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CLINICAL RESEARCH: ELECTROPHYSIOLOGIC DISORDERS

Recognition of far-field electrograms during entrainment mapping of ventricular tachycardia

^a Cardiovascular Division, Department of Internal Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, USA

Manuscript received December 15, 2002; revised manuscript received February 8, 2003, accepted February 25, 2003.

^* Reprint requests and correspondence: Dr. William G. Stevenson, Cardiovascular Division, Brigham and Women’s Hospital, Harvard Medical School, 75 Francis Street, Boston, Massachusetts 02115, USA.
wstevenson{at}partners.org

OBJECTIVES: The goal of this study was to assess entrainment for distinguishing far-field potentials (FFP) due to depolarization of tissue at a distance from the mapping catheter from the local potential (LP) due to depolarization of tissue at the catheter electrode during mapping of ventricular tachycardia (VT).

BACKGROUND: Electrograms with multiple peaks commonly complicate mapping and identification of catheter ablation targets in infarcts.

METHODS: Retrospective analysis of catheter mapping data from eight patients with prior infarction was performed to evaluate multipotential electrograms at sites where pacing entrained VT. Potentials that were visible and not altered during pacing were defined as FFP. Potentials obscured by the pacing stimulus were designated possible LPs. The criteria for FFP were then assessed in a second cohort of five patients.

RESULTS: At 32 of 39 (82%) sites with multiple potentials, entrainment identified one of the potentials as an FFP. Radiofrequency ablation, assessed at 15 sites, reduced the amplitude of LPs by 62%, without significant effect on FFP amplitude. At 56% of sites with multiple potentials, measuring the postpacing interval to an FFP would lead to erroneous classification of the site location relative to the reentry circuit. In prospective evaluation, double potentials were identified at 77 sites in infarcts; entrainment demonstrated an FFP at 66 (86%) sites.

CONCLUSIONS: Far-field potentials are common during mapping in infarcts. Many can be distinguished from local potentials by entrainment, improving the accuracy of mapping.

Abbreviations and Acronyms   FFP   far-field potential   FPPI   false post-pacing interval   LP   local potential   PPI   post-pacing interval   RF   radiofrequency   TCL   tachycardia cycle length   TPPI   true post-pacing interval   VT   ventricular tachycardia

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