Author + information
- Received October 19, 2017
- Revision received December 7, 2017
- Accepted December 11, 2017
- Published online February 2, 2018.
- Andreu Porta-Sánchez, MD, MSca,b,
- Nicholas Jackson, MBBSc,
- Peter Lukac, MD, PhDd,
- Steen Buus Kristiansen, MDd,
- Jan Moller Nielsen, MDd,
- Sigfus Gizurarson, MD, PhDa,
- Stéphane Massé, MASca,
- Christopher Labos, MD, MSce,
- Karthik Viswanathan, MBBSa,
- Benjamin King, MBBSa,
- Andrew C.T. Ha, MDa,
- Eugene Downar, MDa and
- Kumaraswamy Nanthakumar, MDa,∗ ()
- aPeter Munk Cardiac Centre, University Health Network, Toronto, Ontario, Canada
- bDepartment de Medicina, Universitat de Barcelona, Barcelona, Spain
- cJohn Hunter Hospital, Newcastle, Australia
- dÅrhus University Hospital, Skejby, Denmark
- eMcGill University, Montreal, Canada
- ↵∗Address for correspondence:
Dr. Kumaraswamy Nanthakumar, Division of Cardiology, University Health Network, Toronto General Hospital, 150 Gerrard Street West, GW3-522, Toronto, Ontario, Canada, M5G2C4.
Objectives The authors conducted a multicenter study of decrement-evoked potential (DEEP) – based functional ventricular tachycardia (VT) substrate modification to evaluate if such a mechanistic and physiological strategy is feasible and efficient in clinical practice and provides reduction in the VT burden.
Background Only a fraction of the myocardium targeted in current VT substrate modification procedures is involved in the initiation and perpetuation of VT. The physiological basis of the DEEP strategy for identification of areas of initiation and maintenance of VT was recently established.
Methods We included 20 consecutive patients with ischemic cardiomyopathy. During substrate mapping, fractionated and late potentials (LPs) were tagged, and an extra stimulus was performed to determine which LPs displayed decrement (DEEPs). All patients underwent DEEP-focused ablation: elimination of DEEP + further radiofrequency (RF) if VT was still inducible. Patients were followed during 6 months.
Results Patients were predominantly male (95%), and their mean age ± SD was 64.6 ± 17.1 years. Mean ± SD left ventricular ejection fraction was 33.4 ± 11.4%. Mean ± SD ablation time was 30.6 ± 20.4 min. Specificity of DEEPs to detect the isthmus of VT was better than that of LPs (0.97 [95% confidence interval [CI]: 0.95 to 0.98] vs. 0.82 [95% CI: 0.73 to 0.89]), without significant differences in terms of sensitivity (0.61 [95% CI: 0.52 to 0.69] vs. 0.60 [95% CI: 0.44 to 0.74], respectively). Fifteen of 20 (75%) patients were free of any VT after DEEP-RF at 6 months of follow-up and there was a strong reduction in VT burden compared to 6 months pre-ablation.
Conclusions In a multicenter prospective study, DEEP substrate mapping identified the functional substrate critical to the VT circuit with high specificity. DEEP-guided VT ablation, by its physiological nature, may enable greater access to focused ablation therapy for patients requiring VT treatment.
- catheter ablation
- myocardial infarction
- nonischemic cardiomyopathy
- substrate ablation
- ventricular tachycardia
The authors have reported that they have no relationships relevant to the contents of this paper to disclose.
Dr. Massé has received consulting fees from Abbott Laboratories. Dr. Nanthakumar has received consulting fees and grants from Abbott Laboratories and Biosense Webster. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
All authors attest they are in compliance with human studies committees and animal welfare regulations of the authors’ institutions and Food and Drug Administration guidelines, including patient consent where appropriate. For more information, visit the JACC: Clinical Electrophysiology author instructions page.
- Received October 19, 2017.
- Revision received December 7, 2017.
- Accepted December 11, 2017.
- 2018 American College of Cardiology Foundation
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