Ogawa A. et al. Cardiac arrhythmias in healthy children revealed by 24-hour ambulatory ECG monitoring // Peditr. Cardiol.; 1987: 8: 103-108.

19. Shima T., Ohnishi H., Inoue T., et al. The relation between pacing sites in the right ventricular outflow tract and QRS morphology in the 12-lead EGG // Jpn Circ J. - 1998. - V. 62. - Р. 399-404.

20. Smeets J., Ben-Haim S., Rodriguez L. et al. New method for nonfluoroscopic endocardial mapping in humans: accuracy assessment and first clinical results // Circulation; 1998: 97: 2426-2432.

21. Stephen S., Wood M. Catheter ablation of cardiac arrhythmias. 2010. 672 p.

22. Tanel R., Walsh E., Triedman J. et al. Five-year experience with radiofrequency catheter ablation: implications for management of arrhythmias in pediatric and young adult patients // J. Pediatr. 1997; 131: 6: 878-887.

23. Van Hare G., Lesh M.D., Scheinman M., Langberg J. et al. Percutaneous radiofrequency catheter ablation for supraventricular arrhythmias in children // J. Am. Coll. Cardiol. 1991; 17: 7: 1613-1620.

24. Zachariah J., Walsh E., Triedman J. Multiple accessory pathways in the young: the impact of structural heart disease // Am Heart J. 2013 Jan; 165(1): 87-92.

25. Zipes D., Camm A., Borggrefe M. et al. ACC/AHA/ESC 2006 guidelines for management of patients with ventricular arrhythmias and the prevention of sudden cardiac death: a report of the American College of Cardiology / American Heart Association Task Force and the European Society of Cardiology Committee for Practice Guidelines (Writing Committee to Develop Guidelines for Management of Patients With Ventricular Arrhythmias and the Prevention of Sudden Cardiac Death) // J. Am. Coll. Cardiol. 2006; 48: 247-346.

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For citations:

Termosesov S.A., Garipov R.Sh., Volkova Ya.Yu., Ilyich I.L., Skofenko I.N., Khamnagadaev I.A., Kovalev I.A., Shkolnikova M.A. OPTIMIZATION OF APPROACHES TO ENDOCARDIAL MAPPING OF SUBSTRATE OF IDIOPATHIC VENTRICULAR ARRHYTHMIAS IN PEDIATRIC PATIENTS. Journal of Arrhythmology. 2014;(78):19-24. (In Russ.)