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Epicardial voltage mapping in patients with postinfarction ventricular tachycardia: a pilot study

https://doi.org/10.35336/VA-2020-E-22-27

Abstract

Introduction. Radiofrequency ablation (RFA) is an established treatment of post-myocardial infarction ventricular tachycardia (VT). Endocardial VT ablation can be insufficient for VT termination when the scar is intramural/epicardial.

Purpose: to assess the extent of epicardial electrophysiological VT substrate in patients with remote myocardial infarction.

Materials and methods. Thirteen patients with sustained postinfarction VT, who signed an informed consent, were included into the study. All patients underwent full clinical evaluation. Electroanatomical voltage bi- and unipolar mapping of endocardial and epicardial surfaces was performed. Maps were evaluated for the presence of low-voltage areas and local abnormal ventricular activity (LAVA). RFA was performed at LAVA sites. The end-point of the procedure was scar LAVA abolition and VT noninducibility (procedure success). VT recurrence was detected using an implantable cardioverter-defibrillator and/or ECG monitoring.

Results. Epicardial access was successful in 12 patients. Epicardial access was performed at a first procedure in 7 patients, 4 patients had a history of previous endocardial ablation. Epicardial LAVA sites were detected in 9 patients. Endocardial and epicardial arrhythmogenic substrate localization coincided in 8 patients. One patient had only epicardial scar, 1 patient had only septal endocardial scar. In one patient LAVA sites had different localizations on epicardial and endocardial maps. Acute ablation success was noted in 12 patients.

Conclusion. In our patient group transmural scar and epicardial electrophysiological arrhythmogenic substrate was detected in 82% of cases. Isolated endocardial ablation may be unsuccessful, in such cases epicardial mapping and ablation might be useful.

About the Authors

K. A. Simonova
Almazov National Medical Research Centre
Russian Federation
Saint-Petersburg


E. N. Mikhaylov
Almazov National Medical Research Centre; Saint-Petersburg Electrotechnical VUniversity “LETI”
Russian Federation
Saint-Petersburg


R. B. Tatarskiy
Almazov National Medical Research Centre
Russian Federation
Saint-Petersburg


A. V. Kamenev
Almazov National Medical Research Centre
Russian Federation
Saint-Petersburg


D. V. Panin
Federal Center for Cardiovascular Surgery
Russian Federation
Perm


V. S. Orshanskaya
Almazov National Medical Research Centre
Russian Federation
Saint-Petersburg


V. K. Lebedeva
Almazov National Medical Research Centre
Russian Federation
Saint-Petersburg


S. V. Garkina
Almazov National Medical Research Centre
Russian Federation
Saint-Petersburg


M. A. Vander
Almazov National Medical Research Centre
Russian Federation
Saint-Petersburg


D. S. Lebedev
Almazov National Medical Research Centre; Saint-Petersburg Electrotechnical VUniversity “LETI”
Russian Federation
Saint-Petersburg


Review

For citations:


Simonova K.A., Mikhaylov E.N., Tatarskiy R.B., Kamenev A.V., Panin D.V., Orshanskaya V.S., Lebedeva V.K., Garkina S.V., Vander M.A., Lebedev D.S. Epicardial voltage mapping in patients with postinfarction ventricular tachycardia: a pilot study. Journal of Arrhythmology. 2020;27:22-27. https://doi.org/10.35336/VA-2020-E-22-27

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ISSN 1561-8641 (Print)
ISSN 2658-7327 (Online)