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Cardiovascular disease (CVD) continues to be the primary cause of mortality and morbidity globally with middle-aged women presenting with additional and possibly, overlooked risk factors.1 Despite several awareness programmes, there remain several gaps in the political education and representation needs of this group, which includes those from low socioeconomic status (SES) and culturally diverse backgrounds. These […]

187/Activation-repolarisation dynamics for the delineation of the arrhythmogenic substrate of ventricular tachycardia – Formal evaluation of the re-entry vulnerability index

M Orini (Presenting Author) – University College London, London, UK; AJ Graham – Barts Heart Centre, London, UK; NT Srinivasan – Barts Heart Centre, London, UK; FO Campos – King’s College London, London, UK; BM Hanson – UCL, London, UK; A Chow – Barts Heart Centre, London, UK; RJ Hunter – Barts Heart Centre, London, UK; RJ Schilling – Barts Heart Centre, London, UK; M Finlay – Barts Heart Centre, London, UK; MJ Earley – Barts Heart Centre, London, UK; S Sporton – Barts Heart Centre, London, UK; M Dhinoja – Barts Heart Centre, London, UK; M Lowe – Barts Heart Centre, London, UK; B Porter – Guys and St Thomas’ Hospital, London, UK; N Child – Guys and St Thomas’ Hospital, London, UK; CA Rinaldi – Guys and St Thomas’ Hospital, London, UK; J Gill – Guys and St Thomas’ Hospital, London, UK; M Bishop – King’s College London, London, UK; P Taggart – UCL, London, UK; PD Lambiase – Barts Heart Centre, London, UK
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Published Online: Oct 3rd 2008 European Journal of Arrhythmia & Electrophysiology. 2019;5(Suppl. 1):abstr187
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Article

Aim: Recurrence rate of ventricular tachycardia (VT) after catheter ablation remains sub-optimal. The re-entry vulnerability index (RVI) is a metric combining activation and repolarisation timings designed to identify sites critical for re-entrant arrhythmia initiation without inducing VT. This study uses high-density mapping to test its capability of identifying VT sites of origin (VTSO).

Methods: Eighteen VT ablation patients (16M, 72% with ischaemic disease) were studied. Unipolar electrograms were recorded during pacing at short coupling intervals using multipolar catheters (CARTO and Ensite Precision) and analysed off-line to produce activation time (AT), activation-recovery interval (ARI), repolarisation time (RT) and RVI maps (see Figure 1A). Potential target sites were compared for the following parameters: lowest 5% of RVI (see Figure 1A); highest 5% of local AT, ARI and RT gradients; highest and lowest 5% of AT, RT and ARI. The minimum distance between the VTSO and these sites, Dist, was measured. VTSO localization was considered accurate if Dist <10 mm and inaccurate if Dis t>20 mm.

Results: Eighteen VTSO were identified (6 entrainment, 12 pace mapping). RVI maps included 1,012 (408, 2098) (median, 1st–3rd quartiles) points/patient. Lowest RVI provided accurate VTSO localisation in 72.2% of VTs, with Dist=5.1 (3.2, 10.1) mm (see Figure 1B). Inaccurate localisation was significantly less frequent for lowest RVI than longest AT (5.6% versus 33.3%, OR=0.12, p=0.035). Compared to lowest RVI, longest RT and ARI showed significantly larger Dist (p<0.02), while highest AT and ARI gradients showed non-significantly larger Dist.

Conclusion: RVI identifies vulnerable regions closest to VTSO sites. Activation-repolarisation metrics may improve VT substrate delineation and inform novel ablation strategies.

 

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