Introduction: Activation mapping guided catheter ablation (CA) of ventricular arrhythmias (VAs) is limited in some cases when it is only relied on bipolar electrogram (EGM). We hypothesized that activation mapping with use of combined bipolar and unipolar EGM facilitates to identify the focal origin of VAs and results in reduction of recurrence rate of CA of VAs.
Methods: We analyzed the data of patients undergoing repeat ablations for idiopathic out-flow tract VAs. The EGM of the 1 st and 2 nd ablations were compared for earliest local activation time (LAT), presence of discrete potentials, and polarity reversal, unipolar potential morphology (QS or non-QS), potential amplitude and activation slope.
Results: Thirty-seven patients were included. The Local activation time was significantly earlier in the 2nd ablation as compared to the 1st procedure (36.90 msec vs 31.85 msec, P < 0.01). The incidence of discrete potentials and polarity reversal were similar in both procedures (51% vs 57%, P = 0.8 and 62% in both the occasions, respectively). The unipolar voltage was similar in both occasions (6.94 mV vs 7.22 mV in repeat ablations, P = 0.7). The recurrence rate (5.7%) was significantly lower with routine use of combined unipolar and bipolar EGMs, as compared to the use of bipolar EGM alone (16.7%) CONCLUSIONS: Use of both bipolar and unipolar electrograms helps in better delineation of the sites of earliest activation for effective ablation of VAs. Use of unipolar electrograms in addition to bipolar electrograms is associated with lower long term recurrence rate.
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| http://dx.doi.org/10.1016/j.ipej.2021.11.005 | DOI Listing |
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Introduction: Differences in predictability of ablation success for premature ventricular contractions (PVCs) between earliest isochronal map area (EIA), local activation time (LAT) differences on unipolar and bipolar electrograms (⊿LAT), LAT prematurity on bipolar electrograms (LAT), and unipolar morphology of QS or Q pattern remain unclear. We verified multiple statistical predictabilities of those indicators of ablation success on mapped cardiac surface.
Methods: Thirty-five patients with multiple PVCs underwent catheter ablation after LAT mapping using multipolar mapping catheters with unipolar-based annotation.
Local atrial bipolar electrogram voltage drops during cardiac magnetic resonance guided catheter ablation of typical atrial flutter: Associations with delivered radiofrequency energy and peri-procedural imaging.
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November 2024
Department of Cardiology, Maastricht University Medical Centre, Maastricht, The Netherlands.
Background: Cardiac magnetic resonance (CMR)-guided catheter ablation of the cavotricuspid isthmus (CTI) has been proven feasible, but determinants of local electrogram (EGM) voltage drops during radiofrequency (RF) applications are unknown.
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Article Synopsis
- The study aimed to understand the mechanisms behind reentrant ventricular tachycardia (VT) and enhance the targeting of catheter ablation procedures in postinfarction patients.
- Researchers collected and analyzed electrogram data during both sinus rhythm and VT, finding distinct voltage gradients, with significantly lower mean voltage at the VT isthmus compared to its boundaries.
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First Department of Cardiology, TEDA International Cardiovascular Hospital, Tianjin, China.
Objectives: Activation 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.
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Sci Rep
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Department of Cardiology, University Hospital Basel, University of Basel, Petersgraben 4, Basel, 4031, Switzerland.
Characteristics of electrograms depend on the electrode design and distance to the electric source. Our aim was to assess the impact of electrode design and distance from the myocardial electric source on the unipolar and bipolar electrograms to deduce a far-field cut-off. We retrospectively analyzed left atrial electroanatomical maps of 25 patients acquired using an ablation catheter with a 4.
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