Cited 2 times since 2018 (0.4 per year) source: EuropePMC JACC. Clinical electrophysiology, Volume 4, Issue 10, 29 5 2018, Pages 1308-1318 Noninvasive Identification of Ventricular Tachycardia-Related Anatomical Isthmuses in Repaired Tetralogy of Fallot: What Is the Role of the 12-Lead Ventricular Tachycardia Electrocardiogram. Brouwer C, Kapel GFL, Jongbloed MRM, Schalij MJ, de Riva Silva M, Zeppenfeld K
Objectives
This study sought to evaluate the relation between 12-lead ventricular tachycardia (VT) electrocardiography (ECG) and VT-related anatomical isthmuses (AIs) in repaired tetralogy of Fallot (rTOF).
Background
Slow-conducting AIs are the dominant VT substrate in rTOF. Whether an AI is considered critical relies on pace mapping (PM) guided by the VT ECG.
Methods
VT ECGs, electroanatomical mapping data and PM results were analyzed in 25 rTOF patients (group 1) (age 57 ± 13 years). Selection of PM and ablation sites was guided by VT ECG. In 7 patients (group 2) (age 33 ± 14 years), PM was systematically performed within all AIs, irrespective of the VT ECG.
Results
In group 1, all 35 induced VTs (median VT cycle length 270 [interquartile range: 240 to 310] ms) were AI related. All 11 right bundle branch block (RBBB) VTs were related to AI3 (right ventricular septum if positive concordant [7 of 7]), coronary cusp if V2 transition break [3 of 4]). Left bundle branch block (LBBB) VTs with transition In rTOF with only AI1 and AI3, RBBB VTs are due to clockwise and LBBB VTs to counterclockwise activation of AI3. Involvement of both AIs in the VT circuit limits the role of the 12-lead VT ECG and PM. AI3 can always be targeted irrespective of the 12-lead VT ECG.Conclusions
