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

EGM1 EGM2 EGM3
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.
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.
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.