PMID- 31751771
OWN - NLM
STAT- MEDLINE
DCOM- 20210622
LR  - 20210622
IS  - 1556-3871 (Electronic)
IS  - 1547-5271 (Print)
IS  - 1547-5271 (Linking)
VI  - 17
IP  - 4
DP  - 2020 Apr
TI  - Evaluation of the reentry vulnerability index to predict ventricular tachycardia 
      circuits using high-density contact mapping.
PG  - 576-583
LID - S1547-5271(19)31025-2 [pii]
LID - 10.1016/j.hrthm.2019.11.013 [doi]
AB  - BACKGROUND: Identifying arrhythmogenic sites to improve ventricular tachycardia 
      (VT) ablation outcomes remains unresolved. The reentry vulnerability index (RVI) 
      combines activation and repolarization timings to identify sites critical for 
      reentrant arrhythmia initiation without inducing VT. OBJECTIVE: The purpose of 
      this study was to provide the first assessment of RVI's capability to identify VT 
      sites of origin using high-density contact mapping and comparison with other 
      activation-repolarization markers of functional substrate. METHODS: Eighteen VT 
      ablation patients (16 male; 72% ischemic) were studied. Unipolar electrograms 
      were recorded during ventricular pacing and analyzed offline. Activation time 
      (AT), activation-recovery interval (ARI), and repolarization time (RT) were 
      measured. Vulnerability to reentry was mapped based on RVI and spatial 
      distribution of AT, ARI, and RT. The distance from sites identified as vulnerable 
      to reentry to the VT site of origin was measured, with distances <10 mm and >20 
      mm indicating accurate and inaccurate localization, respectively. RESULTS: The 
      origins of 18 VTs (6 entrainment, 12 pace-mapping) were identified. RVI maps 
      included 1012 (408-2098) (median, 1st-3rd quartiles) points per patient. RVI 
      accurately localized 72.2% VT sites of origin, with median distance of 5.1 
      (3.2-10.1) mm. Inaccurate localization was significantly less frequent for RVI 
      than AT (5.6% vs 33.3%; odds ratio 0.12; P = .035). Compared to RVI, distance to 
      VT sites of origin was significantly larger for sites showing prolonged RT and 
      ARI and were nonsignificantly larger for sites showing highest AT and ARI 
      gradients. CONCLUSION: RVI identifies vulnerable regions closest to VT sites of 
      origin. Activation-repolarization metrics may improve VT substrate delineation 
      and inform novel ablation strategies.
CI  - Copyright (c) 2019 The Authors. Published by Elsevier Inc. All rights reserved.
FAU - Orini, Michele
AU  - Orini M
AD  - Institute of Cardiovascular Science, University College London, London, United 
      Kingdom; The William Harvey Research Institute, Queen Mary University of London, 
      London, United Kingdom. Electronic address: m.orini@ucl.ac.uk.
FAU - Graham, Adam J
AU  - Graham AJ
AD  - Electrophysiology Department, Barts Heart Centre, St Bartholomew's Hospital, 
      London, United Kingdom.
FAU - Srinivasan, Neil T
AU  - Srinivasan NT
AD  - Electrophysiology Department, Barts Heart Centre, St Bartholomew's Hospital, 
      London, United Kingdom.
FAU - Campos, Fernando O
AU  - Campos FO
AD  - School of Biomedical Engineering and Imaging Sciences, King's College London, 
      London, United Kingdom.
FAU - Hanson, Ben M
AU  - Hanson BM
AD  - Department of Mechanical Engineering, University College London, London, United 
      Kingdom.
FAU - Chow, Anthony
AU  - Chow A
AD  - Electrophysiology Department, Barts Heart Centre, St Bartholomew's Hospital, 
      London, United Kingdom.
FAU - Hunter, Ross J
AU  - Hunter RJ
AD  - Electrophysiology Department, Barts Heart Centre, St Bartholomew's Hospital, 
      London, United Kingdom.
FAU - Schilling, Richard J
AU  - Schilling RJ
AD  - Electrophysiology Department, Barts Heart Centre, St Bartholomew's Hospital, 
      London, United Kingdom.
FAU - Finlay, Malcolm
AU  - Finlay M
AD  - The William Harvey Research Institute, Queen Mary University of London, London, 
      United Kingdom; Electrophysiology Department, Barts Heart Centre, St 
      Bartholomew's Hospital, London, United Kingdom.
FAU - Earley, Mark J
AU  - Earley MJ
AD  - Electrophysiology Department, Barts Heart Centre, St Bartholomew's Hospital, 
      London, United Kingdom.
FAU - Sporton, Simon
AU  - Sporton S
AD  - Electrophysiology Department, Barts Heart Centre, St Bartholomew's Hospital, 
      London, United Kingdom.
FAU - Dhinoja, Mehul
AU  - Dhinoja M
AD  - Electrophysiology Department, Barts Heart Centre, St Bartholomew's Hospital, 
      London, United Kingdom.
FAU - Lowe, Martin
AU  - Lowe M
AD  - Electrophysiology Department, Barts Heart Centre, St Bartholomew's Hospital, 
      London, United Kingdom.
FAU - Porter, Bradley
AU  - Porter B
AD  - Department of Cardiology, Guys and St Thomas' NHS Trust, London, United Kingdom.
FAU - Child, Nicholas
AU  - Child N
AD  - Department of Cardiology, Guys and St Thomas' NHS Trust, London, United Kingdom.
FAU - Rinaldi, Christopher A
AU  - Rinaldi CA
AD  - Department of Cardiology, Guys and St Thomas' NHS Trust, London, United Kingdom.
FAU - Gill, Jaswinder
AU  - Gill J
AD  - Department of Cardiology, Guys and St Thomas' NHS Trust, London, United Kingdom.
FAU - Bishop, Martin
AU  - Bishop M
AD  - School of Biomedical Engineering and Imaging Sciences, King's College London, 
      London, United Kingdom.
FAU - Taggart, Peter
AU  - Taggart P
AD  - Institute of Cardiovascular Science, University College London, London, United 
      Kingdom.
FAU - Lambiase, Pier D
AU  - Lambiase PD
AD  - Institute of Cardiovascular Science, University College London, London, United 
      Kingdom; Electrophysiology Department, Barts Heart Centre, St Bartholomew's 
      Hospital, London, United Kingdom. Electronic address: p.lambiase@ucl.ac.uk.
LA  - eng
GR  - MR/N011007/1/MRC_/Medical Research Council/United Kingdom
GR  - PG/16/81/32441/BHF_/British Heart Foundation/United Kingdom
PT  - Journal Article
PT  - Research Support, Non-U.S. Gov't
DEP - 20191118
PL  - United States
TA  - Heart Rhythm
JT  - Heart rhythm
JID - 101200317
SB  - IM
MH  - Adult
MH  - Aged
MH  - Body Surface Potential Mapping/*methods
MH  - Catheter Ablation/methods
MH  - Female
MH  - Heart Conduction System/*physiopathology
MH  - Heart Rate/*physiology
MH  - Heart Ventricles/diagnostic imaging/*physiopathology
MH  - Humans
MH  - Male
MH  - Middle Aged
MH  - Predictive Value of Tests
MH  - Tachycardia, Ventricular/*physiopathology/surgery
PMC - PMC7105818
OTO - NOTNLM
OT  - Ablation
OT  - Activation time
OT  - Reentry vulnerability index
OT  - Repolarization time
OT  - Substrate mapping
OT  - Ventricular tachycardia
EDAT- 2019/11/22 06:00
MHDA- 2021/06/23 06:00
PMCR- 2020/04/01
CRDT- 2019/11/22 06:00
PHST- 2019/08/11 00:00 [received]
PHST- 2019/11/22 06:00 [pubmed]
PHST- 2021/06/23 06:00 [medline]
PHST- 2019/11/22 06:00 [entrez]
PHST- 2020/04/01 00:00 [pmc-release]
AID - S1547-5271(19)31025-2 [pii]
AID - 10.1016/j.hrthm.2019.11.013 [doi]
PST - ppublish
SO  - Heart Rhythm. 2020 Apr;17(4):576-583. doi: 10.1016/j.hrthm.2019.11.013. Epub 2019 
      Nov 18.