Use of a novel fragmentation map to identify the substrate for ventricular tachycardia in postinfarction cardiomyopathy

Campos, Bieito; Jauregui, Miguel E.; Marchlinski, Francis E.; Dixit, Sanjay; Gerstenfeld, Edward P.

doi:10.1016/j.hrthm.2014.10.002

Cited by 27 publications

(28 citation statements)

References 12 publications

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“…Recently, Campos et al reported an automated analysis for quantifying the electrogram fragmentation and evaluated the relationship between the fragmented regions and the VT isthmus in patients with structural heart disease using time-domain and frequency-domain analysis. [30] The authors quantified the area with abnormal high frequency fractionation by determining the ratio of the area under the curve for the high-frequency (>80Hz) to low-frequency (<80Hz) components of the resulting spectra and was calculated as the fast Fourier transform ratio (FFTr). They defined a cut-off value for high FFTr at 14% by examining the FFTr distribution within the bipolar scar area in the post-infarction cardiomyopathy group in their study population.…”

Section: Discussionmentioning

confidence: 99%

The use of a novel signal analysis to identify the origin of idiopathic right ventricular outflow tract ventricular tachycardia during sinus rhythm: Simultaneous amplitude frequency electrogram transformation mapping

Chung¹,

Higa²,

Chung³

et al. 2017

PLoS ONE

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IntroductionThe signal characteristics of intracardiac bipolar electrograms at the origin of idiopathic RVOT-VT during sinus rhythm remain unclear.ObjectiveThe study sought to develop a novel real-time/online technique, simultaneous amplitude frequency electrogram transformation (SAFE-T), to quantify and localize the diseased ventricular substrate in idiopathic RVOT-VT.MethodsWe retrospectively investigated the intracardiac bipolar recordings in 70 consecutive patients (26% male, mean age 42±12 years) who underwent successful radiofrequency catheter ablation of idiopathic RVOT-VT. We quantified the extent of the frequency fraction of ventricular potentials during sinus rhythm or ventricular pacing using a novel formula, the product of instantaneous amplitude and frequency, and showed that in a 3D geometry as an online SAFE-T map.ResultsThe characteristics of the HHT spectra of electrograms derived from VT origins demonstrated high frequency components (>70 Hz), which were independent of the rhythm. The density of the abnormal potentials at the VT origins were higher (VT origins, 7.5±2.3 sites/cm2 vs. surrounding myocardium, 1.5±1.3 sites/cm2, p<0.001), and were significantly decreased after ablation (0.7±0.6 sites/cm2, p<0.001). A small region of abnormal potentials were observed in the VT origins (mean area of 1.5±0.8 cm2). The SAFE-T maps predicted the VT origins with 92% sensitivity, 78% specificity with optimal cut-off value of >3.0 Hz·mV.ConclusionThe online SAFE-T map was feasible for quantifying the diseased ventricular substrate, irrespective of the rhythm of activation, and can be used to identify the optimal ablation targets for idiopathic RVOT-VT. We found a limited region of abnormal potentials where the RVOT-VT origins were successfully ablated.

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Section: Discussionmentioning

confidence: 99%

The use of a novel signal analysis to identify the origin of idiopathic right ventricular outflow tract ventricular tachycardia during sinus rhythm: Simultaneous amplitude frequency electrogram transformation mapping

Chung¹,

Higa²,

Chung³

et al. 2017

PLoS ONE

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“…In 2015, Campos et al 7 introduced FFT analysis for the first time to evaluate the substrate for VT. They set a control group with structurally normal hearts and patients with previous myocardial infarction and examined the distribution of the frequency map and its relationship to the VT isthmus sites.…”

Section: Previous Studiesmentioning

confidence: 99%

“…FFT analysis is expected to be the fundamental resolution for both problems above because it can detect fractionated local potentials, suggesting slow conduction zone, even if their voltage amplitude is extremely low within the massive endocardial scar area. 7 We hypothesized that FFT analysis can contribute to increase the precision of VLA for detecting VT isthmuses. The objective of this study was to evaluate the add-on effect of FFT analysis to VLA, by comparing the real VT isthmus sites with the slow conduction channels assumed using FFT analysis and VLA.…”

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confidence: 99%

New Substrate-Guided Method of Predicting Slow Conducting Isthmuses of Ventricular Tachycardia

Kuroki

Nogami

Igarashi

et al. 2018

Circ: Arrhythmia and Electrophysiology

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BACKGROUND:Several conducting channels of ventricular tachycardia (VT) can be identified using voltage limit adjustment (VLA) of substrate mapping. However, the sensitivity or specificity to predict a VT isthmus is not high by using VLA alone. This study aimed to evaluate the efficacy of the combined use of VLA and fast-Fourier transform analysis to predict VT isthmuses. METHODS AND RESULTS:VLA and fast-Fourier transform analyses of local ventricular bipolar electrograms during sinus rhythm were performed in 9 postinfarction patients who underwent catheter ablation for a total of 13 monomorphic VTs. Relatively higher voltage areas on an electroanatomical map were defined as high voltage channels (HVCs), and relatively higher fast-Fourier transform areas were defined as highfrequency channels (HFCs). HVCs were classified into full or partial HVCs (the entire or >30% of HVC can be detectable, respectively). Twelve full HVCs were identified in 7 of 9 patients. HFCs were located on 7 of 12 full HVCs. Five VT isthmuses (71%) were included in the 7 full HVC+/ HFC+ sites, whereas no VT isthmus was found in the 5 full HVC+/HFC− sites. HFCs were identical to 9 of 16 partial HVCs. Eight VT isthmuses (89%) were included in the 9 partial HVC+/HFC+ sites, whereas no VT isthmus was found in the 7 partial HVC+/HFC− sites. All HVC+/HFC+ sites predicted VT isthmus with a sensitivity of 100% and a specificity of 80%. CONCLUSIONS:Combined use of VLA and fast-Fourier transform analysis may be a useful method to detect VT isthmuses.

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“…Three ripple bars are able to identify a sequence of activation and visualize low conducting channels that may represent a more effective site of ablation [28 && ]. Also using MATLAB, Campos et al [29] applied a time-domain and a frequency-domain analysis of the voltage mapping in patients with ischemic cardiomyopathy. In the time-domain analysis, the researchers reported that areas containing electrograms with a high degree of fragmentation are related to ventricular tachycardia circuits.…”

Section: New Directions: Offline Analysis Of Substrate Mappingmentioning

confidence: 99%

Recent advances in ablation of ventricular tachycardia associated with structural heart disease

Proietti

Roux²,

Essebag³

2016

Current Opinion in Cardiology

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Recent advances have improved the ability to ablate ventricular tachycardia using techniques that allow targeting the responsible myocardial substrate while in sinus rhythm. Further research using higher-density mapping with more sophisticated online and offline analysis will aid in the assessment of the complex arrhythmogenicity of the scar and improve efficacy of ventricular tachycardia ablation.

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Use of a novel fragmentation map to identify the substrate for ventricular tachycardia in postinfarction cardiomyopathy

Cited by 27 publications

References 12 publications

The use of a novel signal analysis to identify the origin of idiopathic right ventricular outflow tract ventricular tachycardia during sinus rhythm: Simultaneous amplitude frequency electrogram transformation mapping

The use of a novel signal analysis to identify the origin of idiopathic right ventricular outflow tract ventricular tachycardia during sinus rhythm: Simultaneous amplitude frequency electrogram transformation mapping

New Substrate-Guided Method of Predicting Slow Conducting Isthmuses of Ventricular Tachycardia

Recent advances in ablation of ventricular tachycardia associated with structural heart disease

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