Intracardiac EGM characteristics of intramural outflow tract ventricular arrhythmias

Dr. Ali Uğur Soysal, Dr. Kıvanç YALIN, Dr. Barış İkitimur, Dr. Erkan Baysal, Dr.Ş. Ebru Önder, Sıla Öztürk, Dr. Hakan Yalman, Dr. Adem Atıcı,
Dr. Tolga Aksu, Dr. Ahmet Kaya Bilge

Istanbul University-Cerrahpasa, Cerrahpasa Faculty of Medicine, Department of Cardiology, Istanbul-Turkey

Introduction

Idiopathic VAs are usually beningn and catheter ablation is the selective treatment. Success rates for
CA highly depends on the site of origin. VA originating from RVOT has the highest success rates compared to
other sites. For successful CA determination of earliest site, called activation mapping is necessary.

Idiopathic VAs are usually beningn and catheter ablation is the selective treatment. Success rates for
CA highly depends on the site of origin. VA originating from RVOT has the highest success rates compared to
other sites. For successful CA determination of earliest site, called activation mapping is necessary.

Universally, annotation of earliest depolarization which depends on maximum dV/dt of unipolar (uni)
EGMs and uni-QS morphology is accepted as the site of origin for VPC. Annotation of bipolar EGMs can be
challenging for especially multicomponent EGMs. Time difference between bi- and uni-EGM can be observed
and complicate annotation. Unipolar QS morphology has limitations due to low spatial resolution and low
specificity. Moreover, in a considerable fraction of patients detailed RVOT and LVOT mapping are found to have
several different sites with similar activation times, suggesting an intramyocardial origin. Aim of this study is
identifying EGM characteristics of intramural outflow tract VAs.

Methods

In this retrospective study, 40 patients who underwent successful RFA for RVOT and RVOT+LVOT VPCs
were included. Local activation time (LAT), duration and voltage data of each bi- and uni-EGM at the successful
ablation sites from RVOT and RVOT+LVOT cases were analyzed.

EGM1 EGM2 EGM3

Conclusion

Evaluation of endocardial unipolar and bipolar signals may identify superficial and deep foci for
outflow tract VAs. Main findings of the present study are; (i) endocardial bipolar EGM duration is longer and
the amplitude is lower in patients who needed both sided ablation, (ii) time difference between bipolar and
unipolar recording is greater in intramural arrhythmic focus, (iii) intramural VAs required more ablation
attempts.

QS in uni-EGM was not a perfect predictor for successful ablation sites. Analysis of bipolar voltage
amplitude and duration with Bi-uni EGM time difference may identify deeper source.