Identification of a Zone of Slow Conduction Appropriate for VT Ablation: Theoretical and Practical Considerations

Fontaine, G.; Frank, Robert; Tonet, Joelci; Grosgogeat, Y

doi:10.1111/j.1540-8159.1989.tb02656.x

Cited by 80 publications

(25 citation statements)

References 12 publications

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“…conduction area of the reentrant circuit or only a by stander. Electrophysiological findings during rapid pacings from the site of a double potential should answer these questions (14,15), but because of hemodynamic instability during VT, stimulation from the slow con duction area was not performed.…”

Section: Discussionmentioning

confidence: 99%

Intraventricular Concealed Double Tachycardia: A Case Report.

et al. 1992

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An electrophysiologic study was performed on a patient with ischemic sustained ventricular tachycardia (VT). During pacing at the right ventricular apex, ventricular double potential was recorded at the left ventricular apex. Sustained VT was induced by double extra stimuli from the right ventricular apex. Three types of VTs with different QRS morphologies were observed, and each VT was changeable to other types. The interval between one of the two potentials and the surface QRS was constant during all VTs, but the other potential showed dissociation from the surface QRS. During this dissociation, an intrinsic rhythm of the potential was sometimes shorter than the cycle length of the VT. The mechanism of a block between the VT and a bystander could hardly explain these electrophysiologic findings. Concealed double ventricular tachycardia was considered to be the likely mechanism. (Internal Medicine 31: 227-231, 1992)

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Section: Discussionmentioning

confidence: 99%

Intraventricular Concealed Double Tachycardia: A Case Report.

et al. 1992

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“…10). This measurement is less simple to perform than the previous one which in- volves two consecutive tachycardia beats [44], However, we should remember that it is only valid if the tachycardia rate is con stant (fig. 11).…”

Section: The Sydney Triadmentioning

confidence: 99%

“…This zone of slow conduction connected to the critical path way may be located in any place along the critical zone of slow conduction. We think that this particular situation can be identi fied with electrophysiological measurements [44],…”

Section: Correlation Between Ecg and The Reentry Loopmentioning

confidence: 99%

“…Any point easy to identify on the QRS complex may be chosen. The practical application of this property is examplified by the use of a particular Tektronix digitalstorage oscilloscope [44], The triggering point of the time base may be chosen on the fastest slope of the QRS complex and dis played in the middle (or shifted to the right) of the screen. Therefore the presystolic activ ity as well as the pacing stimulus will be dis played on the left of the QRS complexes and stored in two independent memories.…”

Section: Practical Approachesmentioning

confidence: 99%

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Ablation of the Slow-Conduction Area in Chronic Ventricular Tachycardia

Fontaine¹,

Frank²,

Pavie³

et al. 1990

Cardiology

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The ablation techniques, which derive from surgical approach in the treatment of ventricular tachycardia, were originally based on the modification of conduction in the so-called site of origin of the arrhythmia. A reentrant tachycardia involves two areas of conduction, one which consists of normal tissue, and the other with slow-conduction properties isolated from the previous structure. We now think that a more appropriate place to deliver the shock should be the area of slow conduction. The purpose of this paper is to review the main electrophysiological characteristics of this tissue, which could be interesting markers to identify the site where the shock should be delivered.

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“…We considered only two reentry circuit configurations: the figure-eight type of circuit that has been well characterized in animal models6, [21][22][23][24] 25 However, the existence of such areas in human myocardial scars is speculative at present. We also assumed that the figure-eight reentry circuit was located in the border of a myocardial scar with one loop of the circuit (the loop from sites 1-3 in Figure 1) relatively protected from the surrounding myocardium by the arcs of block and the common central pathway of slow conduction.…”

Section: Limitationsmentioning

confidence: 99%

Programmed electrical stimulation at potential ventricular reentry circuit sites. Comparison of observations in humans with predictions from computer simulations.

Stevenson¹,

Nademanee²,

Weiss³

et al. 1989

Circulation

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The purpose of this study was to define specific types of resetting responses to programmed electrical stimulation during human ventricular tachycardia and to use computer simulations of reentry circuits to assess the possible mechanisms and pacing site location relative to the reentry circuit for each type of response. The effects of scanning single stimuli at 35 left ventricular endocardial sites during sustained monomorphic ventricular tachycardia in 12 patients were studied. In considering alterations in QRS configuration and the delay between the stimulus and the advanced QRS, we identified three types of resetting responses to scanning stimuli consistent with stimulation at sites in or near the reentry circuit at 12 abnormal endocardial sites in eight patients. Type 1: all capturing stimuli were followed after a delay by early QRS complexes that had the same configuration as the tachycardia complexes. Type 2: late stimuli reset tachycardia as in type 1 but early stimuli reset the tachycardia after altering the QRS configuration. Type 3: late stimuli reset tachycardia as in type 1, but early stimuli advanced tachycardia with a short stimulus to QRS delay without altering the QRS configuration. In the simulations, premature depolarization of sites in the circuit produced orthodromic and antidromic wavefronts. The orthodromic wavefront propagated through the circuit and exited the circuit at the same site as did the previous tachycardia wavefronts and advanced the tachycardia without altering the configuration of the advanced QRS. The antidromic wavefront of relatively late stimuli was confined within or near the circuit by collision with the orthodromic wavefront of the preceding tachycardia beat and failed to alter ventricular activation distant from the circuit. Therefore, the QRS configuration after the stimulus was unchanged. A type 1 response occurred when all capturing stimuli produced this effect. However, with increasing stimulus prematurity, the antidromic wavefront propagated farther before colliding with an orthodromic wavefront, and under some conditions, it exited the circuit from a site other than the original circuit "exit," and altered the ventricular activation sequence distant from the circuit and, therefore, the QRS configuration, producing a type 2 pattern. The type 3 pattern occurred when the antidromic wavefront of early premature beats captured the original circuit exit. The effect of a stimulus was dependent on the stimulus prematurity, the relative conduction times from the stimulation site to the potential sites of "exit" from the circuit, and the timing of the excitable gap at the stimulation site. In the figure-eight reentry circuit simulations, the type 1 response tended to occur during stimulation within, the type 2 response near the entrance to, and the type 3 response outside but near the exit from the slowly conducting central common pathway. Type 2 responses could also occur with stimulation at a site that was close to but not within the circuit. The recognition of specific ...

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Identification of a Zone of Slow Conduction Appropriate for VT Ablation: Theoretical and Practical Considerations

Cited by 80 publications

References 12 publications

Intraventricular Concealed Double Tachycardia: A Case Report.

Intraventricular Concealed Double Tachycardia: A Case Report.

Ablation of the Slow-Conduction Area in Chronic Ventricular Tachycardia

Programmed electrical stimulation at potential ventricular reentry circuit sites. Comparison of observations in humans with predictions from computer simulations.

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