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Negative concordance pattern in bipolar and unipolar recordings: An additional mapping criterion to localize the site of origin of focal ventricular arrhythmias

Published:November 06, 2015DOI:https://doi.org/10.1016/j.hrthm.2015.11.005

      Background

      The relevance of the temporal relationship between a unipolar electrogram (UEGM) and a bipolar electrogram (BEGM) in determining the site of origin (SOO) of focal arrhythmias has been largely demonstrated.

      Objective

      We sought to demonstrate that a negative concordance in the initial forces of these EGMs is also helpful in predicting the SOO of premature ventricular contractions (PVCs).

      Methods

      Mapping and radiofrequency (RF) ablation were performed in 41 patients with symptomatic PVCs in the absence of structural heart disease. Simultaneous recordings of the minimally filtered (0.5–500 Hz) UEGM and filtered BEGM (30–500 Hz) were analyzed at 247 mapping sites, where RF was attempted. EGMs of 63 mechanically induced PVCs were separately analyzed as a validation group. All ablation sites had a QS pattern in the UEGM. Acute PVC suppression was defined as a complete disappearance of ventricular ectopic beats after a 60-second pulse of RF.

      Results

      RF ablation obtained PVC suppression (RF+) in 33 of 247 sites (13.3%). A negative concordance pattern (NCP) during the initial 20 ms of both UEGM and BEGM was observed in 31 of 33 (94%) RF+ sites compared with 10 of 214 (4%)RF− sites (P < .0001). The NCP criterion demonstrated to be an additional powerful predictor of acute RF success with sensitivity, specificity, positive predictive value, and negative predictive value of 94%, 95%, 76%, and 99%, respectively. Similarly to RF+ sites, the NCP was observed in 60 of 63 sites (95.2%) in the mechanical PVC group.

      Conclusion

      An NCP in both UEGM and BEGM may be an additional criterion that helps to localize the SOO of focal ventricular arrhythmias.

      Abbreviations:

      BEGM (bipolar electrogram), Bip (first peak (positive or negative) of the bipolar electrogram), ECG (electrocardiogram/electrocardiographic), NCP (negative concordance pattern), NPV (negative predictive value), PPV (positive predictive value), PVC (premature ventricular contraction), RF (points where radiofrequency was delivered without suppression of PVC's), RF+ (radiofrequency-induced complete premature ventricular contraction suppression), ROC (receiver operating characteristic), SOO (site of origin), UEGM (unipolar electrogram), UNIon (onset of the unipolar electrogram), UNIS (rapid negative deflection of the unipolar electrogram)

      Keywords

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