Initial negative concordance on unipolar and bipolar electrograms: a novel parameter for localizing the origin of premature ventricular contractions arising from pulmonary sinus cusps

Wang, Xiaoqing; Wang, Mengfei; Cheng, Ya-Min; Hui, Jie

doi:10.1007/s10840-023-01473-4

Cited by 2 publications

(3 citation statements)

References 20 publications

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“…У сучасній літературі наявна досить обмежена кількість публікацій, присвячених оцінюванню значення морфології біполярного локального сигналу при абляції ІША. Наявні публікації вказують на роль негативної полярності біполярного сигналу, що збігається з негативним уніполярним сигналом, формуючи негативну конкордантність [15,16]. Саме негатив-на конкордантність визначається як один з критеріїв оптимального місця для супресії аритмії, хоча і не є обов'язковим критерієм, а розглядається як додаткова ознака [15,16].…”

Section: таблиця 1 якісна характеристика ендограм у місці успішної су...unclassified

“…Наявні публікації вказують на роль негативної полярності біполярного сигналу, що збігається з негативним уніполярним сигналом, формуючи негативну конкордантність [15,16]. Саме негатив-на конкордантність визначається як один з критеріїв оптимального місця для супресії аритмії, хоча і не є обов'язковим критерієм, а розглядається як додаткова ознака [15,16]. Сучасні рекомендації взагалі не приділяють уваги цьому питанню, концентруючись винятково на часі випередження ЛЕ по відношенню до QRS [4].…”

Section: таблиця 1 якісна характеристика ендограм у місці успішної су...unclassified

“…Сучасні рекомендації, ігноруючи біполярний сигнал, акцентують увагу винятково на морфології уніполярного сигналу, вказуючи на важливість його негативної полярності в місці успішної супресії [4]. Водночас досить обмежена кількість публікацій присвячена вивченню значення морфології локального біполярного сигналу для ефективної супресії аритмії [15,16]. Отже, це питання залишається недостатньо вивченим і не висвітленим у сучасних публікаціях.…”

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Characteristics of Local Endograms at the Site of Successful Arrhythmia Suppression During Activation Mapping of Idiopathic Ventricular Arrhythmias Using 3D Navigation

Prorok,

Lebedieva

2024

ujcvs

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A topical issue is the determination of the optimal values of activation time of local endograms (LE) and bipolar signal morphology during ablation in patients with idiopathic ventricular arrhythmias (VA) at the site of successful suppression, and the influence of 3D navigation on these values. The aim. To study earliest activation time (EAT) and LE morphology in the area of successful suppression during ablation of idiopathic VA using 3D navigation. Materials and methods. Analysis of the results of ablation in 57 patients with idiopathic VA was made. The patients were divided into two groups. Group I included 30 (52.6%) patients in whom mapping was performed using 3D navigation (EnSite Velocity Cardiac Mapping System). Group II included 27 (47.4%) patients who were mapped using conventional methods. In group I, extrasystole was found in 20 (66.7%) patients, while ventricular tachycardia was observed in 10 (33.3%) patients. In group II, extrasystole was revealed in 16 (59.3%) patients, and ventricular tachycardia in 11 (40.7%) patients. Group I included 21 (70%) patients with right ventricular localization of arrhythmia and 9 (30%) patients with left ventricular localization. Meanwhile, group II included 17 (63%) patients with a focus in the right ventricle and 10 (33%) patients with that in the left ventricle. The morphology of the LE was evaluated according to criteria such as polarity (positive or negative) and degree of signal fragmentation (monomorphic or fragmented). Polarity was determined by the initial direction of the signal during the first 10 ms, regardless of further changes in the endogram. The signal was considered fragmented if there were three or more polarity changes. Results. In group I, EAT of LE was -38.0±7.0 ms, while in group II it was -38.0±8.5 ms. No difference was found between the studied groups (p=0.834). Among all patients in both groups, the average value of EAT of LE at the site of successful arrhythmia elimination was -37.0±8.5 ms. In 92.9% cases EAT of LE was -30 ms or earlier. Only in four (7.1%) patients it was possible to achieve suppression of the arrhythmia with EAT of LE not earlier than -30 ms, while in all these cases the focus was always localized in the right ventricle. The minimum value of EAT of LE at the site of successful suppression of arrhythmia was -27 ms. The dominant morphology at the site of successful suppression among the patients in both groups, regardless of the type of mapping, was positive polarity of endogram. Conclusions. Regardless of the mapping method, in the site of successful idiopathic VA suppression LE must precede QRS by at least 27 ms.

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Section: таблиця 1 якісна характеристика ендограм у місці успішної су...unclassified

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Characteristics of Local Endograms at the Site of Successful Arrhythmia Suppression During Activation Mapping of Idiopathic Ventricular Arrhythmias Using 3D Navigation

Prorok,

Lebedieva

2024

ujcvs

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Limitation of Unipolar Electrograms in Guiding Successful RFCA of Idiopathic Ventricular Arrhythmias Associated With Discrete Pre‐Potential

Di,

Wang,

et al. 2024

Cardiovasc electrophysiol

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ObjectivesActivation mapping for idiopathic ventricular arrhythmias (IVAs) typically relies on identifying the earliest bipolar electrograms and unipolar electrograms characterized by an initial QS morphology preceding the intrinsic deflection. However, the utility of unipolar electrogram morphology, particularly when associated with discrete pre‐potentials, in guiding IVA mapping is not well understood.MethodsWe retrospectively analyzed 537 patients who underwent successful radiofrequency catheter ablation (RFCA) for IVAs between March 2016 and August 2023. Among them, 23 patients (4.3%) exhibited discrete bipolar pre‐potentials with an isoelectric line between the end of the discrete pre‐potential and the onset of the QRS complex during IVAs at the successful RFCA site. These cases were included in this study.ResultsThe time interval from the onset of the discrete pre‐potential to the onset of the QRS complex was 66.4 ± 18.3 ms. The duration of the isoelectric line between the end of the discrete pre‐potential and the onset of the QRS complex was 36.9 ± 13.6 ms. Unipolar electrograms associated with discrete pre‐potentials exhibited an initial negative morphology in only 13 out of 23 patients (56.5%). In contrast, initial positive and isoelectric configurations in unipolar electrograms were observed in two patients (8.7%) and eight patients (34.8%), respectively. Perfect pace mapping was obtained in 21 patients (91.3%). RFCA was successful at the earliest site of the pre‐potential within 3.5 ± 1.5 s in all 23 patients. During the 2.4 ± 1.2 years follow‐up period, only one patient (4.3%) experienced a recurrence of clinical IVAs, with no complications reported during RFCA or follow‐up.ConclusionsUnipolar electrograms show limited reliability in guiding the identification of IVAs origins compared to bipolar electrograms associated with discrete pre‐potentials.

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Initial negative concordance on unipolar and bipolar electrograms: a novel parameter for localizing the origin of premature ventricular contractions arising from pulmonary sinus cusps

Cited by 2 publications

References 20 publications

Characteristics of Local Endograms at the Site of Successful Arrhythmia Suppression During Activation Mapping of Idiopathic Ventricular Arrhythmias Using 3D Navigation

Characteristics of Local Endograms at the Site of Successful Arrhythmia Suppression During Activation Mapping of Idiopathic Ventricular Arrhythmias Using 3D Navigation

Limitation of Unipolar Electrograms in Guiding Successful RFCA of Idiopathic Ventricular Arrhythmias Associated With Discrete Pre‐Potential

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