High-density substrate-guided ventricular tachycardia ablation

Role of activation mapping in an attempt to improve procedural effectiveness

Corrado Carbucicchio, Nadeem Ahmad Raja, Luigi Di Biase, Valeria Volpe, Antonio Dello Russo, Chintan Trivedi, Stefano Bartoletti, Martina Zucchetti, Michela Casella, Eleonora Russo, Pasquale Santangeli, Massimo Moltrasio, Fabrizio Tundo, Gaetano Fassini, Andrea Natale, Claudio Tondo

Research output: Contribution to journalArticle

13 Citations (Scopus)

Abstract

Background Advanced techniques of electroanatomical mapping efficiently guide ventricular tachycardia (VT) ablation strategies; in this context, the adjunctive value of combining activation mapping (AMap) to improve accuracy has not been elucidated. Objective To investigate whether conventional AMap further contributes to the identification of critical sites of VT reentry and whether this translates into a more effective ablation outcome in a cohort of patients undergoing VT ablation. Methods We prospectively enrolled 126 patients (mean age 65.3 ± 10.5 years; left ventricular ejection fraction 33.3% ± 7.2%) with ischemic (n = 89) or idiopathic (n = 37) dilated cardiomyopathy undergoing endocardial (n = 105) or endo-epicardial (n = 21) electroanatomical mapping and ablation. A substrate-guided strategy targeting surrogate markers of reentry was accomplished in all patients, but the feasibility and efficacy of AMap was preliminarily assessed for all induced VTs focusing on early VT suppression obtained during radiofrequency delivery. VT-free survival was assessed by ICD interrogation. Results AMap successfully guided ablation in 62 of 104 (59.6%) patients with inducible VT(s). At 1 year, 6 of 126 (4.8%) patients died; VT recurred in 28 of 126 (22.2%) patients. No significant difference in VT recurrence rate was observed between patients in whom AMap proved effective versus those in whom substrate-guided ablation was not corroborated by AMap (16 of 62 [25.8%] vs 12 of 64 [18.8%]; log-rank test, P =.3). Conclusions Our findings support the efficacy of a substrate-guided strategy targeting specific markers of arrhythmogenicity identified during sinus rhythm. AMap proves highly efficient acutely but does not improve overall VT-free survival, suggesting that in patients with advanced cardiac disease, life-threatening arrhythmias can be successfully treated by ablation in sinus rhythm, thus limiting procedural risks.

Original languageEnglish (US)
Pages (from-to)1850-1858
Number of pages9
JournalHeart Rhythm
Volume10
Issue number12
DOIs
StatePublished - Dec 2013

Fingerprint

Ventricular Tachycardia
Survival
Dilated Cardiomyopathy
Stroke Volume
Cardiac Arrhythmias
Heart Diseases
Biomarkers
Recurrence

Keywords

  • Catheter ablation
  • Electroanatomical mapping
  • Ischemic heart disease
  • Nonischemic cardiomyopathy
  • Ventricular tachycardia

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Physiology (medical)

Cite this

High-density substrate-guided ventricular tachycardia ablation : Role of activation mapping in an attempt to improve procedural effectiveness. / Carbucicchio, Corrado; Ahmad Raja, Nadeem; Di Biase, Luigi; Volpe, Valeria; Dello Russo, Antonio; Trivedi, Chintan; Bartoletti, Stefano; Zucchetti, Martina; Casella, Michela; Russo, Eleonora; Santangeli, Pasquale; Moltrasio, Massimo; Tundo, Fabrizio; Fassini, Gaetano; Natale, Andrea; Tondo, Claudio.

In: Heart Rhythm, Vol. 10, No. 12, 12.2013, p. 1850-1858.

Research output: Contribution to journalArticle

Carbucicchio, C, Ahmad Raja, N, Di Biase, L, Volpe, V, Dello Russo, A, Trivedi, C, Bartoletti, S, Zucchetti, M, Casella, M, Russo, E, Santangeli, P, Moltrasio, M, Tundo, F, Fassini, G, Natale, A & Tondo, C 2013, 'High-density substrate-guided ventricular tachycardia ablation: Role of activation mapping in an attempt to improve procedural effectiveness', Heart Rhythm, vol. 10, no. 12, pp. 1850-1858. https://doi.org/10.1016/j.hrthm.2013.09.059
Carbucicchio, Corrado ; Ahmad Raja, Nadeem ; Di Biase, Luigi ; Volpe, Valeria ; Dello Russo, Antonio ; Trivedi, Chintan ; Bartoletti, Stefano ; Zucchetti, Martina ; Casella, Michela ; Russo, Eleonora ; Santangeli, Pasquale ; Moltrasio, Massimo ; Tundo, Fabrizio ; Fassini, Gaetano ; Natale, Andrea ; Tondo, Claudio. / High-density substrate-guided ventricular tachycardia ablation : Role of activation mapping in an attempt to improve procedural effectiveness. In: Heart Rhythm. 2013 ; Vol. 10, No. 12. pp. 1850-1858.
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abstract = "Background Advanced techniques of electroanatomical mapping efficiently guide ventricular tachycardia (VT) ablation strategies; in this context, the adjunctive value of combining activation mapping (AMap) to improve accuracy has not been elucidated. Objective To investigate whether conventional AMap further contributes to the identification of critical sites of VT reentry and whether this translates into a more effective ablation outcome in a cohort of patients undergoing VT ablation. Methods We prospectively enrolled 126 patients (mean age 65.3 ± 10.5 years; left ventricular ejection fraction 33.3{\%} ± 7.2{\%}) with ischemic (n = 89) or idiopathic (n = 37) dilated cardiomyopathy undergoing endocardial (n = 105) or endo-epicardial (n = 21) electroanatomical mapping and ablation. A substrate-guided strategy targeting surrogate markers of reentry was accomplished in all patients, but the feasibility and efficacy of AMap was preliminarily assessed for all induced VTs focusing on early VT suppression obtained during radiofrequency delivery. VT-free survival was assessed by ICD interrogation. Results AMap successfully guided ablation in 62 of 104 (59.6{\%}) patients with inducible VT(s). At 1 year, 6 of 126 (4.8{\%}) patients died; VT recurred in 28 of 126 (22.2{\%}) patients. No significant difference in VT recurrence rate was observed between patients in whom AMap proved effective versus those in whom substrate-guided ablation was not corroborated by AMap (16 of 62 [25.8{\%}] vs 12 of 64 [18.8{\%}]; log-rank test, P =.3). Conclusions Our findings support the efficacy of a substrate-guided strategy targeting specific markers of arrhythmogenicity identified during sinus rhythm. AMap proves highly efficient acutely but does not improve overall VT-free survival, suggesting that in patients with advanced cardiac disease, life-threatening arrhythmias can be successfully treated by ablation in sinus rhythm, thus limiting procedural risks.",
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T1 - High-density substrate-guided ventricular tachycardia ablation

T2 - Role of activation mapping in an attempt to improve procedural effectiveness

AU - Carbucicchio, Corrado

AU - Ahmad Raja, Nadeem

AU - Di Biase, Luigi

AU - Volpe, Valeria

AU - Dello Russo, Antonio

AU - Trivedi, Chintan

AU - Bartoletti, Stefano

AU - Zucchetti, Martina

AU - Casella, Michela

AU - Russo, Eleonora

AU - Santangeli, Pasquale

AU - Moltrasio, Massimo

AU - Tundo, Fabrizio

AU - Fassini, Gaetano

AU - Natale, Andrea

AU - Tondo, Claudio

PY - 2013/12

Y1 - 2013/12

N2 - Background Advanced techniques of electroanatomical mapping efficiently guide ventricular tachycardia (VT) ablation strategies; in this context, the adjunctive value of combining activation mapping (AMap) to improve accuracy has not been elucidated. Objective To investigate whether conventional AMap further contributes to the identification of critical sites of VT reentry and whether this translates into a more effective ablation outcome in a cohort of patients undergoing VT ablation. Methods We prospectively enrolled 126 patients (mean age 65.3 ± 10.5 years; left ventricular ejection fraction 33.3% ± 7.2%) with ischemic (n = 89) or idiopathic (n = 37) dilated cardiomyopathy undergoing endocardial (n = 105) or endo-epicardial (n = 21) electroanatomical mapping and ablation. A substrate-guided strategy targeting surrogate markers of reentry was accomplished in all patients, but the feasibility and efficacy of AMap was preliminarily assessed for all induced VTs focusing on early VT suppression obtained during radiofrequency delivery. VT-free survival was assessed by ICD interrogation. Results AMap successfully guided ablation in 62 of 104 (59.6%) patients with inducible VT(s). At 1 year, 6 of 126 (4.8%) patients died; VT recurred in 28 of 126 (22.2%) patients. No significant difference in VT recurrence rate was observed between patients in whom AMap proved effective versus those in whom substrate-guided ablation was not corroborated by AMap (16 of 62 [25.8%] vs 12 of 64 [18.8%]; log-rank test, P =.3). Conclusions Our findings support the efficacy of a substrate-guided strategy targeting specific markers of arrhythmogenicity identified during sinus rhythm. AMap proves highly efficient acutely but does not improve overall VT-free survival, suggesting that in patients with advanced cardiac disease, life-threatening arrhythmias can be successfully treated by ablation in sinus rhythm, thus limiting procedural risks.

AB - Background Advanced techniques of electroanatomical mapping efficiently guide ventricular tachycardia (VT) ablation strategies; in this context, the adjunctive value of combining activation mapping (AMap) to improve accuracy has not been elucidated. Objective To investigate whether conventional AMap further contributes to the identification of critical sites of VT reentry and whether this translates into a more effective ablation outcome in a cohort of patients undergoing VT ablation. Methods We prospectively enrolled 126 patients (mean age 65.3 ± 10.5 years; left ventricular ejection fraction 33.3% ± 7.2%) with ischemic (n = 89) or idiopathic (n = 37) dilated cardiomyopathy undergoing endocardial (n = 105) or endo-epicardial (n = 21) electroanatomical mapping and ablation. A substrate-guided strategy targeting surrogate markers of reentry was accomplished in all patients, but the feasibility and efficacy of AMap was preliminarily assessed for all induced VTs focusing on early VT suppression obtained during radiofrequency delivery. VT-free survival was assessed by ICD interrogation. Results AMap successfully guided ablation in 62 of 104 (59.6%) patients with inducible VT(s). At 1 year, 6 of 126 (4.8%) patients died; VT recurred in 28 of 126 (22.2%) patients. No significant difference in VT recurrence rate was observed between patients in whom AMap proved effective versus those in whom substrate-guided ablation was not corroborated by AMap (16 of 62 [25.8%] vs 12 of 64 [18.8%]; log-rank test, P =.3). Conclusions Our findings support the efficacy of a substrate-guided strategy targeting specific markers of arrhythmogenicity identified during sinus rhythm. AMap proves highly efficient acutely but does not improve overall VT-free survival, suggesting that in patients with advanced cardiac disease, life-threatening arrhythmias can be successfully treated by ablation in sinus rhythm, thus limiting procedural risks.

KW - Catheter ablation

KW - Electroanatomical mapping

KW - Ischemic heart disease

KW - Nonischemic cardiomyopathy

KW - Ventricular tachycardia

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