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.
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.