Automated isochronal late activation mapping to identify deceleration zones: Rationale and methodology of a practical electroanatomic mapping approach for ventricular tachycardia ablation

Computers in Biology and Medicine
Michael Raiman, Roderick Tung

Abstract

Sinus rhythm surrogates for critical isthmus sites are highly desirable because the vast majority of VT is hemodynamically unstable. While many ablation strategies to decrease the arrhythmogenicity of scar have been shown to be effective, the predominant method for electroanatomic mapping relies on a voltage-based depiction of scar and abnormal electrograms. A functional prioritization of slow conduction, distinct from late activation, is feasible in clinical practice with the creation of isochronal late activation maps. Regions of slow conduction are easily visualized with isochronal displays of baseline intrinsic rhythm activation and deceleration zones, where isochrones crowd, have been observed to have strong correlation with successful ablation sites. Automated annotation of the offset of local electrograms was developed to create the propagation maps to incorporate electrogram width and completion of local activation. Simple conduction velocity estimates where three isochrones are seen within a 1 cm radium confirm that deceleration zones harbor conduction velocity of <0.6 m/s. We present a practical methodology of analyzing electroanatomic substrate in a voltage-independent manner with correlation to reentrant VT. Non-lin...Continue Reading

Citations

May 11, 2019·Europace : European Pacing, Arrhythmias, and Cardiac Electrophysiology : Journal of the Working Groups on Cardiac Pacing, Arrhythmias, and Cardiac Cellular Electrophysiology of the European Society of Cardiology·Edmond M CroninUNKNOWN ESC Scientific Document Group
Jan 10, 2020·Journal of Cardiovascular Electrophysiology·Akiko UedaUNKNOWN other members of the ILAM-PM Study Group
Jan 28, 2020·Journal of Interventional Cardiac Electrophysiology : an International Journal of Arrhythmias and Pacing·Edmond M CroninKatja Zeppenfeld
Aug 10, 2021·Heart Rhythm : the Official Journal of the Heart Rhythm Society·Edward J CiaccioHasan Garan

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