Electroanatomic Substrate and Ablation Outcome for Suspected Epicardial Ventricular Tachycardia in Left Ventricular Nonischemic Cardiomyopathy

JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY

卷:54

Article

Cano, Oscar^1,2  Hutchinson, Mathew¹  Lin, David¹  Garcia, Fermin¹  Zado, Erica¹  Bala, Rupa¹  Riley, Michael¹  Cooper, Joshua¹  Dixit, Sanjay¹  Gerstenfeld, Edward¹  Callans, David¹  Marchlinski, Francis E.¹ 

[1] Univ Penn, Dept Med, Sch Med, Div Cardiovasc,Electrophysiol Sect, Philadelphia, PA 19104 USA

[2] Univ Autonoma Barcelona, E-08193 Barcelona, Spain

关键词: electroanatomical mapping;    nonischemic cardiomyopathy;    ventricular tachycardia;   

DOI  :  10.1016/j.jacc.2009.05.032

来源: Elsevier

【 摘 要 】

Objectives The aim of the study was to define the epicardial substrate and ablation outcome in patients with left ventricular nonischemic cardiomyopathy (NICM) and suspected epicardial ventricular tachycardia (VT). Background Ventricular tachycardia in NICM often originates from the epicardium. Methods Twenty-two patients with NICM underwent detailed endocardial and epicardial bipolar voltage maps and VT ablation for suspected epicardial VT. Eight patients with normal hearts and idiopathic VT served to define normal epicardial electrograms. Low-voltage regions were also assessed for wide (> 80 ms), split, or late electrograms. Results Normal epicardial bipolar voltage was identified as > 1.0 mV on the basis of the reference population. Confluent low-voltage areas were present in 18 epicardial (82%) and 12 endocardial (54%) maps and were typically over basal lateral LV. In the 18 patients with epicardial VT on the basis of activation/pacemapping, the mean epicardial area was greater than the endocardial low-voltage area (55.3 +/- 33.5 cm(2) vs. 22.9 +/- 32.4 cm(2), p < 0.01). Epicardial low-voltage areas showed 49.7% wide (> 80 ms), split, and/ or late electrograms rarely seen in the reference patients (2.3%). During follow-up of 18 +/- 7 months, ablation resulted in VT elimination in 15 of 21 patients (71%) including 14 of 18 patients (78%) with epicardial VT. Conclusions In patients with NICM and VT of epicardial origin, the substrate is characterized by areas of basal LV epicardial > endocardial bipolar low voltage. The electrograms in these areas are not only small (< 1.0 mV) but wide (> 80 ms), split, and/ or late, and help identify the substrate targeted for successful ablation. (J Am Coll Cardiol 2009; 54: 799-808) (C) 2009 by the American College of Cardiology Foundation

【 授权许可】

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