The use of a novel signal analysis to identify the origin of idiopathic right ventricular outflow tract ventricular tachycardia during sinus rhythm: Simultaneous amplitude frequency electrogram transformation mapping

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Abstract

Introduction

The signal characteristics of intracardiac bipolar electrograms at the origin of idiopathic RVOT-VT during sinus rhythm remain unclear.

Objective

The study sought to develop a novel real-time/online technique, simultaneous amplitude frequency electrogram transformation (SAFE-T), to quantify and localize the diseased ventricular substrate in idiopathic RVOT-VT.

Methods

We retrospectively investigated the intracardiac bipolar recordings in 70 consecutive patients (26% male, mean age 42±12 years) who underwent successful radiofrequency catheter ablation of idiopathic RVOT-VT. We quantified the extent of the frequency fraction of ventricular potentials during sinus rhythm or ventricular pacing using a novel formula, the product of instantaneous amplitude and frequency, and showed that in a 3D geometry as an online SAFE-T map.

Results

The characteristics of the HHT spectra of electrograms derived from VT origins demonstrated high frequency components (>70 Hz), which were independent of the rhythm. The density of the abnormal potentials at the VT origins were higher (VT origins, 7.5±2.3 sites/cm ² vs. surrounding myocardium, 1.5±1.3 sites/cm ², p<0.001), and were significantly decreased after ablation (0.7±0.6 sites/cm ², p<0.001). A small region of abnormal potentials were observed in the VT origins (mean area of 1.5±0.8 cm ²). The SAFE-T maps predicted the VT origins with 92% sensitivity, 78% specificity with optimal cut-off value of >3.0 Hz·mV.

Conclusion

The online SAFE-T map was feasible for quantifying the diseased ventricular substrate, irrespective of the rhythm of activation, and can be used to identify the optimal ablation targets for idiopathic RVOT-VT. We found a limited region of abnormal potentials where the RVOT-VT origins were successfully ablated.

Related collections

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This report describes the clinical and electrophysiologic characteristics of 30 patients without myocardial disease who had ventricular tachycardia with the morphologic characteristics of left bundle branch block and inferior axis. The tachycardias were nonsustained in 24 patients, sustained (greater than 30 sec) in six patients, and provocable by exercise in 14 of 23 patients undergoing a standard Bruce protocol. Ventricular tachycardia was induced during electrophysiologic study in 22 of 30 patients. Programmed stimulation induced tachycardia in 10 of 30 patients, most frequently by rapid atrial or ventricular pacing. Isoproterenol infusion facilitated tachycardia induction in 13 of 23 patients. Endocardial activation mapping, performed in 10 patients, confirmed that earliest ventricular activation during tachycardia occurred at the right ventricular outflow tract on the interventricular septum. These tachycardias were unique in their responsiveness to a wide variety of antiarrhythmic drugs, including type I drugs and propranolol. During a mean follow-up of 30 months, no patient has died or experienced cardiac arrest. Two patients appear to be in spontaneous remission, and no patient has developed additional signs of cardiac disease.

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Author and article information

Contributors

Elena Tolkacheva: Role: Editor

Journal

Journal ID (nlm-ta): PLoS One

Journal ID (iso-abbrev): PLoS ONE

Journal ID (publisher-id): plos

Journal ID (pmc): plosone

Title: PLoS ONE

Publisher: Public Library of Science (San Francisco, CA USA )

ISSN (Electronic): 1932-6203

Publication date (Electronic): 10 March 2017

Publication date Collection: 2017

Volume: 12

Issue: 3

Electronic Location Identifier: e0173189

Affiliations

[1 ]Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan

[2 ]Cardiac Electrophysiology and Pacing Laboratory, Division of Cardiovascular Medicine, Makiminato Central Hospital, Okinawa, Japan

[3 ]Faculty of Medicine and Institute of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan

[4 ]Research Center for Adaptive Data Analysis and Center for Dynamical Biomarkers and Translational Medicine, National Central University, Jhongli, Taiwan

University of Minnesota, UNITED STATES

Author notes

Competing Interests: The authors have declared that no competing interests exist.

Conceptualization: SH ALDT YJL.
Data curation: SH ALDT CYL MTL CAL CL YCC YJL.
Formal analysis: SH ALDT CYL MTL CL YCC YJL.
Funding acquisition: YJL.
Investigation: SH ALDT CYL MTL CL YCC SLC LWL YFH FPC TCT TFC JNL YTC CHL YH SY KLP YJL SAC.
Methodology: SH ALDT CYL MTL CL YCC YJL.
Project administration: YJL SAC.
Resources: SH ALDT CYL MTL CL YCC SLC LWL YFH FPC TCT TFC JNL YTC CHL YH SY KLP YJL SAC.
Software: MTL CL YCC.
Supervision: YJL SAC.
Validation: SH ALDT YJL SAC.
Visualization: SH ALDT CYL MTL CL YCC YJL SAC.
Writing – original draft: SH ALDT YJL.
Writing – review & editing: SH ALDT YJL SAC.

* E-mail: linyennjiang@ 123456gmail.com

Article

Publisher ID: PONE-D-16-35531

DOI: 10.1371/journal.pone.0173189

PMC ID: 5345764

PubMed ID: 28282453

SO-VID: d79671a7-813c-4772-bb48-8b681f1df1df

License:

This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

History

Date received : 4 September 2016

Date accepted : 16 February 2017

Page count

Figures: 5, Tables: 3, Pages: 16