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An activation-repolarization time metric to predict localized regions of high susceptibility to reentry

Child, N; Bishop, MJ; Hanson, B; Coronel, R; Opthof, T; Boukens, BJ; Walton, RD; ... Taggart, P; + view all (2015) An activation-repolarization time metric to predict localized regions of high susceptibility to reentry. Heart Rhythm , 12 (7) pp. 1644-1653. 10.1016/j.hrthm.2015.04.013. Green open access

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Abstract

BACKGROUND Initiation of reentrant ventricular tachycardia (VT)involves complex interactions between front and tail of the activation wave. Recent experimental work has identified the time interval between S2 repolarization proximal to a line of functional block and S2 activation at the adjacent distal side as a critical determinant of reentry. OBJECTIVES We hypothesized that (1) an algorithm could be developed to generate a spatial map of this interval (“reentry vulnerability index” [RVI]), (2) this would accurately identify a site of reentry without the need to actually induce the arrhythmia, and (3) it would be possible to generate an RVI map in patients during routine clinical procedures. METHODS An algorithm was developed that calculated RVI between all pairs of electrodes within a given radius. RESULTS The algorithm successfully identified the region with increased susceptibility to reentry in an established Langendorff pig heart model and the site of reentry and rotor formation in an optically mapped sheep ventricular preparation and computational simulations. The feasibility of RVI mapping was evaluated during a clinical procedure by coregistering with cardiac anatomy and physiology of a patient undergoing VT ablation. CONCLUSION We developed an algorithm to calculate a reentry vulnerability index from intervals between local repolarization and activation. The algorithm accurately identified the region of reentry in 2 animal models of functional reentry. The clinical application was demonstrated in a patient with VT and identified the area of reentry without the need of inducing the arrhythmia.

Type: Article
Title: An activation-repolarization time metric to predict localized regions of high susceptibility to reentry
Open access status: An open access version is available from UCL Discovery
DOI: 10.1016/j.hrthm.2015.04.013
Publisher version: http://dx.doi.org/10.1016/j.hrthm.2015.04.013
Language: English
Additional information: Copyright © 2015. This manuscript version is published under a Creative Commons Attribution Non-commercial Non-derivative 4.0 International licence (CC BY-NC-ND 4.0). This licence allows you to share, copy, distribute and transmit the work for personal and non-commercial use providing author and publisher attribution is clearly stated. Further details about CC BY licences are available at http://creativecommons.org/licenses/by/4.0. Access may be initially restricted by the publisher.
Keywords: Arrhythmia; ventricular tachycardia; ablation
UCL classification: UCL > Provost and Vice Provost Offices
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Pop Health Sciences > Institute of Cardiovascular Science
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Pop Health Sciences > Institute of Cardiovascular Science > Clinical Science
UCL > Provost and Vice Provost Offices > UCL BEAMS
UCL > Provost and Vice Provost Offices > UCL BEAMS > Faculty of Engineering Science
UCL > Provost and Vice Provost Offices > UCL BEAMS > Faculty of Engineering Science > Dept of Mechanical Engineering
URI: http://discovery.ucl.ac.uk/id/eprint/1466311
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