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The heterogeneous composition of post-infarct ventricular scar is a critical factor compared to local myocardial volume in influencing the accuracy of electroanatomical voltage mapping
Abstract
S251
.. Results: EGM amplitude of scar borders comprised of 50% .. .. viable myocardium were -4.2±0.3mv (PNV) and 6.8± 0.5mv .. The heterogeneous composition of .. (PPV). The presence of adipose tissue (r PPV=-0.601, r PNV=.. post-infarct ventricular scar is a critical .. 0.561) had greater correlation (r), and reliability (Figure: AUC) .. factor compared to local myocardial volume .. than collagen (r PPV=-0.48, r PNV=-0.42), (all p<0.001) in .. influencing EGM amplitude. Attenuation of EGMs were prein influencing the accuracy of .. electroanatomical voltage mapping .. dominantly influenced by the adipose:collagen ratio than .. .. proportion of viable myocardium (Figure). 1,∗ 1 1 R. Samanta , W. Chik , T. Barry , S. Al .. 1 1 1 1,2 Conclusion: Accurate definition of scar borders and chan.. Raisi , M. Farraha , J. Lu , P. Kovoor , A. .. nels within healed MI by electroanatomical voltage mapping 1,2,3 1,2 . Thiagalingam , E. Kizana , J. .. .. may be compromised by variation in collagen and adipose Pouliopoulos 1,2,3 .. composition. .. 1 Westmead Hospital, Department of Cardiology, .. .. Westmead, NSW, Australia .. http://dx.doi.org/10.1016/j.hlc.2015.06.330 .. 2 The University of Sydney, Sydney, NSW, .. .. 330 Australia .. 3 Westmead Millenium Institute, Westmead, .. .. The role of permanent pacemaker therapy NSW, Australia .. .. in vasovagal syncope: a systematic review .. Background: Electrogram (EGM) amplitude is commonly ... A. Khan ∗ , A. Ashraf . used as a tool to identify scar borders during electrophys- ... Cardiovascular department, John Hunter iological mapping and ablation of ventricular tachycardia. ... .. Hospital, Newcastle, NSW, Australia Previously the presence of intramyocardial adipose has been .. . associated with altered ventricular electrophysiology and .. . Introduction: Vasovagal syncope may have a predominant increased ventricular tachycardia propensity. We aimed to ... . identify whether scar composition is a significant factor in the ... cardioinhibitory, vasodepressor or a mixed response with sigaccuracy of electroanatomical voltage mapping post myocar- ... nificant psychosocial and/or physical morbidity. .. Methods: We did a literature review and looked at all the dial infarction (MI). .. randomised trials involving permanent pacing in vasovagal . . Methods: Left ventricular (LV) plunge-needle and catheter . . mapping was performed in sheep with healed MI (n=15). ... syncope. .. Results: There are multiple randomised trials published on .. .. the role of permanent pacing in VVS. .. .. .. Trial Name Year Study Design PM System N FU(months) PM Effect Recurrent Syncope P Value . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .... . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. VPS 1999 PM vs. Standard of care DDD-RDR 54 16 Yes 22% vs 70% 0.00002 .. .. . VASIS 2000 PM vs Standard of care DDI-RH 42 44 Yes 5% vs 61% 0.0006 .. .. . SYDIT 2001 PM vs atenolol DDD-RDR 93 17.3 Yes 4.3% vs 25.5% 0.004 .. .. . VPS 2 2003 PM-on vs PM-off DDD-RDR 100 6 No 31% vs 40% 0.16 .. .. . SYNPACE 2004 PM-on vs PM-off DDD-RDR 29 23.8 No 50% vs 38% 0.38 .. .. . ISSUE 3 2012 PM-on vs PM-off DDD-RDR 77 24 Yes 25% vs 57% 0.039 ... .. . PM=Pacemaker, FU=Follow-up, RDR=Rate-drop response, RH =Rate hysteresis. . .. .. .. Conclusion: Though permanent pacing is beneficial in Histological quantity of viable myocardium, intramyocar- ... . patients with vasovagal syncope but there is a residual risk of dial adipose tissue and collagen, was co-registered with .. .. syncope that speaks to the inability of pacing to overcome the electroanatomical maps of EGM amplitude (PNV and PPV) .. .. vasodepressor component of the reflex, universally present to recorded from each needle site. .. .. some degree. The ISSUE-3 study led to reappraisal of pacing .. .. therapy (using DDD pacing with rate-drop response algo.. rithm) for reducing syncope recurrence in a highly selected .. .. patient group (age>40 years) with asystolic VVS. However, .. .. the role of pacemaker in the treatment for younger VVS .. .. patients (age < 40 years) remains to be established. .. .. .. http://dx.doi.org/10.1016/j.hlc.2015.06.331 .. .. .. .. .. .. .. .. . 329
S251
.. Results: EGM amplitude of scar borders comprised of 50% .. .. viable myocardium were -4.2±0.3mv (PNV) and 6.8± 0.5mv .. The heterogeneous composition of .. (PPV). The presence of adipose tissue (r PPV=-0.601, r PNV=.. post-infarct ventricular scar is a critical .. 0.561) had greater correlation (r), and reliability (Figure: AUC) .. factor compared to local myocardial volume .. than collagen (r PPV=-0.48, r PNV=-0.42), (all p<0.001) in .. influencing EGM amplitude. Attenuation of EGMs were prein influencing the accuracy of .. electroanatomical voltage mapping .. dominantly influenced by the adipose:collagen ratio than .. .. proportion of viable myocardium (Figure). 1,∗ 1 1 R. Samanta , W. Chik , T. Barry , S. Al .. 1 1 1 1,2 Conclusion: Accurate definition of scar borders and chan.. Raisi , M. Farraha , J. Lu , P. Kovoor , A. .. nels within healed MI by electroanatomical voltage mapping 1,2,3 1,2 . Thiagalingam , E. Kizana , J. .. .. may be compromised by variation in collagen and adipose Pouliopoulos 1,2,3 .. composition. .. 1 Westmead Hospital, Department of Cardiology, .. .. Westmead, NSW, Australia .. http://dx.doi.org/10.1016/j.hlc.2015.06.330 .. 2 The University of Sydney, Sydney, NSW, .. .. 330 Australia .. 3 Westmead Millenium Institute, Westmead, .. .. The role of permanent pacemaker therapy NSW, Australia .. .. in vasovagal syncope: a systematic review .. Background: Electrogram (EGM) amplitude is commonly ... A. Khan ∗ , A. Ashraf . used as a tool to identify scar borders during electrophys- ... Cardiovascular department, John Hunter iological mapping and ablation of ventricular tachycardia. ... .. Hospital, Newcastle, NSW, Australia Previously the presence of intramyocardial adipose has been .. . associated with altered ventricular electrophysiology and .. . Introduction: Vasovagal syncope may have a predominant increased ventricular tachycardia propensity. We aimed to ... . identify whether scar composition is a significant factor in the ... cardioinhibitory, vasodepressor or a mixed response with sigaccuracy of electroanatomical voltage mapping post myocar- ... nificant psychosocial and/or physical morbidity. .. Methods: We did a literature review and looked at all the dial infarction (MI). .. randomised trials involving permanent pacing in vasovagal . . Methods: Left ventricular (LV) plunge-needle and catheter . . mapping was performed in sheep with healed MI (n=15). ... syncope. .. Results: There are multiple randomised trials published on .. .. the role of permanent pacing in VVS. .. .. .. Trial Name Year Study Design PM System N FU(months) PM Effect Recurrent Syncope P Value . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .... . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. VPS 1999 PM vs. Standard of care DDD-RDR 54 16 Yes 22% vs 70% 0.00002 .. .. . VASIS 2000 PM vs Standard of care DDI-RH 42 44 Yes 5% vs 61% 0.0006 .. .. . SYDIT 2001 PM vs atenolol DDD-RDR 93 17.3 Yes 4.3% vs 25.5% 0.004 .. .. . VPS 2 2003 PM-on vs PM-off DDD-RDR 100 6 No 31% vs 40% 0.16 .. .. . SYNPACE 2004 PM-on vs PM-off DDD-RDR 29 23.8 No 50% vs 38% 0.38 .. .. . ISSUE 3 2012 PM-on vs PM-off DDD-RDR 77 24 Yes 25% vs 57% 0.039 ... .. . PM=Pacemaker, FU=Follow-up, RDR=Rate-drop response, RH =Rate hysteresis. . .. .. .. Conclusion: Though permanent pacing is beneficial in Histological quantity of viable myocardium, intramyocar- ... . patients with vasovagal syncope but there is a residual risk of dial adipose tissue and collagen, was co-registered with .. .. syncope that speaks to the inability of pacing to overcome the electroanatomical maps of EGM amplitude (PNV and PPV) .. .. vasodepressor component of the reflex, universally present to recorded from each needle site. .. .. some degree. The ISSUE-3 study led to reappraisal of pacing .. .. therapy (using DDD pacing with rate-drop response algo.. rithm) for reducing syncope recurrence in a highly selected .. .. patient group (age>40 years) with asystolic VVS. However, .. .. the role of pacemaker in the treatment for younger VVS .. .. patients (age < 40 years) remains to be established. .. .. .. http://dx.doi.org/10.1016/j.hlc.2015.06.331 .. .. .. .. .. .. .. .. . 329