Role of activation signatures in re-entrant ventricular tachycardia circuits
Author(s)
Ciaccio, Edward J
Saluja, Deepak S
Peters, Nicholas S
Yarmohammadi, Hirad
Type
Journal Article
Abstract
INTRODUCTION: Development of a rapid means to verify the ventricular tachycardia (VT) isthmus location from heart surface electrogram recordings would be a helpful tool for the electrophysiologist. METHOD: Myocardial infarction was induced in 22 canines by left anterior descending coronary artery ligation under general anesthesia. After 3-5 days, VT was inducible via programmed electrical stimulation at the anterior left ventricular epicardial surface. Bipolar VT electrograms were acquired from 196 to 312 recording sites using a multielectrode array. Electrograms were marked for activation time, and activation maps were constructed. The activation signal, or signature, is defined as the cumulative number of recording sites that have activated per millisecond, and it was utilized to segment each circuit into inner and outer circuit pathways, and as an estimate of best ablation lesion location to prevent VT. RESULTS: VT circuit components were differentiable by activation signals as: inner pathway (mean: 0.30 sites activating/ms) and outer pathway (mean: 2.68 sites activating/ms). These variables were linearly related (p < .001). Activation signal characteristics were dependent in part upon the isthmus exit site. The inner circuit pathway determined by the activation signal overlapped and often extended beyond the activation map isthmus location for each circuit. The best lesion location estimated by the activation signal would likely block an electrical impulse traveling through the isthmus, to prevent VT in all circuits. CONCLUSIONS: The activation signal algorithm, simple to implement for real-time computer display, approximates the VT isthmus location and shape as determined from activation marking, and best ablation lesion location to prevent reinduction.
Date Issued
2024-02-01
Date Acceptance
2023-11-21
Citation
Journal of Cardiovascular Electrophysiology, 2024, 35 (2), pp.267-277
ISSN
1045-3873
Publisher
Wiley
Start Page
267
End Page
277
Journal / Book Title
Journal of Cardiovascular Electrophysiology
Volume
35
Issue
2
Copyright Statement
© 2023 The Authors.Journal of Cardiovascular Electrophysiologypublished by Wiley Periodicals LLC. his is an open access article under the terms of theCreative Commons Attribution‐NonCommercialLicense, which permits use, distribution and reproduction in anymedium, provided the original work is properly cited and is not used for commercial purposes.
License URL
Identifier
https://www.ncbi.nlm.nih.gov/pubmed/38073065
Subjects
Algorithms
Animals
Catheter Ablation
Dogs
Heart Conduction System
Myocardial Infarction
Tachycardia, Ventricular
activation
circuit
electrogram
mapping
ventricular tachycardia
Publication Status
Published
Coverage Spatial
United States
Date Publish Online
2023-12-10