The use of a novel signal analysis to identify the origin of idiopathic right ventricular outflow tract ventricular tachycardia during sinus rhythm: Simultaneous amplitude frequency electrogram transformation mapping

Abigail Louise D. Te, Satoshi Higa, Fa Po Chung, Chin Yu Lin, Men Tzung Lo, Che An Liu, Chen Lin, Yi Chung Chang, Shih Lin Chang, Li Wei Lo, Yu Feng Hu, Ta Chuan Tuan, Tze Fan Chao, Jonan Liao, Yao Ting Chang, Chung-Hsing Lin, Yuan Hung, Shinya Yamada, Kuo Li Pan, Yenn Jiang LinShih Ann Chen

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Abstract

Introduction The signal characteristics of intracardiac bipolar electrograms at the origin of idiopathic RVOT-VT during sinus rhythm remain unclear. Objective The study sought to develop a novel real-time/online technique, simultaneous amplitude frequency electrogram transformation (SAFE-T), to quantify and localize the diseased ventricular substrate in idiopathic RVOT-VT. Methods We retrospectively investigated the intracardiac bipolar recordings in 70 consecutive patients (26% male, mean age 42±12 years) who underwent successful radiofrequency catheter ablation of idiopathic RVOT-VT. We quantified the extent of the frequency fraction of ventricular potentials during sinus rhythm or ventricular pacing using a novel formula, the product of instantaneous amplitude and frequency, and showed that in a 3D geometry as an online SAFE-T map. Results The characteristics of the HHT spectra of electrograms derived from VT origins demonstrated high frequency components (>70 Hz), which were independent of the rhythm. The density of the abnormal potentials at the VT origins were higher (VT origins, 7.5±2.3 sites/cm2 vs. surrounding myocardium, 1.5±1.3 sites/cm2, p<0.001), and were significantly decreased after ablation (0.7±0.6 sites/cm2, p<0.001). A small region of abnormal potentials were observed in the VT origins (mean area of 1.5±0.8 cm2). The SAFE-T maps predicted the VT origins with 92% sensitivity, 78% specificity with optimal cut-off value of >3.0 Hz·mV. Conclusion The online SAFE-T map was feasible for quantifying the diseased ventricular substrate, irrespective of the rhythm of activation, and can be used to identify the optimal ablation targets for idiopathic RVOT-VT. We found a limited region of abnormal potentials where the RVOTVT origins were successfully ablated.

Original languageEnglish
Article numbere0173189
JournalPLoS One
Volume12
Issue number3
DOIs
Publication statusPublished - Mar 1 2017
Externally publishedYes

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ASJC Scopus subject areas

  • Biochemistry, Genetics and Molecular Biology(all)
  • Agricultural and Biological Sciences(all)

Cite this

Te, A. L. D., Higa, S., Chung, F. P., Lin, C. Y., Lo, M. T., Liu, C. A., Lin, C., Chang, Y. C., Chang, S. L., Lo, L. W., Hu, Y. F., Tuan, T. C., Chao, T. F., Liao, J., Chang, Y. T., Lin, C-H., Hung, Y., Yamada, S., Pan, K. L., ... Chen, S. A. (2017). The use of a novel signal analysis to identify the origin of idiopathic right ventricular outflow tract ventricular tachycardia during sinus rhythm: Simultaneous amplitude frequency electrogram transformation mapping. PLoS One, 12(3), [e0173189]. https://doi.org/10.1371/journal.pone.0173189