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Relationship of slow conduction detected by pace-mapping to ventricular tachycardia re-entry circuit sites after infarction

Corinna B. Brunckhorst, MD^*, William G. Stevenson, MD^,*, Kyoko Soejima, MD, William H. Maisel, MD, MPH, Etienne Delacretaz, MD, Peter L. Friedman, MD, PhD and Shlomo A. Ben-Haim, MD, DSc

^* University of Zurich, Zurich, Switzerland
Brigham and Women’s Hospital, Boston, Massachusetts, USA
Swiss Cardiovascular Center, University Hospital, Bern, Switzerland
Technion-Israel Institute of Technology, Haifa, Israel

View larger version (28K): [in a new window]   Figure 1 The 12-lead electrocardiogram of ventricular tachycardia (VT) (left panel), pace-mapping at site 5 (inferoseptal left ventricle) (middle panel), and pace-mapping at site 6-8 (basal lateral left ventricle [LV]) (right panel) in Patient 3 are shown. The pace-map at site 5 is a much closer match of VT with stimulus to QRS interval (S-QRS) <40 ms (no conduction delay) than the pace-map at site 6-8, which does not resemble VT but has a S-QRS delay of 65 ms. Entrainment mapping indicated that site 5 was an outer loop site and site 6-8 was an isthmus site in the re-entry circuit. Patient 3 in Figure 2 shows the S-QRS map and voltage map of this patient.

View larger version (81K): [in a new window]   Figure 2 Electroanatomic maps for all 12 patients are shown. For each patient, the left image (a or c) is the stimulus to QRS interval (S-QRS) map, with S-QRS <40 ms color-coded as red and S-QRS >80 ms shown as purple. The right hand image (b or d) shows the voltage map for each patient in the same projection as the S-QRS map. Voltage <1 mV is color-coded in red and voltage >3 mV is color-coded purple. The 14 target regions are indicated by white circles. Patient 12 had two target regions and maps are shown in two different views (a and c are S-QRS maps; b and d are voltage maps). An area of S-QRS delay overlaps each of the target areas with the exception of Patient 4. Projections were selected to show the target areas: AP tilt = anterior tilted upward; LAO = left anterior oblique; PA = posterior; RL tilt = right lateral tilted rightward; RPO = right posterior oblique. Each background square represents 2 cm2.

View larger version (39K): [in a new window]   Figure 3 Plots for each of the 14 targets in the 12 patients (abscissa) showing the distance to the center of the target for all pace-mapping sites (y-axis). Sites are coded according to stimulus to QRS interval (S-QRS) during pace-mapping as <40 ms (open circles), 40 to 80 ms (gray circles), and >80 ms (black circles).