The different substrate characteristics of arrhythmogenic triggers in idiopathic right ventricular outflow tract tachycardia and arrhythmogenic right ventricular dysplasia: New insight from noncontact mapping

Van Buu Dan Do; Wen Chin Tsai; Yenn Jiang Lin; Satoshi Higa; Nobumori Yagi; Shih Lin Chang; Li Wei Lo; Fa Po Chung; Jo Nan Liao; Yen Chang Huang; Chao Shun Chan; Hung Kai Huang; Yu Feng Hu; Hsuan Ming Tsao; Shih Ann Chen

doi:10.1371/journal.pone.0140167

The different substrate characteristics of arrhythmogenic triggers in idiopathic right ventricular outflow tract tachycardia and arrhythmogenic right ventricular dysplasia: New insight from noncontact mapping

Van Buu Dan Do, Wen Chin Tsai, Yenn Jiang Lin, Satoshi Higa, Nobumori Yagi, Shih Lin Chang, Li Wei Lo, Fa Po Chung, Jo Nan Liao, Yen Chang Huang, Chao Shun Chan, Hung Kai Huang, Yu Feng Hu, Hsuan Ming Tsao, Shih Ann Chen

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Abstract

Background: The aim of this study was to investigate the different substrate characteristics of repetitive premature ventricular complexed (PVC) trigger sites by the non-contact mapping (NCM). Methods: Thirty-five consecutive patients, including 14 with arrhythmogenic right ventricular cardiomyopathy/dysplasia (ARVC) and 21 with idiopathic right ventricular outflow tract tachycardia (RVOT VT), were enrolled for electrophysiological study and catheter ablation guided by the NCM. Substrate and electrogram (Eg) characteristics of the earliest activation (EA) and breakout (BO) sites of PVCs were investigated, and these were confirmed by successful PVC elimination. Results: Overall 35 dominant focal PVCs were identified. PVCs arose from the focal origins with preferential conduction, breakout, and spread to the whole right ventricle. The conduction time and distance from EA to BO site were both longer in the ARVC than the RVOT group. The conduction velocity was similar between the 2 groups. The negative deflection of local unipolar Eg at the EA site (EA slope_3,5,10ms values) was steeper in the RVOT, compared to ARVC patients. The PVCs of ARVC occurred in the diseased substrate in the ARVC patients. More radiofrequency applications were required to eliminate the triggers in ARVC patients. Conclusions/interpretation: The substrate characteristics of PVC trigger may help to differentiate between idiopathic RVOT VT and ARVC. The slowing and slurred QS unipolar electrograms and longer distance from EA to BO in RVOT endocardium suggest that the triggers of ARVC may originate from mid- or sub-epicardial myocardium. More extensive ablation to the trigger site was required in order to create deeper lesions for a successful outcome.

Original language	English
Article number	e0140167
Journal	PLoS ONE
Volume	10
Issue number	10
DOIs	https://doi.org/10.1371/journal.pone.0140167
Publication status	Published - Oct 21 2015
Externally published	Yes

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Do, V. B. D., Tsai, W. C., Lin, Y. J., Higa, S., Yagi, N., Chang, S. L., Lo, L. W., Chung, F. P., Liao, J. N., Huang, Y. C., Chan, C. S., Huang, H. K., Hu, Y. F., Tsao, H. M., & Chen, S. A. (2015). The different substrate characteristics of arrhythmogenic triggers in idiopathic right ventricular outflow tract tachycardia and arrhythmogenic right ventricular dysplasia: New insight from noncontact mapping. PLoS ONE, 10(10), Article e0140167. https://doi.org/10.1371/journal.pone.0140167

The different substrate characteristics of arrhythmogenic triggers in idiopathic right ventricular outflow tract tachycardia and arrhythmogenic right ventricular dysplasia: New insight from noncontact mapping. / Do, Van Buu Dan; Tsai, Wen Chin; Lin, Yenn Jiang et al.
In: PLoS ONE, Vol. 10, No. 10, e0140167, 21.10.2015.

Research output: Contribution to journal › Article › peer-review

Do, VBD, Tsai, WC, Lin, YJ, Higa, S, Yagi, N, Chang, SL, Lo, LW, Chung, FP, Liao, JN, Huang, YC, Chan, CS, Huang, HK, Hu, YF, Tsao, HM & Chen, SA 2015, 'The different substrate characteristics of arrhythmogenic triggers in idiopathic right ventricular outflow tract tachycardia and arrhythmogenic right ventricular dysplasia: New insight from noncontact mapping', PLoS ONE, vol. 10, no. 10, e0140167. https://doi.org/10.1371/journal.pone.0140167

@article{ef677994133840418b33ed860e2b5bcd,

title = "The different substrate characteristics of arrhythmogenic triggers in idiopathic right ventricular outflow tract tachycardia and arrhythmogenic right ventricular dysplasia: New insight from noncontact mapping",

abstract = "Background: The aim of this study was to investigate the different substrate characteristics of repetitive premature ventricular complexed (PVC) trigger sites by the non-contact mapping (NCM). Methods: Thirty-five consecutive patients, including 14 with arrhythmogenic right ventricular cardiomyopathy/dysplasia (ARVC) and 21 with idiopathic right ventricular outflow tract tachycardia (RVOT VT), were enrolled for electrophysiological study and catheter ablation guided by the NCM. Substrate and electrogram (Eg) characteristics of the earliest activation (EA) and breakout (BO) sites of PVCs were investigated, and these were confirmed by successful PVC elimination. Results: Overall 35 dominant focal PVCs were identified. PVCs arose from the focal origins with preferential conduction, breakout, and spread to the whole right ventricle. The conduction time and distance from EA to BO site were both longer in the ARVC than the RVOT group. The conduction velocity was similar between the 2 groups. The negative deflection of local unipolar Eg at the EA site (EA slope3,5,10ms values) was steeper in the RVOT, compared to ARVC patients. The PVCs of ARVC occurred in the diseased substrate in the ARVC patients. More radiofrequency applications were required to eliminate the triggers in ARVC patients. Conclusions/interpretation: The substrate characteristics of PVC trigger may help to differentiate between idiopathic RVOT VT and ARVC. The slowing and slurred QS unipolar electrograms and longer distance from EA to BO in RVOT endocardium suggest that the triggers of ARVC may originate from mid- or sub-epicardial myocardium. More extensive ablation to the trigger site was required in order to create deeper lesions for a successful outcome.",

author = "Do, {Van Buu Dan} and Tsai, {Wen Chin} and Lin, {Yenn Jiang} and Satoshi Higa and Nobumori Yagi and Chang, {Shih Lin} and Lo, {Li Wei} and Chung, {Fa Po} and Liao, {Jo Nan} and Huang, {Yen Chang} and Chan, {Chao Shun} and Huang, {Hung Kai} and Hu, {Yu Feng} and Tsao, {Hsuan Ming} and Chen, {Shih Ann}",

note = "Funding Information: This work was supported by Ministry of Science and Technology of Taiwan support for the Center for Dynamical Biomarkers and Translational Medicine, National Central University, National Yang-Ming University, and Taipei Veterans General Hospital (MOST 103-2911-I-008-001, 103-2314-B-010-048-MY3, 102-2314-B-010-056-MY2); Grant of Taipei Veterans General Hospital (V103E7-003); Joint foundation of Taipei Veterans General Hospital and National Taiwan University Hospital (VN103-04). Publisher Copyright: {\textcopyright} 2015 Do et al This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.",

year = "2015",

month = oct,

day = "21",

doi = "10.1371/journal.pone.0140167",

language = "English",

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TY - JOUR

T1 - The different substrate characteristics of arrhythmogenic triggers in idiopathic right ventricular outflow tract tachycardia and arrhythmogenic right ventricular dysplasia

T2 - New insight from noncontact mapping

AU - Do, Van Buu Dan

AU - Tsai, Wen Chin

AU - Lin, Yenn Jiang

AU - Higa, Satoshi

AU - Yagi, Nobumori

AU - Chang, Shih Lin

AU - Lo, Li Wei

AU - Chung, Fa Po

AU - Liao, Jo Nan

AU - Huang, Yen Chang

AU - Chan, Chao Shun

AU - Huang, Hung Kai

AU - Hu, Yu Feng

AU - Tsao, Hsuan Ming

AU - Chen, Shih Ann

N1 - Funding Information: This work was supported by Ministry of Science and Technology of Taiwan support for the Center for Dynamical Biomarkers and Translational Medicine, National Central University, National Yang-Ming University, and Taipei Veterans General Hospital (MOST 103-2911-I-008-001, 103-2314-B-010-048-MY3, 102-2314-B-010-056-MY2); Grant of Taipei Veterans General Hospital (V103E7-003); Joint foundation of Taipei Veterans General Hospital and National Taiwan University Hospital (VN103-04). Publisher Copyright: © 2015 Do et al This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

PY - 2015/10/21

Y1 - 2015/10/21

N2 - Background: The aim of this study was to investigate the different substrate characteristics of repetitive premature ventricular complexed (PVC) trigger sites by the non-contact mapping (NCM). Methods: Thirty-five consecutive patients, including 14 with arrhythmogenic right ventricular cardiomyopathy/dysplasia (ARVC) and 21 with idiopathic right ventricular outflow tract tachycardia (RVOT VT), were enrolled for electrophysiological study and catheter ablation guided by the NCM. Substrate and electrogram (Eg) characteristics of the earliest activation (EA) and breakout (BO) sites of PVCs were investigated, and these were confirmed by successful PVC elimination. Results: Overall 35 dominant focal PVCs were identified. PVCs arose from the focal origins with preferential conduction, breakout, and spread to the whole right ventricle. The conduction time and distance from EA to BO site were both longer in the ARVC than the RVOT group. The conduction velocity was similar between the 2 groups. The negative deflection of local unipolar Eg at the EA site (EA slope3,5,10ms values) was steeper in the RVOT, compared to ARVC patients. The PVCs of ARVC occurred in the diseased substrate in the ARVC patients. More radiofrequency applications were required to eliminate the triggers in ARVC patients. Conclusions/interpretation: The substrate characteristics of PVC trigger may help to differentiate between idiopathic RVOT VT and ARVC. The slowing and slurred QS unipolar electrograms and longer distance from EA to BO in RVOT endocardium suggest that the triggers of ARVC may originate from mid- or sub-epicardial myocardium. More extensive ablation to the trigger site was required in order to create deeper lesions for a successful outcome.

AB - Background: The aim of this study was to investigate the different substrate characteristics of repetitive premature ventricular complexed (PVC) trigger sites by the non-contact mapping (NCM). Methods: Thirty-five consecutive patients, including 14 with arrhythmogenic right ventricular cardiomyopathy/dysplasia (ARVC) and 21 with idiopathic right ventricular outflow tract tachycardia (RVOT VT), were enrolled for electrophysiological study and catheter ablation guided by the NCM. Substrate and electrogram (Eg) characteristics of the earliest activation (EA) and breakout (BO) sites of PVCs were investigated, and these were confirmed by successful PVC elimination. Results: Overall 35 dominant focal PVCs were identified. PVCs arose from the focal origins with preferential conduction, breakout, and spread to the whole right ventricle. The conduction time and distance from EA to BO site were both longer in the ARVC than the RVOT group. The conduction velocity was similar between the 2 groups. The negative deflection of local unipolar Eg at the EA site (EA slope3,5,10ms values) was steeper in the RVOT, compared to ARVC patients. The PVCs of ARVC occurred in the diseased substrate in the ARVC patients. More radiofrequency applications were required to eliminate the triggers in ARVC patients. Conclusions/interpretation: The substrate characteristics of PVC trigger may help to differentiate between idiopathic RVOT VT and ARVC. The slowing and slurred QS unipolar electrograms and longer distance from EA to BO in RVOT endocardium suggest that the triggers of ARVC may originate from mid- or sub-epicardial myocardium. More extensive ablation to the trigger site was required in order to create deeper lesions for a successful outcome.

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The different substrate characteristics of arrhythmogenic triggers in idiopathic right ventricular outflow tract tachycardia and arrhythmogenic right ventricular dysplasia: New insight from noncontact mapping

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