PMID- 35643806 OWN - NLM STAT- MEDLINE DCOM- 20220725 LR - 20220816 IS - 2405-5018 (Electronic) IS - 2405-500X (Linking) VI - 8 IP - 7 DP - 2022 Jul TI - Limitations of Unipolar Signals in Guiding Successful Outflow Tract Premature Ventricular Contraction Ablation. PG - 843-853 LID - S2405-500X(22)00303-6 [pii] LID - 10.1016/j.jacep.2022.03.013 [doi] AB - BACKGROUND: Unipolar electrograms (UniEGMs) are commonly used to annotate earliest local activation of focal arrhythmias. However, their utility in guiding premature ventricular contractions (PVCs) ablation may be limited when the PVC source is less superficial. OBJECTIVES: The authors sought to compare bipolar electrograms (BiEGMs) vs UniEGMs in guiding successful ablation of right ventricular outflow tract (RVOT) vs intramural outflow tract (OT) PVCs. The authors hypothesized that: 1) earliest bipolar local activation time (LAT(Bi)) would better guide mapping and ablation, vs UniEGM dV/dt (LAT(Uni)) or QS morphology; and 2) LAT differences using bipolar vs unipolar EGMs (DeltaLAT(Bi-Uni)) would be greater for intramural OT than RVOT PVCs. METHODS: Consecutive patients undergoing successful PVC ablation 2017 to2020 requiring only RVOT or RVOT+left ventricular OT (RVOT+LVOT) ablation were retrospectively analyzed. BiEGMs and UniEGMs at successful ablation sites were compared. RESULTS: Of 70 patients, 50 required RVOT-only, and 20 required RVOT+LVOT ablation for acute and long-term PVC suppression. Mean DeltaLAT(Bi-Uni) was lower for RVOT vs RVOT+LVOT groups (9.3 +/- 6.4 ms vs 17.4 +/- 9.9 ms; P < 0.01). QS UniEGM was seen in 78% of RVOT, compared with 53% of RVOT+LVOT patients (P < 0.016). RVOT+LVOT sites most frequently included the posteroseptal RVOT and adjacent LVOT (73%), and 43% lacked a QS unipolar EGM. DeltaLAT(Bi-Uni) >/=15 ms best distinguished sites in which RVOT-only vs RVOT+LVOT ablation achieved acute PVC suppression (area under the curve: 0.77). CONCLUSIONS: Earliest BiEGM activation guides successful ablation of OT PVCs better than UniEGM-guided analysis, especially when an intramural PVC source is present. CI - Copyright (c) 2022 American College of Cardiology Foundation. All rights reserved. FAU - Sabzwari, Syed Rafay Ali AU - Sabzwari SRA AD - Cardiac Electrophysiology Section, Division of Cardiology, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA. FAU - Rosenberg, Michael A AU - Rosenberg MA AD - Cardiac Electrophysiology Section, Division of Cardiology, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA. FAU - Mann, James AU - Mann J AD - Cardiac Electrophysiology Section, Division of Cardiology, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA. FAU - Cerbin, Lukasz AU - Cerbin L AD - Cardiac Electrophysiology Section, Division of Cardiology, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA. FAU - Barrett, Christopher AU - Barrett C AD - Cardiac Electrophysiology Section, Division of Cardiology, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA. FAU - Garg, Lohit AU - Garg L AD - Cardiac Electrophysiology Section, Division of Cardiology, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA. FAU - Aleong, Ryan G AU - Aleong RG AD - Cardiac Electrophysiology Section, Division of Cardiology, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA. FAU - Sandhu, Amneet AU - Sandhu A AD - Cardiac Electrophysiology Section, Division of Cardiology, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA. FAU - West, Jason AU - West J AD - Cardiac Electrophysiology Section, Division of Cardiology, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA. FAU - Tumolo, Alexis Z AU - Tumolo AZ AD - Cardiac Electrophysiology Section, Division of Cardiology, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA. FAU - Varosy, Paul D AU - Varosy PD AD - Cardiac Electrophysiology Section, Division of Cardiology, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA. FAU - Sauer, William H AU - Sauer WH AD - Cardiac Arrhythmia Service, Division of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA. FAU - Zipse, Matthew M AU - Zipse MM AD - Cardiac Electrophysiology Section, Division of Cardiology, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA. FAU - Tzou, Wendy S AU - Tzou WS AD - Cardiac Electrophysiology Section, Division of Cardiology, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA. Electronic address: Wendy.Tzou@cuanschutz.edu. LA - eng PT - Journal Article PT - Research Support, N.I.H., Extramural DEP - 20220525 PL - United States TA - JACC Clin Electrophysiol JT - JACC. Clinical electrophysiology JID - 101656995 SB - IM CIN - JACC Clin Electrophysiol. 2022 Jul;8(7):854-856. PMID: 35863810 MH - *Catheter Ablation MH - Humans MH - Retrospective Studies MH - *Tachycardia, Ventricular/surgery MH - Treatment Outcome MH - *Ventricular Premature Complexes/surgery OTO - NOTNLM OT - activation mapping OT - bipolar electrogram OT - left ventricular outflow tract OT - premature ventricular contractions OT - right ventricular outflow tract OT - unipolar electrogram COIS- Funding Support and Author Disclosures Dr Rosenberg has received support from National Heart, Lung, and Blood Institute grants R01HL143070, R01HL146824, R01HL151152, and K23HL12729. Dr Tumolo is a consultant for Biosense Webster and Boston Scientific. Dr Sauer has received consulting fees from Biosense Webster, Abbott, Biotronik, and Boston Scientific. Dr Zipse has received consulting fees from Philips, Medtronic, and Biosense Webster. Dr Tzou has received research grants or speaker honoraria or is consultant for the American Heart Association, Abbott, Biosense Webster, BioSig, Boston Scientific, BioTel, Medtronic, and Zoll. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose. EDAT- 2022/06/02 06:00 MHDA- 2022/07/26 06:00 CRDT- 2022/06/01 09:46 PHST- 2021/12/22 00:00 [received] PHST- 2022/02/25 00:00 [revised] PHST- 2022/03/23 00:00 [accepted] PHST- 2022/06/02 06:00 [pubmed] PHST- 2022/07/26 06:00 [medline] PHST- 2022/06/01 09:46 [entrez] AID - S2405-500X(22)00303-6 [pii] AID - 10.1016/j.jacep.2022.03.013 [doi] PST - ppublish SO - JACC Clin Electrophysiol. 2022 Jul;8(7):843-853. doi: 10.1016/j.jacep.2022.03.013. Epub 2022 May 25.