Author + information
- Received May 17, 2019
- Revision received November 4, 2019
- Accepted November 14, 2019
- Published online January 29, 2020.
- Ruhong Jiang, MDa,b,
- Andrew D. Beaser, MDa,
- Zaid Aziz, MDa,
- Gaurav A. Upadhyay, MDa,
- Hemal M. Nayak, MDa and
- Roderick Tung, MDa,b,∗ ()
- aCenter for Arrhythmia Care, Pritzker School of Medicine, The University of Chicago Medicine, Chicago, Illinois
- bDepartment of Cardiology, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, China
- ↵∗Address for correspondence:
Dr. Roderick Tung, The University of Chicago Medicine, Center for Arrhythmia Care, 5841 South Maryland Avenue, MC 6080, Chicago, Illinois 60637.
Objectives This study aimed to evaluate the feasibility and accuracy of using a novel grid mapping catheter during scar-related ventricular tachycardia (VT) ablation.
Background Ultra–high-density (UHD) mapping improves identification of local abnormal ventricular activities (LAVAs) and characterization of scar substrates.
Methods Consecutive patients underwent endocardial and/or epicardial ablation guided by a HD grid mapping catheter. A linear duodecapolar catheter was used in the initial cases for systematic correlation. Isochronal late activation mapping was performed during sinus rhythm to identify deceleration zones, and activation mapping of VT was performed when tolerated.
Results In 38 patients, 51 electroanatomic maps (left ventricle: 26, epicardium: 21, right ventricle: 4) were created using a grid catheter. LAVAs were identified in 98% of cases and deceleration zones were observed in 86%. High-frequency electrograms with diastolic activation were identified during 44 sustained monomorphic VTs, and the critical isthmus was colocalized to deceleration zones during sinus rhythm in 96% of cases. In 17 cases that underwent sequential mapping with both grid and linear catheters, the low voltage area detected using the grid (HD wave) was significantly smaller, with ratios of 0.61 (<0.5 mV) and 0.81 (<1.5 mV) relative to the duodecapolar catheter.
Conclusions VT ablation guided by a novel HD grid catheter is safe and feasible for clinical use in human scar-related VT via both endocardial and epicardial approaches. Automated selection of larger bipolar amplitudes among orthogonal pairs consistently displayed smaller low voltage areas than a previously validated linear catheter.
Dr. Upadhyay has been a speaker for Biotronik and Medtronic; and a consultant to Abbott, Biotronik, and Medtronic. Dr. Nayak has been a speaker for Medtronic, Biotronik, and Boston Scientific. Dr. Tung has received speaking fees and fees for travel and lodging from Abbott. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
The 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 May 17, 2019.
- Revision received November 4, 2019.
- Accepted November 14, 2019.
- 2020 American College of Cardiology Foundation
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