QTc dispersion as a novel marker in identifying patients requiring an epicardial approach for ablation of scar mediated ventricular tachycardia

Darshan Krishnappa, Baris Akdemir, Teerapat Nantsupawat, Balaji Krishnan, Ilknur Can, Selcuk Adabag, Jian Ming Li, Venkatakrishna N. Tholakanahalli

Research output: Contribution to journalArticlepeer-review

Abstract

Introduction: Epicardial exit sites of ventricular tachycardia (VT) are frequently encountered during VT ablation requiring an epicardial ablation approach for successful elimination of VT. We sought to assess the utility of repolarization markers in identifying individuals requiring an epicardial ablation approach in addition to an endocardial approach. Methods: 32 patients who underwent successful ablation for scar mediated VT were included in the study. Fourteen patients who required a combined endocardial and epicardial VT ablation were defined as epicardial VT group (Epi) whereas 18 patients who were successfully ablated from the endocardium alone constituted the endocardial VT group (Endo). Repolarization markers during sinus rhythm were compared between the two groups. Results: A higher QTc max and QTc dispersion were seen in the Epi group compared to Endo group (479 ± 34 vs 449 ± 20, p = 0.008 and 63 ± 13 vs 38 ± 8, p = 0.001, respectively). Ts-p and Ts-p/Tp-e were higher in the Epi group (166 ± 23 vs 143 ± 23, p = 0.008 and 1.55 ± 0.26 vs 1.3 ± 0.21, p < 0.005). On multivariate regression, QTc dispersion was an independent predictor of the need for an epicardial approach to ablation. A QTc dispersion more than 51.5 msec identified individuals requiring a combined epicardial and endocardial approach to ablation with a sensitivity of 92.9% and a specificity of 100%. Conclusions: Patients requiring an epicardial ablation have a higher QTc dispersion. A value greater than 51.5 msec reliably differentiates between the two groups with high sensitivity and specificity.

Original languageEnglish (US)
Pages (from-to)141-146
Number of pages6
JournalIndian Pacing and Electrophysiology Journal
Volume20
Issue number4
DOIs
StatePublished - Jul 1 2020

Keywords

  • Epicardial
  • QTc dispersion
  • Ventricular tachycardia

PubMed: MeSH publication types

  • Journal Article

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