Home > News > 187/Activation-repolarisation dynamics for the delineation of the arrhythmogenic substrate of ventricular tachycardia – Formal evaluation of the re-entry vulnerability index
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187/Activation-repolarisation dynamics for the delineation of the arrhythmogenic substrate of ventricular tachycardia – Formal evaluation of the re-entry vulnerability index

Published Online: October 3rd 2008 European Journal of Arrhythmia & Electrophysiology. 2019;5(Suppl. 1):abstr187
Authors: M Orini (Presenting Author) – University College London, London, UK; AJ Graham – Barts Heart Centre, London, UK; NT Srinivasan – Barts Heart Centre, London, UK; FO Campos – King’s College London, London, UK; BM Hanson – UCL, London, UK; A Chow – Barts Heart Centre, London, UK; RJ Hunter – Barts Heart Centre, London, UK; RJ Schilling – Barts Heart Centre, London, UK; M Finlay – Barts Heart Centre, London, UK; MJ Earley – Barts Heart Centre, London, UK; S Sporton – Barts Heart Centre, London, UK; M Dhinoja – Barts Heart Centre, London, UK; M Lowe – Barts Heart Centre, London, UK; B Porter – Guys and St Thomas’ Hospital, London, UK; N Child – Guys and St Thomas’ Hospital, London, UK; CA Rinaldi – Guys and St Thomas’ Hospital, London, UK; J Gill – Guys and St Thomas’ Hospital, London, UK; M Bishop – King’s College London, London, UK; P Taggart – UCL, London, UK; PD Lambiase – Barts Heart Centre, London, UK
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Aim: Recurrence rate of ventricular tachycardia (VT) after catheter ablation remains sub-optimal. The re-entry vulnerability index (RVI) is a metric combining activation and repolarisation timings designed to identify sites critical for re-entrant arrhythmia initiation without inducing VT. This study uses high-density mapping to test its capability of identifying VT sites of origin (VTSO).

Methods: Eighteen VT ablation patients (16M, 72% with ischaemic disease) were studied. Unipolar electrograms were recorded during pacing at short coupling intervals using multipolar catheters (CARTO and Ensite Precision) and analysed off-line to produce activation time (AT), activation-recovery interval (ARI), repolarisation time (RT) and RVI maps (see Figure 1A). Potential target sites were compared for the following parameters: lowest 5% of RVI (see Figure 1A); highest 5% of local AT, ARI and RT gradients; highest and lowest 5% of AT, RT and ARI. The minimum distance between the VTSO and these sites, Dist, was measured. VTSO localization was considered accurate if Dist <10 mm and inaccurate if Dis t>20 mm.

Results: Eighteen VTSO were identified (6 entrainment, 12 pace mapping). RVI maps included 1,012 (408, 2098) (median, 1st–3rd quartiles) points/patient. Lowest RVI provided accurate VTSO localisation in 72.2% of VTs, with Dist=5.1 (3.2, 10.1) mm (see Figure 1B). Inaccurate localisation was significantly less frequent for lowest RVI than longest AT (5.6% versus 33.3%, OR=0.12, p=0.035). Compared to lowest RVI, longest RT and ARI showed significantly larger Dist (p<0.02), while highest AT and ARI gradients showed non-significantly larger Dist.

Conclusion: RVI identifies vulnerable regions closest to VTSO sites. Activation-repolarisation metrics may improve VT substrate delineation and inform novel ablation strategies.

 

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43/Cardiac tamponade as a complication of transseptal puncture: associations and operatordependent variables during left atrial ablation at Barts Heart Centre
E Maclean (Presenting Author) - St Bartholomew’s Hospital, London; K Mahtani - St Bartholomew’s Hospital, London; C Butcher - St Bartholomew’s Hospital, London; N Ahluwalia - St Bartholomew’s Hospital, London; M Finlay - St Bartholomew’s Hospital, London; S Honarbakhsh - St Bartholomew’s Hospital, London; A Creta - St Bartholomew’s Hospital, London; A Chow - St Bartholomew’s Hospital, London; V Sawhney - St Bartholomew’s Hospital, London; V Ezzat - St Bartholomew’s Hospital, London; MJ Earley - St Bartholomew’s Hospital, London; M Dhinoja - St Bartholomew’s Hospital, London; S Sporton - St Bartholomew’s Hospital, London; MD Lowe - St Bartholomew’s Hospital, London; PD Lambiase - St Bartholomew’s Hospital, London; F Khan - St Bartholomew’s Hospital, London; SY Ahsan - St Bartholomew’s Hospital, London; RJ Hunter - St Bartholomew’s Hospital, London; RJ Schilling - St Bartholomew’s Hospital, London; O Sega - St Bartholomew’s Hospital, London Read Time: 2 mins

European Journal of Arrhythmia & Electrophysiology. 2021;7(Suppl. 1):abstr43

Introduction: Cardiac tamponade is a high morbidity complication of transseptal puncture (TSP). We examined the incidence and predictors of TSP-related cardiac tamponade (TRCT) for all patients undergoing left atrial ablation at our centre from 2016-2020. Methods: Patient and procedural variables were extracted retrospectively. Cases of cardiac tamponade were scrutinised to adjudicate TSP culpability. Adjusted multivariate […]

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