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Can adjustments in voltage criteria unmask conducting channels in patients with post-infarction ventricular tachycardia?
Session:
Posters 5 - Écran 06 - Arritmologia Invasiva
Speaker:
Micaela Rodrigues Neto
Congress:
CPC 2018
Topic:
C. Arrhythmias and Device Therapy
Theme:
08. Ventricular Arrhythmias and Sudden Cardiac Death (SCD)
Subtheme:
08.3 Ventricular Arrhythmias and SCD - Diagnostic Methods
Session Type:
Posters
FP Number:
---
Authors:
Micaela Rodrigues Neto; Pedro Lopes Do Carmo; Carlos Lovatto; João Carmo; Francisco Moscoso Costa; Maria Salomé Carvalho; Mariana Pereira; Elizabete Vaz; Diogo Cavaco; Francisco Bello Morgado; Pedro Adragão; Miguel Mendes
Abstract
<p><strong><u>Background</u></strong>: High density substrate mapping during sinus rhythm is useful to delineate post-infarction endocardial scar and allows characterization of possible reentry circuits of ventricular tachycardia (VT), as conducting channels. Adjustments in voltage criteria might unmask potential channels by discriminating subtle areas of healthy tissue.</p> <p><strong><u>Purpose:</u></strong> To assess the correlation between electrophysiological findings able to identify conducting channels in patients with ischemic VT and bipolar maps using different voltage cutoff values.</p> <p><strong><u>Methods</u></strong>: Retrospective analysis of 15 patients (86,7% males; 69 years-old [IQR=11]; ejection fraction 30% [IQR 10,8]) with post-infarction VT submitted to substrate guided ablation using CARTO-UNIVU mapping system and Pentaray catheter between october 2015 and september 2017.</p> <p>All patients had an endocardial bipolar voltage map under sinus rhythm (median of total points/map 1563 [IQR 1400]). Electrograms with delayed, high frequency, fractionated and low voltage components (LP) were tagged and correlated with conducting channels. Then, different voltage cutoffs were used to identify scar area and were compared offline with standard voltage cut-off (A: 0,5-1,5; B: 0,3-1,0; C: 0,2-0,8 and D: 0,1-0,5) and correlated with electrophysiological findings. Patients with epicardial or right-sided VTs origin were excluded.</p> <p><strong><u>Results</u></strong>: A total of 15 patients were included. The percentage of scar decreased as voltage values were lower (A: 76,5cm<sup>2</sup> [IQR 26,2]; B: 61,0cm<sup>2</sup> [IQR 48,8]; C: 47,7cm<sup>2</sup> [IQR 31,1]; D: 26,4cm<sup>2</sup> [IQR 32,8]).</p> <p>With decreasing voltage values, the number of conducting channels increased (A: 0 [IQR 0-2]; B: 1 [IQR0-4]; C: 2 [IQR 1-4]; D: 1 [IQR 0-3]), and a smaller percentage of late potentials was located within dense scar (A: 80,0%; B: 49,3%; C: 40,0%; D: 0%).</p> <p>VT ablation was successful in 80% of the patients. During a median follow-up of 6 months, 2 pts had VT recurrence and 2 died.</p> <p> </p> <p><strong><u>Conclusions:</u></strong> When voltage cutoffs were changed, conducting channels in the scar and multiple areas with late potentials were revealed (figure 1). The optimal cutoff was 0,2-0,8.</p>
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