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Derivative tissue activation as a unique marker of arrhythmogenic myocardium

Published:October 18, 2022DOI:https://doi.org/10.1016/j.hrthm.2022.10.013

      Background

      Mapping techniques to identify diseased myocardial substrate during ventricular tachycardia ablation procedures remain limited.

      Objective

      We hypothesized that tissue derivative of the voltage with respect to time (dV/dt), the slope of the unipolar ventricular electrogram registered by local ventricular activation, represents a unique parameter for identifying potential arrhythmogenic tissue in the ischemic scar border zone.

      Methods

      Using high-resolution electrical mapping, we examined dV/dt characteristics in the border zone of animals after chronic myocardial infarction (MI).

      Results

      Minimum dV/dt (dV/dtmin) in MI animals was less than that in control animals (−344.7 ± 68.7 in controls vs −174.2 ± 104.5 in MI; P < .001) and related to ventricular fibrosis. In MI animals, dV/dtmin values were divided into high (≤−200 μV/ms) and low (>−200 μV/ms) dV/dtmin. Low dV/dtmin regions harbored arrhythmogenic substrates that were characterized by (1) high responsiveness to sympathetic stimulation, (2) presence of late potentials, and (3) lower unipolar and bipolar voltage amplitudes.

      Conclusion

      Our data indicate that dV/dtmin is a unique parameter for identifying arrhythmogenic myocardium and may add a useful metric to conventional mapping strategies.

      Keywords

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      Linked Article

      • Identifying the ventricular tachycardia arrhythmogenic substrate: The quest for the holy grail continues
        Heart Rhythm
        • Preview
          The development of electroanatomic mapping (EAM) technology during the 1990s transformed the field of cardiac electrophysiology.1 Substrate identification facilitated by EAM technologies has been the foundation of catheter ablation procedures for ventricular tachycardia (VT) in patients with structural heart disease. Because reentry typically is the mechanism of scar-related VT, substrate mapping techniques focus on (1) differentiating normal vs abnormal areas of myocardial tissue; and (2) identifying the underlying arrhythmogenic pathophysiological substrate, typically within areas of scar, that contribute to the formation of reentrant circuits.
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