Electrophysiologic Characterization of the Arrhythmogenic Substrate in Reentrant Atrial and Ventricular Arrhythmias Insights from the Clinical and Experimental Electrophysiology Laboratories

This thesis encompasses an overview and critical analysis of 11 publications of clinical and translational cardiac electrophysiology research that has been executed over the last seven years. The focus of this dissertation and the selected papers is on the use of electroanatomic mapping technology to define the arrhythmogenic substrate in patients with structural heart disease and ventricular arrhythmias. Such advancements in elucidating the mechanisms and pathophysiology underlying scar-related ventricular tachycardia have yielded improved clinical outcomes for patients with drug-refractory ventricular arrhythmias. Chapter 1 describes the epidemiologic background and introduces the concept of intracardiac mapping and the technological evolution that has provided the basis for this current body of work. Chapter 2 and Chapter 3 provide a detailed description of how electroanatomic mapping studies have provided critical insight into disease pathogenesis in patients with dilated nonischemic cardiomyopathy arrhythmogenic right ventricular cardiomyopathy (ARVC). The clinical impact and relevance of these studies are discussed based on conventional electroanatomic mapping technologies to define abnormal physiological substrates. Chapter 3 also addresses important considerations regarding percutaneous epicardial mapping and ablation that have been derived from extensive clinical experience. Chapter 4 and Chapter 5 describe the evolution of mapping technologies and the use of high-resolution mapping system technologies. These chapters discuss the potential clinical advantages of these technologies during substrate and activation mapping, particularly in post-infarct ventricular scar and VT. Finally, Chapter 6 concludes this thesis with final thoughts on the broader context of the lessons that have been learned from the studies that are presented in this thesis and implications for future work.

Name dc:type.qualificationname

dphil

Level dc:type.qualificationlevel

doctoral

Grantor dc:publisher.institution

City, University of London

Year dc:date.issued

2016

Author dc:creator

• Tschabrunn, Michael, Cory

• R Medicine (General)