Model of reentrant ventricular tachycardia based on infarct border zone geometry predicts reentrant circuit features as determined by activation mapping

Ciaccio, Edward J.; Ashikaga, Hiroshi; Kaba, Riyaz A.; Cervantes, Daniel Sandoval; Hopenfeld, Bruce; Wit, Andrew L.; Peters, Nicholas S.; McVeigh, Elliot R.; Garan, Hasan; Coromilas, James

doi:10.1016/j.hrthm.2007.04.015

Cited by 80 publications

(71 citation statements)

References 30 publications

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“…Several mathematical models exist that may be able to predict VT channels and successful ablation sites based on the infarct border zone geometry. 25 …”

Section: Supplementary Mri Substrate Characterization During Vt Ablationmentioning

confidence: 99%

MRI-Guided Ventricular Tachycardia Ablation

Dickfeld

Tian

Ahmad

et al. 2011

Circ: Arrhythmia and Electrophysiology

185

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“…Several mathematical models exist that may be able to predict VT channels and successful ablation sites based on the infarct border zone geometry. 25 …”

Section: Supplementary Mri Substrate Characterization During Vt Ablationmentioning

confidence: 99%

MRI-Guided Ventricular Tachycardia Ablation

Dickfeld

Tian

Ahmad

et al. 2011

Circ: Arrhythmia and Electrophysiology

185

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“…In contrast, regions of fast conduction coincided with areas of thicker border zones with minimal gradients. 1,16 Tachycardia-related slow-conducting channels have been identified within dense electroanatomic scar areas in the majority of patients with monomorphic VT after AMI. The mean length of these channels was 23Ϯ11 mm, and the mean cycle length of the channel-related VT was 365Ϯ77 ms, similar to the VT cycle length found in nonreperfused patients in our study.…”

Section: Arrhythmia and Electroanatomic Scarmentioning

confidence: 99%

“…Mapping studies have shown that reentry circuit locations and VT characteristics vary greatly among patients and are influenced by the 3-dimensional geometry of infarcted areas. [1][2][3] In animal models, the duration of coronary artery occlusion determines the size, transmurality, and geometry of myocardial fibrosis after AMI. 4,5 Thus, it seems likely that early reperfusion, which has become the standard treatment of AMI, will influence the nature of the VT substrate.…”

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confidence: 99%

Early Reperfusion During Acute Myocardial Infarction Affects Ventricular Tachycardia Characteristics and the Chronic Electroanatomic and Histological Substrate

et al. 2010

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Background-Reperfusion therapy during acute myocardial infarction results in myocardial salvage and improved ventricular function but may also influence the arrhythmogenic substrate for ventricular tachycardia (VT). This study used electroanatomic mapping and infarct histology to assess the impact of reperfusion on the substrate and on VT characteristics late after acute myocardial infarction. Methods and Results-The study population consisted of 36 patients (32 men; age, 63Ϯ15 years) referred for treatment of VT 13Ϯ9 years after acute myocardial infarction. Fourteen patients with early reperfusion during acute myocardial infarction were compared with 22 nonreperfused patients. Spontaneous and induced VTs and the characteristics of electroanatomic voltage maps were analyzed. Twenty-seven patients were treated by radiofrequency catheter ablation. Ten patients (6 nonreperfused) were treated by ventricular restoration with intraoperative cryoablation in 9. During surgery, biopsies were obtained from the resected core of the infarct. VT cycle length of spontaneous and induced VTs was shorter in reperfused patients (reperfused, 299Ϯ52/270Ϯ58 ms; nonreperfused, 378Ϯ77/362Ϯ74 ms; Pϭ0.01). An electroanatomic patchy scar pattern was present in 71% of reperfused and 14% of nonreperfused patients (Pϭ0.004). The proportion of electroanatomic dense scar was smaller in reperfused patients (24Ϯ18% versus 45Ϯ21%; Pϭ0.02). Histological assessment in 10 patients revealed thick layers of surviving myocardium in 75% of reperfused but in none of the nonreperfused patients. Conclusions-Scar size and pattern defined by electroanatomic mapping are different between VT patients with and without reperfusion during acute myocardial infarction. Less confluent electroanatomic scars match with thick layers of surviving myocardium on histology. Early reperfusion and less confluent electroanatomic scar are associated with faster

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“…1 Canine and swine models of experimental infarction can be useful to study the electrophysiological characteristics of this arrhythmia. [2][3][4] In a canine infarction model, the VT reentrant circuit often resides in the infarct border zone (IBZ), which is the thin region of surviving myocardium between the infarct rim and the epicardial surface. 2,5,6 For the canine infarction model, the IBZ is thinnest at the reentrant circuit isthmus location.…”

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confidence: 99%

Model of Bipolar Electrogram Fractionation and Conduction Block Associated With Activation Wavefront Direction at Infarct Border Zone Lateral Isthmus Boundaries

Ciaccio

Ashikaga

Coromilas

et al. 2014

Circ: Arrhythmia and Electrophysiology

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Background-Improved understanding of the mechanisms underlying infarct border zone electrogram fractionation may be helpful to identify arrhythmogenic regions in the postinfarction heart. We describe the generation of electrogram fractionation from changes in activation wavefront curvature in experimental canine infarction. Methods and Results-A model was developed to estimate the extracellular signal shape that would be generated by wavefront propagation parallel to versus perpendicular to the lateral boundary (LB) of the reentrant ventricular tachycardia (VT) isthmus or diastolic pathway. LBs are defined as locations where functional block forms during VT, and elsewhere they have been shown to coincide with sharp thin-to-thick transitions in infarct border zone thickness. To test the model, bipolar electrograms were acquired from infarct border zone sites in 10 canine heart experiments 3 to 5 days after experimental infarction. Activation maps were constructed during sinus rhythm and during VT. The characteristics of model-generated versus actual electrograms were compared. Quantitatively expressed VT fractionation (7.6±1.2 deflections; 16.3±8.9-ms intervals) was similar to model-generated values with wavefront propagation perpendicular to the LB (9.4±2.4 deflections; 14.4±5.2-ms intervals). Fractionation during sinus rhythm (5.9±1.8 deflections; 9.2±4.4-ms intervals) was similar to model-generated fractionation with wavefront propagation parallel to the LB (6.7±3.1 deflections; 7.1±3.8-ms intervals). VT and sinus rhythm fractionation sites were adjacent to LBs ≈80% of the time. Conclusions-The results suggest that in a subacute canine infarct model, the LBs are a source of activation wavefront discontinuity and electrogram fractionation, with the degree of fractionation being dependent on activation rate and wavefront orientation with respect to the LB. (Circ Arrhythm Electrophysiol. 2014;7:152-163.)

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Model of reentrant ventricular tachycardia based on infarct border zone geometry predicts reentrant circuit features as determined by activation mapping

Abstract: Background-Infarct border zone (IBZ) geometry likely affects inducibility and characteristics of postinfarction reentrant ventricular tachycardia, but the connection has not been established.

Cited by 80 publications

References 30 publications

MRI-Guided Ventricular Tachycardia Ablation

MRI-Guided Ventricular Tachycardia Ablation

Early Reperfusion During Acute Myocardial Infarction Affects Ventricular Tachycardia Characteristics and the Chronic Electroanatomic and Histological Substrate

Model of Bipolar Electrogram Fractionation and Conduction Block Associated With Activation Wavefront Direction at Infarct Border Zone Lateral Isthmus Boundaries

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