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2. Orthogonal high-density mapping with ventricular tachycardia isthmus analysis vs. pure substrate ventricular tachycardia ablation: A case–control study

Author

Sara Vázquez-Calvo, Paz Garre, Paula Sanchez-Somonte, Roger Borras, Levio Quinto, Gala Caixal, Margarida Pujol-Lopez, Till Althoff, Eduard Guasch, Elena Arbelo, José Maria Tolosana, Josep Brugada, Lluís Mont, and Ivo Roca-Luque

Subjects
ventricular tachycardia ablation, high-density mapping catheters, activation mapping, cardiac magnetic resonance, arrhythmic burden, Diseases of the circulatory (Cardiovascular) system, RC666-701
Abstract

BackgroundSubstrate-based ablation has become a successful technique for ventricular tachycardia (VT) ablation. High-density (HD) mapping catheters provide high-resolution electroanatomical maps and better discrimination of local abnormal electrograms. The HD Grid Mapping Catheter is an HD catheter with the ability to map orthogonal signals on top of conventional bipolar signals, which could provide better discrimination of the arrhythmic substrate. On the other hand, conventional mapping techniques, such as activation mapping, when possible, help to identify the isthmus of the tachycardia.AimThe purpose of this study was to compare clinical outcomes after using two different VT ablation strategies: one based on extensive mapping with the HD Grid Mapping Catheter, including VT isthmus analysis, and the other based on pure substrate ablation.MethodsForty consecutive patients undergoing VT ablation with extensive HD mapping method in the hospital clinic (November 2018–November 2019) were included. Clinical outcomes were compared with a historical cohort of 26 consecutive patients who underwent ablation using a scar dechanneling technique before 2018.ResultsThe density of mapping points was higher in the extensive mapping group (2370.24 ± 920.78 vs. 576.45 ± 294.46; p < 0.001). After 1 year of follow-up, VT recurred in 18.4% of patients in the extensive mapping group vs. 34.6% of patients in the historical control group (p = 0.14), with a significantly greater reduction of VT burden: VT episodes (81.7 ± 7.79 vs. 43.4 ± 19.9%, p < 0.05), antitachycardia pacing (99.45 ± 2.29 vs. 33.9 ± 102.5%, p < 0.001), and implantable cardioverter defibrillator (ICD) shocks (99 ± 4.5 vs. 64.7 ± 59.9%, p = 0.02).ConclusionThe use of a method based on extensive mapping with the HD Grid Mapping Catheter and VT isthmus analysis allows better discrimination of the arrhythmic substrate and could be associated with a greater decrease in VT burden.

Published
2022
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3. Optimized single-point left ventricular pacing leads to improved resynchronization compared with multipoint pacing

Author

Alejandro Liberos, Eduard Guasch, Felipe Atienza, Paz Garre, Andreu M. Climent, Francisco Alarcón, Rodolfo San Antonio, Marta Sitges, Lluís Mont, Omar Trotta, Maria S. Guillem, Margarida Pujol-López, Ivo Roca-Luque, Josep Brugada, Roger Borràs, Francisco Fernández-Avilés, José María Tolosana, Levio Quinto, Adelina Doltra, Elena Arbelo, Rafael Jiménez-Arjona, and Ana Gonzalez-Ascaso

Subjects
Male, medicine.medical_specialty, medicine.medical_treatment, Cardiac resynchronization therapy, 030204 cardiovascular system & hematology, Multipoint pacing, Cardiac Resynchronization Therapy, TECNOLOGIA ELECTRONICA, Electrocardiography, Ventricular Dysfunction, Left, 03 medical and health sciences, QRS complex, Electric Power Supplies, 0302 clinical medicine, Fusion, Internal medicine, medicine, Humans, Prospective Studies, cardiovascular diseases, 030212 general & internal medicine, Reverse remodeling, Aged, business.industry, Electrocardiographic imaging, General Medicine, Middle Aged, Ventricular pacing, 3. Good health, medicine.anatomical_structure, Battery longevity, Optimized intervals, Echocardiography, Ventricle, Cardiology, Female, Single point, Cardiology and Cardiovascular Medicine, business
Abstract

[EN] Background Multipoint pacing (MPP) in cardiac resynchronization therapy (CRT) activates the left ventricle from two locations, thereby shortening the QRS duration and enabling better resynchronization; however, compared with conventional CRT, MPP reduces battery longevity. On the other hand, electrocardiogram-based optimization using the fusion-optimized intervals (FOI) method achieves more significant reverse remodeling than nominal CRT programming. Our study aimed to determine whether MPP could attain better resynchronization than single-point pacing (SPP) optimized by FOI. Methods This prospective study included 32 consecutive patients who successfully received CRT devices with MPP capabilities. After implantation, the QRS duration was measured during intrinsic rhythm and with three pacing configurations: MPP, SPP-FOI, and MPP-FOI. In 14 patients, biventricular activation times (by electrocardiographic imaging, ECGI) were obtained during intrinsic rhythm and for each pacing configuration to validate the findings. Device battery longevity was estimated at the 45-day follow-up. Results The SPP-FOI method achieved greater QRS shortening than MPP (-56 +/- 16 vs. -42 +/- 17 ms, p < .001). Adding MPP to the best FOI programming did not result in further shortening (MPP-FOI: -58 +/- 14 ms, p = .69). Although biventricular activation times did not differ significantly among the three pacing configurations, only the two FOI configurations achieved significant shortening compared with intrinsic rhythm. The estimated battery longevity was longer with SPP than with MPP (8.1 +/- 2.3 vs. 6.3 +/- 2.0 years, p = .03). Conclusions SPP optimized by FOI resulted in better resynchronization and longer battery duration than MPP., Centro de Investigacion Biomedica en Red Enfermedades Cardiovasculares, Grant/Award Number: CB16/11/00354; Instituto de Salud Carlos III, Grant/Award Numbers: DTS16/0160, PI16/00435, PI16/00703, PI17/01059, PI17/01106; Sociedad Espanola de Cardiologia, Grant/Award Numbers: 2018, SEC_ESTIM_01; Agencia deGestio d'Ajuts Universitaris i de Recerca, Grant/AwardNumber: 2017_SGR_1548; Fundacio laMarato de TV3, Grant/Award Number: 20152730; Horizon 2020 Framework Programme, Grant/Award Number: 633196 - CATCH MEproject; European Regional Development Fund, Grant/Award Number: EITHealth 19600 AFFINE

Published
2021
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