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Mapping Strategy Associated with QRS Morphology for Catheter Ablation in Patients with Idiopathic Ventricular Outflow Tract Tachyarrhythmia
Author(s) -
KANESHIRO TAKASHI,
SUZUKI HITOSHI,
NODERA MINORU,
YAMADA SHINYA,
KAMIOKA MASASHI,
KAMIYAMA YOSHIYUKI,
TAKEISHI YASUCHIKA
Publication year - 2016
Publication title -
pacing and clinical electrophysiology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.686
H-Index - 101
eISSN - 1540-8159
pISSN - 0147-8389
DOI - 10.1111/pace.12810
Subject(s) - medicine , cardiology , catheter ablation , ventricular outflow tract , ablation , qrs complex , outflow , catheter , ventricular tachycardia , surgery , physics , meteorology
Background In catheter ablation of idiopathic ventricular arrhythmia (VA), it is still unclear whether pace mapping or activation mapping is more useful for successful catheter ablation. The depth of origin in the ventricular wall especially affects the success rate of endocardial‐approached catheter ablation. Thus, we examined the relationship between these tactics and QRS morphology. Methods We evaluated the relationship among pace mapping score, activation time, and peak deflection index (PDI) in 28 patients, with a total of 30 origins, who underwent successful catheter ablation of idiopathic VA. Results All origins were located in the ventricular outflow tract area, including three in the left coronary cusp (LCC). PDI, activation time, and pace mapping score at successful ablation sites were 0.60 ± 0.08, 26.3 ± 9.9 ms, and 19.1 ± 4.6, respectively. The pace mapping score inversely correlated with the PDI (R = −0.540, P = 0.0017), but the activation time did not correlate with the PDI. When excluding the three VAs originating from the LCC, in which perfect pace mapping was obtained from epicardial sites despite high PDI, this correlation coefficient became more intensive (R = −0.734, P < 0.0001). Conclusions Our study suggests that pace mapping with an endocardial approach could not reproduce the precise QRS morphology for VA originating from the intramural site of the ventricular wall. With such origins, we should rely on activation mapping to detect the optimal ablation site.