Lateral boundaries of the ventricular tachycardia circuit align with sinus rhythm discontinuities
File(s)
Author(s)
Type
Journal Article
Abstract
BACKGROUND: Sinus rhythm electrical activation mapping can provide information regarding the ischemic re-entrant ventricular tachycardia (VT) circuit. The information gleaned may include the localization of sinus rhythm electrical discontinuities, which can be defined as arcs of disrupted electrical conduction with large activation time differences across the arc. OBJECTIVES: This study sought to detect and localize sinus rhythm electrical discontinuities that might be present in activation maps constructed from infarct border zone electrograms. METHODS: Monomorphic re-entrant VT with a double-loop circuit and central isthmus was repeatedly inducible by programmed electrical stimulation in the epicardial border zone of 23 postinfarction canine hearts. Sinus rhythm and VT activation maps were constructed from 196 to 312 bipolar electrograms acquired surgically at the epicardial surface and analyzed computationally. A complete re-entrant circuit was mappable from the epicardial electrograms of VT, and isthmus lateral boundary (ILB) locations were ascertained. The difference in sinus rhythm activation time across ILB locations, vs the central isthmus and vs the circuit periphery, was determined. RESULTS: Sinus rhythm activation time differences averaged 14.4 milliseconds across the ILB vs 6.5 milliseconds at the central isthmus and 6.4 milliseconds at the periphery (ie, the outer circuit loop) (P ≤ 0.001). Locations with large sinus rhythm activation difference tended to overlap ILB (60.3% ± 23.2%) compared with their overlap with the entire grid (27.5% ± 18.5%) (P < 0.001). CONCLUSIONS: Disrupted electrical conduction is evident as discontinuity in sinus rhythm activation maps, particularly at ILB locations. These areas may represent permanent fixtures relating to spatial differences in border zone electrical properties, caused in part by alterations in underlying infarct depth. The tissue properties producing sinus rhythm discontinuity at ILB may contribute to functional conduction block formation at VT onset.
Date Issued
2023-06
Date Acceptance
2022-11-20
Citation
JACC: Clinical Electrophysiology, 2023, 9 (6), pp.851-861
ISSN
2405-5018
Publisher
Elsevier
Start Page
851
End Page
861
Journal / Book Title
JACC: Clinical Electrophysiology
Volume
9
Issue
6
Copyright Statement
Copyright © Elsevier Ltd. All rights reserved. This manuscript version is made available under the CC-BY-NC-ND 4.0 license https://creativecommons.org/licenses/by-nc-nd/4.0/
Identifier
https://www.ncbi.nlm.nih.gov/pubmed/37227361
PII: S2405-500X(23)00018-X
Subjects
Animals
Dogs
Heart Block
Heart Conduction System
Myocardial Infarction
Tachycardia, Ventricular
activation mapping
isthmus
re-entrant circuit
sinus rhythm
ventricular tachycardia
Publication Status
Published
Coverage Spatial
United States
Date Publish Online
2023-05-24