The derivative of tissue activation as a marker of arrhythmogenic myocardium

Taro Temma; Robert L Lux; Koji Yoshie; Justin Hayase; Jason S Bradfield; Kalyanam Shivkumar; Olujimi A Ajijola

doi:10.1016/j.hrthm.2022.10.013

The derivative of tissue activation as a marker of arrhythmogenic myocardium

Heart Rhythm. 2023 Feb;20(2):261-271. doi: 10.1016/j.hrthm.2022.10.013. Epub 2022 Oct 18.

Authors

Taro Temma¹, Robert L Lux², Koji Yoshie³, Justin Hayase¹, Jason S Bradfield¹, Kalyanam Shivkumar¹, Olujimi A Ajijola⁴

Affiliations

¹ UCLA Cardiac Arrhythmia Center, UCLA Neurocardiology Research Program of Excellence, University of California, Los Angeles, California.
² Cardiovascular Research and Training Institute, University of Utah, Salt Lake, Utah.
³ UCLA Cardiac Arrhythmia Center, UCLA Neurocardiology Research Program of Excellence, University of California, Los Angeles, California; Department of Cardiovascular Medicine, Shinshu University School of Medicine, Matsumoto, Nagano, Japan.
⁴ UCLA Cardiac Arrhythmia Center, UCLA Neurocardiology Research Program of Excellence, University of California, Los Angeles, California. Electronic address: oajijola@mednet.ucla.edu.

PMID: 36270579
DOI: 10.1016/j.hrthm.2022.10.013

Abstract

Background: Mapping techniques to identify diseased myocardial substrate during ventricular tachycardia ablation procedures remain limited.

Objective: We hypothesized that tissue derivative of the voltage with respect to time (dV/dt), the slope of the unipolar ventricular electrogram registered by local ventricular activation, represents a unique parameter for identifying potential arrhythmogenic tissue in the ischemic scar border zone.

Methods: Using high-resolution electrical mapping, we examined dV/dt characteristics in the border zone of animals after chronic myocardial infarction (MI).

Results: Minimum dV/dt (dV/dt_min) in MI animals was less than that in control animals (-344.7 ± 68.7 in controls vs -174.2 ± 104.5 in MI; P < .001) and related to ventricular fibrosis. In MI animals, dV/dt_min values were divided into high (≤-200 μV/ms) and low (>-200 μV/ms) dV/dt_min. Low dV/dt_min regions harbored arrhythmogenic substrates that were characterized by (1) high responsiveness to sympathetic stimulation, (2) presence of late potentials, and (3) lower unipolar and bipolar voltage amplitudes.

Conclusion: Our data indicate that dV/dt_min is a unique parameter for identifying arrhythmogenic myocardium and may add a useful metric to conventional mapping strategies.

Keywords: Arrhythmogenic myocardium; Ischemic scar border zone; Local activation; Myocardial infarct; Unipolar ventricular electrogram; VT ablation; Ventricular tachycardia; dV/dt.

Publication types

Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov't

MeSH terms

Arrhythmias, Cardiac
Catheter Ablation* / methods
Heart Ventricles
Humans
Myocardial Infarction*
Myocardium
Tachycardia, Ventricular* / diagnosis
Tachycardia, Ventricular* / etiology
Tachycardia, Ventricular* / surgery

Grants and funding

DP2 HL142045/HL/NHLBI NIH HHS/United States