Characteristics of sinus rhythm electrograms at sites of ablation of ventricular tachycardia relative to all other sites: a noncontact mapping study of the entire left ventricle.

Introduction: Regions of the diseased ventricle that activate abnormally during sinus rhythm (SR) may be the areas of slow and disorganized conduction that form the diastolic pathway through which reentry may occur during ventricular tachycardia (VT).

Methods And Results: We examined features of electrograms recorded during SR that might indicate a site suitable for ablation of VT using a noncontact mapping system, which enables reconstruction of > 3,000 electrograms. Preablation SR electrogram characteristics at sites of successful radiofrequency ablation (RFA) were examined in 13 patients with 53 VTs. Timing of onset, lateness of activity, electrogram duration, and number of baseline crossing events of reconstructed electrograms at the sites of successful RFA were compared with the electrograms of latest onset, latest activity, longest duration, and most baseline crossing events of all ventricular sites. Onset of activation at sites of successful RFA were 26.9+/-25.2 msec (mean +/- SD) earlier than (and 2.9+/-1.7 cm away from) the site of latest onset of SR activation. Electrogram duration at sites of successful RFA was 83%+/-14.6% of (and 4.3+/-1.8 cm away from) the longest electrogram. The baseline crossing events at sites of successful RFA were 53%+/-22% of (and 4.9+/-1.9 cm away from) the most fractionated electrogram. The latest activity at sites of successful RFA was 21.6+/-24.8 msec earlier than (and 4.3+/-1.6 cm away from) the site of latest activity.

Conclusion: Although the site of latest onset of endocardial activation during SR proved to be the most sensitive indicator, the characteristics of SR electrograms did not usefully predict successful ablation sites.