Interpretation of Local Potential during Sinus Rhythm, Pacing, and Tachycardia in Diagnosis and Treatment of Tachyarrhythmia
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概要
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Recent advances in 3-D mapping that visualizes the activation pattern of the tachycardia makes us easily understand whether the mechanism is focal or macroreentrant tachycardia. For successful ablation, however, the interpretation of the local electrogram is quite important. For supraventricula tachycardia, identification of local potential specific to respecting tachycardia, such as slow potential for AV nodal reentry or Kent potential for WPW syndrome, is fundamental. For tachycardias of focal mechanism, not only the timing (i.e. early or late), but the morphology of unipolar electrogram is important. In ablation of tachyarrhythmias using 3-D mapping system, interpretation of local electrogram is also important especially when it shows complex pattern such as fractionation or splitting, to construct correct activation map and to identify effective ablation sites. For ablation of ventricular tachycardia in structural heart disease, the substrate for VT such as slow conduction zone is often indicated by delayed potential during sinus rhythm. In ablation of verapamil-sensitive idiopathic left ventricular tachycardia, identification of purkinje potential is necessary. Even in arrhythmias in which ablation is mainly done by anatomical approach such as PV isolation, local electrogram important to know the contact to the tissue and effect of RF application. This lecture focus on the interpretation of local electrogram that plays key roles in successful ablation of various tachyarrhythmias.
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