PMID- 30614114
OWN - NLM
STAT- MEDLINE
DCOM- 20200720
LR  - 20200720
IS  - 1540-8167 (Electronic)
IS  - 1045-3873 (Linking)
VI  - 30
IP  - 4
DP  - 2019 Apr
TI  - Exit sites on the epicardium rarely subtend critical diastolic path of ischemic 
      VT on the endocardium: Implications for noninvasive ablation.
PG  - 520-527
LID - 10.1111/jce.13843 [doi]
AB  - BACKGROUND: Noninvasive electrocardiographic mapping of ventricular tachycardia 
      (VT) and ablation using stereotactic radiotherapy was recently reported. This 
      strategy does not directly evaluate the critical diastolic components and assumes 
      that the epicardial exit site of VT subtends closely over the endocardial 
      mid-diastolic isthmus. OBJECTIVE: To determine if the epicardial exit site of VT 
      spatially corresponds to the critical diastolic components of ischemic 
      scar-related VT. MATERIALS AND METHODS: Intraoperative simultaneous endocardial 
      and epicardial mapping were performed during VT using a 112-bipole endocardial 
      balloon and 112-bipole epicardial sock array. In eight patients, nine VTs having 
      entire diastolic circuit mapped were included in the study. The diastolic path 
      and VT-exit sites (epicardial and endocardial) were determined. RESULTS: The 
      diastolic path was mapped in the endocardium for all nine VTs (median length, 50; 
      interquartile range [IQR], 28 mm). The tachycardia cycle length ranged from 
      210-500 ms. The VT-exit site was early in the endocardium for six VTs and on the 
      epicardium for three VTs. The mid-diastolic isthmus and endocardial exit site of 
      the six endocardial VTs were spatially distant from their epicardial exit site by 
      a median distance of 32 and 27 mm, respectively. For the three VTs with an early 
      epicardial exit, the isthmus and endocardial exit sites were distant from the 
      epicardial exit site by a median distance of 34 and 38 mm, respectively. 
      CONCLUSION: The epicardial exit site and the mid-diastolic isthmus sites were 
      spatially distant and discrepant. Surface electrocardiography (ECG)-derived 
      strategy in identifying epicardial exit site to select noninvasive ablation 
      targets is prone to identify epicardial exit sites and may not identify critical 
      targets in ischemic scar VT.
CI  - (c) 2019 Wiley Periodicals, Inc.
FAU - Bhaskaran, Abhishek
AU  - Bhaskaran A
AUID- ORCID: 0000-0003-2963-4907
AD  - Division of Cardiology, Peter Munk Cardiac Centre, Toronto General Hospital, 
      University Health Network, Toronto, Ontario, Canada.
FAU - Nayyar, Sachin
AU  - Nayyar S
AUID- ORCID: 0000-0002-7972-5375
AD  - Division of Cardiology, Peter Munk Cardiac Centre, Toronto General Hospital, 
      University Health Network, Toronto, Ontario, Canada.
FAU - Porta-Sanchez, Andreu
AU  - Porta-Sanchez A
AD  - Division of Cardiology, Peter Munk Cardiac Centre, Toronto General Hospital, 
      University Health Network, Toronto, Ontario, Canada.
FAU - Haldar, Shouvik
AU  - Haldar S
AUID- ORCID: 0000-0001-8129-8520
AD  - Division of Cardiology, Peter Munk Cardiac Centre, Toronto General Hospital, 
      University Health Network, Toronto, Ontario, Canada.
FAU - Bokhari, Mahmoud
AU  - Bokhari M
AD  - Division of Cardiology, Peter Munk Cardiac Centre, Toronto General Hospital, 
      University Health Network, Toronto, Ontario, Canada.
FAU - Masse, Stephane
AU  - Masse S
AD  - Division of Cardiology, Peter Munk Cardiac Centre, Toronto General Hospital, 
      University Health Network, Toronto, Ontario, Canada.
FAU - Liang, Timothy
AU  - Liang T
AD  - Division of Cardiology, Peter Munk Cardiac Centre, Toronto General Hospital, 
      University Health Network, Toronto, Ontario, Canada.
FAU - Zehra, Nawazish
AU  - Zehra N
AD  - Division of Cardiology, Peter Munk Cardiac Centre, Toronto General Hospital, 
      University Health Network, Toronto, Ontario, Canada.
FAU - Farid, Talha
AU  - Farid T
AD  - Division of Cardiology, Peter Munk Cardiac Centre, Toronto General Hospital, 
      University Health Network, Toronto, Ontario, Canada.
FAU - Downar, Eugene
AU  - Downar E
AD  - Division of Cardiology, Peter Munk Cardiac Centre, Toronto General Hospital, 
      University Health Network, Toronto, Ontario, Canada.
FAU - Nanthakumar, Kumaraswamy
AU  - Nanthakumar K
AD  - Division of Cardiology, Peter Munk Cardiac Centre, Toronto General Hospital, 
      University Health Network, Toronto, Ontario, Canada.
LA  - eng
PT  - Journal Article
DEP - 20190115
PL  - United States
TA  - J Cardiovasc Electrophysiol
JT  - Journal of cardiovascular electrophysiology
JID - 9010756
SB  - IM
MH  - Action Potentials
MH  - Adult
MH  - *Catheter Ablation/adverse effects
MH  - Electrocardiography
MH  - Endocardium/*physiopathology
MH  - Epicardial Mapping
MH  - Female
MH  - *Heart Rate
MH  - Humans
MH  - Male
MH  - Middle Aged
MH  - Myocardial Ischemia/*complications/diagnosis/physiopathology
MH  - Pericardium/*physiopathology
MH  - Predictive Value of Tests
MH  - Retrospective Studies
MH  - Tachycardia, Ventricular/diagnosis/etiology/physiopathology/*surgery
MH  - Time Factors
MH  - Treatment Outcome
OTO - NOTNLM
OT  - body surface mapping
OT  - catheter ablation
OT  - epicardial ablation
OT  - ischemic cardiomyopathy
OT  - noninvasive mapping
OT  - ventricular tachycardia
EDAT- 2019/01/08 06:00
MHDA- 2020/07/21 06:00
CRDT- 2019/01/08 06:00
PHST- 2018/10/27 00:00 [received]
PHST- 2018/12/04 00:00 [revised]
PHST- 2019/12/24 00:00 [accepted]
PHST- 2019/01/08 06:00 [pubmed]
PHST- 2020/07/21 06:00 [medline]
PHST- 2019/01/08 06:00 [entrez]
AID - 10.1111/jce.13843 [doi]
PST - ppublish
SO  - J Cardiovasc Electrophysiol. 2019 Apr;30(4):520-527. doi: 10.1111/jce.13843. Epub 
      2019 Jan 15.