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• W4377016119 abstract "Delay between ventricular pacing stimulus and QRS onset (S-QRS delay), often seen in regions of myocardial fibrosis, suggests conduction along a protected channel which often represents substrate for re-entrant arrhythmias. 1. To analyze the relationship between pacing stimulus site and myocardial exit site in regions with stimulus-QRS delay and imaging-defined myocardial fibrosis undergoing VT ablation and 2. To consider conduction time between these two locations. Six patients with structural heart disease who underwent VT catheter ablation with pre-procedural cardiac CT image processing (InHeart Models (Pessac, France)) and evidence of late-iodine enhancement were included. CT images were registered with electroanatomic mapping. At pacing sites with S-QRS delay >40 msec, catheter location was compared to the exit site, predicted using a previously validated algorithm (RAPID-VT). Imputed conduction velocity (CV) between stimulus site and exit site was calculated (stim-QRS time/Euclidian distance). Stimulus to QRS delay in regions of imaging derived fibrosis ranged 40 to 291.4 ms; At 9 pacing sites, multiple QRS morphologies were generated. Imputed CV was reduced in dense scar and borderzone compared to values seen in healthy myocardium and varied between 0.16 and 0.65 m/s. These results may under-estimate true tissue CV given complex routes between pacing and exit sites. In the same region, following delivery of RF, mean imputed CV was reduced, raising the possibility that conduction was altered, potentially diverted along a different path (0.21m/s vs 0.14m/s, p=0.024). Myocardial fibrosis defined on CT may be associated with slowed conduction through protected channels. Delivery of RF increases conduction time and results in different exit sites following pacing, indicating multiple and likely complex routes of conduction in regions of imaging-defined fibrosis. Visualization of predicted exit sites in real time could help focus RF to interrupt these conduction paths.Tabled 1Patient #Stim to QRS onset (ms)Imputed conduction velocity (m/s)166.8±15.20.18±0.09241.0±1.50.65±0.08351.0±9.10.30±0.10460.6±11.50.20±0.105103.7±0.160.16±0.10674.3±13.60.19±0.02 Open table in a new tab" @default.
• W4377016119 created "2023-05-19" @default.
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• W4377016119 date "2023-05-01" @default.
• W4377016119 modified "2023-09-26" @default.
• W4377016119 title "PO-04-200 ANALYSIS OF RELATIONSHIP BETWEEN PACING SITE AND EXIT SITE IN REGIONS WITH STIMULUS-QRS DELAY AND IMAGING DEFINED MYOCARDIAL FIBROSIS" @default.
• W4377016119 doi "https://doi.org/10.1016/j.hrthm.2023.03.1216" @default.
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