Model of reentrant ventricular tachycardia based on infarct border zone geometry predicts reentrant circuit features as determined by activation mapping

TY - JOUR

T1 - Model of reentrant ventricular tachycardia based on infarct border zone geometry predicts reentrant circuit features as determined by activation mapping

AU - Ciaccio, Edward J.

AU - Ashikaga, Hiroshi

AU - Kaba, Riyaz A.

AU - Cervantes, Daniel

AU - Hopenfeld, Bruce

AU - Wit, Andrew L.

AU - Peters, Nicholas S.

AU - McVeigh, Elliot R.

AU - Garan, Hasan

AU - Coromilas, James

N1 - Funding Information: This study was supported by an Established Investigator Award no. 9940237N from the American Heart Association and a Whitaker Foundation Research Award (to EJC), National Institutes of Health-National Heart, Lung and Blood Institute (NIH-NHLBI) Intramural grant no. Z01-HL4004609 (to ERM), NIH-NHLBI Program Project grant no. HL30557 (to ALW), and British Heart Foundation grant no. RG/05/009 (to NSP).

PY - 2007/8

Y1 - 2007/8

N2 - Background: Infarct border zone (IBZ) geometry likely affects inducibility and characteristics of postinfarction reentrant ventricular tachycardia, but the connection has not been established. Objective: The purpose of this study was to determine characteristics of postinfarction ventricular tachycardia in the IBZ. Methods: A geometric model describing the relationship between IBZ geometry and wavefront propagation in reentrant circuits was developed. Based on the formulation, slow conduction and block were expected to coincide with areas where IBZ thickness (T) is minimal and the local spatial gradient in thickness (ΔT) is maximal, so that the degree of wavefront curvature ρ ∝ ΔT/T is maximal. Regions of fastest conduction velocity were predicted to coincide with areas of minimum ΔT. In seven arrhythmogenic postinfarction canine heart experiments, tachycardia was induced by programmed stimulation, and activation maps were constructed from multichannel recordings. IBZ thickness was measured in excised hearts from histologic analysis or magnetic resonance imaging. Reentrant circuit properties were predicted from IBZ geometry and compared with ventricular activation maps after tachycardia induction. Results: Mean IBZ thickness was 231 ± 140 μm at the reentry isthmus and 1440 ± 770 μm in the outer pathway (P <0.001). Mean curvature ρ was 1.63 ± 0.45 mm-1 at functional block line locations, 0.71 ± 0.18 mm-1 at isthmus entrance-exit points, and 0.33 ± 0.13 mm-1 in the outer reentrant circuit pathway. The mean conduction velocity about the circuit during reentrant tachycardia was 0.32 ± 0.04 mm/ms at entrance-exit points, 0.42 ± 0.13 mm/ms for the entire outer pathway, and 0.64 ± 0.16 mm/ms at outer pathway regions with minimum ΔT. Model sensitivity and specificity to detect isthmus location was 75.0% and 97.2%. Conclusions: Reentrant circuit features as determined by activation mapping can be predicted on the basis of IBZ geometrical relationships.

AB - Background: Infarct border zone (IBZ) geometry likely affects inducibility and characteristics of postinfarction reentrant ventricular tachycardia, but the connection has not been established. Objective: The purpose of this study was to determine characteristics of postinfarction ventricular tachycardia in the IBZ. Methods: A geometric model describing the relationship between IBZ geometry and wavefront propagation in reentrant circuits was developed. Based on the formulation, slow conduction and block were expected to coincide with areas where IBZ thickness (T) is minimal and the local spatial gradient in thickness (ΔT) is maximal, so that the degree of wavefront curvature ρ ∝ ΔT/T is maximal. Regions of fastest conduction velocity were predicted to coincide with areas of minimum ΔT. In seven arrhythmogenic postinfarction canine heart experiments, tachycardia was induced by programmed stimulation, and activation maps were constructed from multichannel recordings. IBZ thickness was measured in excised hearts from histologic analysis or magnetic resonance imaging. Reentrant circuit properties were predicted from IBZ geometry and compared with ventricular activation maps after tachycardia induction. Results: Mean IBZ thickness was 231 ± 140 μm at the reentry isthmus and 1440 ± 770 μm in the outer pathway (P <0.001). Mean curvature ρ was 1.63 ± 0.45 mm-1 at functional block line locations, 0.71 ± 0.18 mm-1 at isthmus entrance-exit points, and 0.33 ± 0.13 mm-1 in the outer reentrant circuit pathway. The mean conduction velocity about the circuit during reentrant tachycardia was 0.32 ± 0.04 mm/ms at entrance-exit points, 0.42 ± 0.13 mm/ms for the entire outer pathway, and 0.64 ± 0.16 mm/ms at outer pathway regions with minimum ΔT. Model sensitivity and specificity to detect isthmus location was 75.0% and 97.2%. Conclusions: Reentrant circuit features as determined by activation mapping can be predicted on the basis of IBZ geometrical relationships.

KW - Arrhythmia

KW - Border zone

KW - Conduction velocity

KW - Infarction

KW - MRI

KW - Mapping

KW - Propagation

KW - Ventricular tachycardia

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U2 - https://doi.org/10.1016/j.hrthm.2007.04.015

DO - https://doi.org/10.1016/j.hrthm.2007.04.015

M3 - Article

C2 - 17675078

SN - 1547-5271

VL - 4

SP - 1034

EP - 1045

JO - Heart Rhythm

JF - Heart Rhythm

IS - 8

ER -