4.4 Article

Effect of bipolar electrode orientation on local electrogram properties

Journal

HEART RHYTHM
Volume 15, Issue 12, Pages 1853-1861

Publisher

ELSEVIER SCIENCE INC
DOI: 10.1016/j.hrthm.2018.07.020

Keywords

Electrograms; Infarction; LAVA; Mapping; Multipolar catheters; Voltage

Funding

  1. Equipex MUSIC [ANR-11-EQPX-0030]
  2. British Heart Foundation [FS/16/71/32487]
  3. IHU LIRYC [ANR-10-IAHU-04]

Ask authors/readers for more resources

BACKGROUND The direct effect of bipolar orientation on electrograms (EGMs) remains unknown. OBJECTIVE The purpose of this study was to examine the variation of EGMs with diagonally orthogonal bipoles. METHODS The HD-32 Grid catheter (Abbott, Minneapolis, MN) can assess the effect of bipolar orientation while keeping the interelectrode distance and center unchanged. Seven sheep with anterior myocardial infarction were analyzed using diagonally orthogonal electrode pairs across splines by comparing local EGMs from each pair of opposing electrodes {eg. A1-B3 (southeast direction [SE]) vs A3-B1 (northeast direction [NE])}. RESULTS A total of 4084 EGMs (1 in each direction) were analyzed for 2042 sites (544 in the infarcted area, 488 in the border area, and 1010 in the normal area). The higher and lower voltages measured using each pair of opposing electrodes significantly differed (1.10 mV [0.43-2.56 mV] vs 0.69 mV [0.28-1.58 mV]; P,.0001), and the median variation was 0.28 mV (0.11-0.80 mV) (31.7% [16.0%-48.9%]). The voltage variation was maximized to 48.7% (37.7%-61.6%) (P,. 0001) on sites where the activation wavefront was perpendicular to the one bipolar direction and parallel to the other. A total of 594 of 719 (82.6%) sites with the voltage < 0.5 mV and 539 of 699 (77.1%) sites with the voltage >1.5 mV in NE stayed in the same voltage range as those in SE. However, only 348 of 624 (55.8%) sites with the voltage 0.5-1.5 mV in NE stayed in the same range as those in SE. Local ventricular abnormal activities (LAVAs) were detected in 592 of 2042 (29.0%) sites in total, frequently distributed in the border area. A total of 177 (29.9%) LAVAs were missed in one direction and 180 (30.4%) in the other. When 415 (70.1%) LAVAs detected in NE are defined as the reference, 235 of 415 (56.6%) matched with those detected in SE. CONCLUSION The bipolar voltage and distribution of LAVAs may differ significantly between diagonally orthogonal bipolar pairs at any given site.

Authors

I am an author on this paper
Click your name to claim this paper and add it to your profile.

Reviews

Primary Rating

4.4
Not enough ratings

Secondary Ratings

Novelty
-
Significance
-
Scientific rigor
-
Rate this paper

Recommended

Article Cardiac & Cardiovascular Systems

Prevalence and risk factors of cardiac thrombus prior to ventricular tachycardia catheter ablation in structural heart disease

Thomas Bonnin, Pierre Roumegou, Soumaya Sridi, Saagar Mahida, Aurelien Bustin, Josselin Duchateau, Romain Tixier, Nicolas Derval, Thomas Pambrun, Ghassen Chniti, Takamitsu Takagi, Tsukasa Kamakura, Philipp Krisai, Clementine Andre, Remi Chauvel, Meleze Hocini, Michel Haissaguerre, Pierre Jais, Hubert Cochet, Frederic Sacher

Summary: This study assessed the prevalence, risk factors, and management of intra-cardiac thrombus in patients referred for scar-related VT ablation. The results showed that 11% of patients had cardiac thrombi, highlighting the importance of systematic thrombus screening to minimize the risk of embolism.

EUROPACE (2023)

Editorial Material Cardiac & Cardiovascular Systems

Accidental coronary artery kinking by leadless pacemaker fixation tine

Sylvain Ploux, Marc Strik, Hubert Cochet, Pierre Bordachar

EUROPEAN HEART JOURNAL (2023)

Article Cardiac & Cardiovascular Systems

High-resolution mapping of reentrant atrial tachycardias: Relevance of low bipolar voltage

F. Daniel Ramirez, Marianna Meo, Corentin Dallet, Philipp Krisai, Konstantinos Vlachos, Antonio Frontera, Masateru Takigawa, Yosuke Nakatani, Takashi Nakashima, Clementine Andre, Tsukasa Kamakura, Takamitsu Takagi, Aline Carapezzi, Romain Tixier, Remi Chauvel, Ghassen Cheniti, Josselin Duchateau, Thomas Pambrun, Frederic Sacher, Mfileze Hocini, Michel Haissaguerre, Pierre Jais, Remi Dubois, Nicolas Derval

Summary: This study aimed to evaluate the diagnostic performance of bipolar voltage thresholds in identifying regions of slow conduction during reentrant atrial tachycardias. The results showed that bipolar voltage can predict regions of slow conduction, but the correlation between voltage and conduction velocity is modest. Furthermore, no clinical predictors of AT circuit dimensions were identified.

HEART RHYTHM (2023)

Editorial Material Cardiac & Cardiovascular Systems

Fat deposition and repolarization: another brick in the wall promoting ventricular tachycardia?

Frederic Sacher, Pierre Jais, Hubert Cochet

Summary: This editorial discusses the article by L. Xu et al. on lipomatous metaplasia and its effects on repolarization and repolarization dispersion within post-infarct ventricular tachycardia circuits.

EUROPACE (2023)

Article Multidisciplinary Sciences

Real-time automatic temperature regulation during in vivo MRI-guided laser-induced thermotherapy (MR-LITT)

Manon Desclides, Valery Ozenne, Pierre Bour, Thibaut Faller, Guillaume Machinet, Christophe Pierre, Stephane Chemouny, Bruno Quesson

Summary: A method to automatically regulate temperature increase during Laser-Induced Thermotherapy (LITT) using real-time rapid volumetric Magnetic Resonance thermometry is presented, with excellent accuracy and stability for temperature increases up to +30 degrees C above body temperature and a long heating duration.

SCIENTIFIC REPORTS (2023)

Article Cardiac & Cardiovascular Systems

Electrical isolation of the right ventricular outflow tract in idiopathic ventricular tachycardia: a case report

Miruna A. Popa, Gabriele Hessling, Isabel Deisenhofer, Felix Bourier

Summary: This study describes a novel catheter ablation strategy for treating symptomatic right ventricular outflow tract ventricular tachycardia. The strategy involves electrical isolation of the right ventricular outflow tract using high-density electroanatomic mapping and CT reconstruction. The patient remained free of arrhythmia during a 6-month follow-up period.

EUROPEAN HEART JOURNAL-CASE REPORTS (2023)

Editorial Material Cardiac & Cardiovascular Systems

Has genetic disposition implications for treatment decisions in atrial fibrillation?

Felix Bourier, Heribert Schunkert

CARDIOVASCULAR RESEARCH (2023)

Letter Cardiac & Cardiovascular Systems

Inducibility of Short-Coupled Purkinje Ectopy by Pharmacological Tests in Patients With Spontaneous Short-Coupled Idiopathic Ventricular Fibrillation

Michel Haissaguerre, Josselin Duchateau, Mikael Laredo, Thomas Lavergne, Pierre F. Winum, Ghassen Cheniti, Xavier Waintraub, Sophie Samson, Elodie Surget, Romain Tixier, Frederic Sacher, Eloi Marijon, Olivier Bernus, Estelle Gandjbakhch

CIRCULATION (2023)

Review Cardiac & Cardiovascular Systems

Practical guidance to reduce radiation exposure in electrophysiology applying ultra low-dose protocols: a European Heart Rhythm Association review

Philipp Sommer, Vanessa Sciacca, Matteo Anselmino, Roland Tilz, Felix Bourier, Heiko Lehrmann, Alan Bulava

Summary: Interventional electrophysiology provides various treatment options for patients with symptomatic cardiac arrhythmia. Catheter ablation has become a cornerstone in modern arrhythmia management, and complex procedures using multiple ablation tools have been developed. However, the use of X-ray technologies in fluoroscopy poses serious health risks. The main goal of radiation management is to reduce fluoroscopy and establish optimal protection for patients and operators. This manuscript provides an overview of strategies for fluoroscopy reduction and radiation protection.

EUROPACE (2023)

Article Cardiac & Cardiovascular Systems

Detailed analysis of tachycardia cycle length aids diagnosis of the mechanism and location of atrial tachycardias

Masateru Takigawa, Tsukasa Kamakura, Claire Martin, Nicolas Derval, Ghassen Cheniti, Josselin Duchateau, Thomas Pambrun, Frederic Sacher, Hubert Cochet, Meleze Hocini, Miho Negishi, Tasuku Yamamoto, Takashi Ikenouchi, Kentaro Goto, Takatoshi Shigeta, Takuro Nishimura, Susumu Tao, Shinsuke Miyazaki, Masahiko Goya, Tetsuo Sasano, Michel Haissaguierre, Pierre Jais

Summary: Detailed analysis of the cycle length of atrial tachycardia can help predict the mechanism and localization of the tachycardia.

EUROPACE (2023)

Article Cardiac & Cardiovascular Systems

Impact of filter configurations on bipolar EGMs: An optimal filter setting for identifying VT substrates

Masateru Takigawa, Frederic Sacher, Claire Martin, Ghassen Cheniti, Josselin Duchateau, Thomas Pambrun, Nicolas Derval, Hubert Cochet, Meleze Hocini, Tasuku Yamamoto, Takuro Nishimura, Susumu Tao, Shinsuke Miyazaki, Masahiko Goya, Tetsuo Sasano, Michel Haissaguierre, Pierre Jais

Summary: This study aimed to investigate the impact of filter settings on ventricular tachycardia (VT) ablation. The results showed that in scar/border areas, the filter configuration of 30-250 Hz or 30-500 Hz can minimize baseline fluctuation, baseline noise, and detect local abnormal ventricular activity (LAVA), while not applying a 50 Hz notch filter may be beneficial in avoiding missing VT substrate.

JOURNAL OF CARDIOVASCULAR ELECTROPHYSIOLOGY (2023)

Editorial Material Cardiac & Cardiovascular Systems

Local impedance, current, power-what should be considered in RF ablation?

Felix Bourier

JOURNAL OF CARDIOVASCULAR ELECTROPHYSIOLOGY (2023)

Article Cardiac & Cardiovascular Systems

Left Ventricular Abnormal Substrate in Brugada Syndrome

Ghassen Cheniti, Michel Haissaguerre, Christian Dina, Tsukasa Kamakura, Josselin Duchateau, Frederic Sacher, Hugo-Pierre Racine, Elodie Surget, Floriane Simonet, Jean-Baptiste Gourraud, Soumaya Sridi, Hubert Cochet, Clementine Andre, Benjamin Bouyer, Remi Chauvel, Romain Tixier, Nicolas Derval, Thomas Pambrun, Remi Dubois, Pierre Jais, Koonlawee Nademanee, Richard Redon, Jean-Jacques Schott, Vincent Probst, Meleze Hocini, Julien Barc, Olivier Bernus

Summary: Patients with Brugada syndrome may have abnormal substrate extending onto the left ventricular (LV) epicardium and inferior right ventricle (RV), and this abnormal substrate is associated with SCN5A mutations and multigenic variants.

JACC-CLINICAL ELECTROPHYSIOLOGY (2023)

No Data Available