PMID- 35031494
OWN - NLM
STAT- MEDLINE
DCOM- 20220706
LR  - 20220722
IS  - 1556-3871 (Electronic)
IS  - 1547-5271 (Linking)
VI  - 19
IP  - 7
DP  - 2022 Jul
TI  - How to use bipolar and unipolar electrograms for selecting successful ablation 
      sites of ventricular premature contractions.
PG  - 1067-1073
LID - S1547-5271(22)00010-8 [pii]
LID - 10.1016/j.hrthm.2021.12.035 [doi]
AB  - BACKGROUND: Local activation time is often determined by the maximal negative of 
      the extracellular unipolar potential (-dV/dT(max)). While this is accurate in 
      2-dimensional uniform tissue, propagation through nonuniform or 3-dimensional 
      structures have shown discordance between -dV/dT(max) and local activation time. 
      OBJECTIVE: The purpose of this study was to examine the relationship between 
      bipolar and unipolar electrograms for selecting successful ablation sites of 
      endocardial (superficial) vs intramural (deep) ventricular premature contractions 
      (VPCs). METHODS: This cohort consisted of 66 patients with VPCs presenting for 
      ablation in a bigeminy, trigeminy, or quadrigeminy pattern. VPCs were classified 
      as endocardial if ablation at the earliest endocardial site resulted in immediate 
      suppression (<10 seconds) or as intramural if ablation resulted in delayed 
      suppression (>/=10 seconds), required multiple applications, or was not achieved. 
      Unipolar and bipolar electrograms were analyzed. RESULTS: In endocardial VPCs, 
      the first rapid bipolar deflection corresponded with unipolar -dV/dT(max), 
      occurring 20.5 ms (17.8-26.0 ms) and 16.0 ms (6.8-22.0 ms), respectively, before 
      the QRS onset. In successfully ablated intramural VPCs, the first rapid bipolar 
      deflection preceded the QRS onset by 14.0 ms (11.2-22.6 ms) and coincided with 
      the first rapid unipolar deflection, although -dV/dT(max) occurred 10.5 ms 
      (0.0-20.8 ms) after the QRS onset and often coincided with far-field activity. In 
      unsuccessfully ablated intramural VPCs, the first rapid bipolar deflection to QRS 
      onset interval was shorter in comparison to successfully ablated intramural VPCs 
      (1.5 ms vs 14.0 ms; P < .001) while the unipolar -dV/dT(max) to QRS onset 
      interval was similar (P = .095). CONCLUSION: Mapping of VPCs should be guided by 
      the first rapid bipolar deflection that corresponds to a similarly early unipolar 
      deflection but not with -dV/dT(max).
CI  - Copyright (c) 2022. Published by Elsevier Inc.
FAU - Higuchi, Koji
AU  - Higuchi K
AD  - Cardiac Electrophysiology Section, Department of Cardiovascular Medicine, 
      Cleveland Clinic, Cleveland, Ohio.
FAU - Yavin, Hagai D
AU  - Yavin HD
AD  - Cardiac Electrophysiology Section, Department of Cardiovascular Medicine, 
      Cleveland Clinic, Cleveland, Ohio.
FAU - Sroubek, Jakub
AU  - Sroubek J
AD  - Cardiac Electrophysiology Section, Department of Cardiovascular Medicine, 
      Cleveland Clinic, Cleveland, Ohio.
FAU - Younis, Arwa
AU  - Younis A
AD  - Cardiac Electrophysiology Section, Department of Cardiovascular Medicine, 
      Cleveland Clinic, Cleveland, Ohio.
FAU - Zilberman, Israel
AU  - Zilberman I
AD  - Cardiac Electrophysiology Section, Department of Cardiovascular Medicine, 
      Cleveland Clinic, Cleveland, Ohio.
FAU - Anter, Elad
AU  - Anter E
AD  - Cardiac Electrophysiology Section, Department of Cardiovascular Medicine, 
      Cleveland Clinic, Cleveland, Ohio; Department of Cardiovascular & Metabolic 
      Sciences, Cleveland Clinic, Lerner Research Institute, Cleveland, Ohio. 
      Electronic address: antere@ccf.org.
LA  - eng
PT  - Journal Article
DEP - 20220111
PL  - United States
TA  - Heart Rhythm
JT  - Heart rhythm
JID - 101200317
SB  - IM
MH  - *Catheter Ablation/methods
MH  - Electrocardiography
MH  - Endocardium
MH  - Humans
MH  - *Ventricular Premature Complexes/diagnosis/surgery
OTO - NOTNLM
OT  - Ablation
OT  - Bipolar electrograms
OT  - Electrograms
OT  - Mapping
OT  - Unipolar electrograms
OT  - Ventricular premature contractions
EDAT- 2022/01/16 06:00
MHDA- 2022/07/07 06:00
CRDT- 2022/01/15 05:41
PHST- 2021/11/08 00:00 [received]
PHST- 2021/12/09 00:00 [revised]
PHST- 2021/12/24 00:00 [accepted]
PHST- 2022/01/16 06:00 [pubmed]
PHST- 2022/07/07 06:00 [medline]
PHST- 2022/01/15 05:41 [entrez]
AID - S1547-5271(22)00010-8 [pii]
AID - 10.1016/j.hrthm.2021.12.035 [doi]
PST - ppublish
SO  - Heart Rhythm. 2022 Jul;19(7):1067-1073. doi: 10.1016/j.hrthm.2021.12.035. Epub 
      2022 Jan 11.