Rotational Activation Pattern During Functional Substrate Mapping: Novel Target for Catheter Ablation of Scar-Related Ventricular Tachycardia.

BACKGROUND: Recent advancements in a 3-dimensional mapping system allow for the assessment of detailed conduction properties during sinus rhythm and thus the establishment of a strategy targeting functionally abnormal regions in scar-related ventricular tachycardia (VT). We hypothesized that a rotational activation pattern (RAP) observed in maps during baseline rhythm was associated with the critical location of VT. METHODS: We retrospectively examined the pattern of wavefront propagation during sinus rhythm in patients with scar-related VT. The prevalence and features of the RAP on critical VT circuits were analyzed. RAP was defined as >90° of inward curvature directly above or at the edge of the slow conductive areas. RESULTS: Forty-five VTs in 37 patients (66±15 years old, 89% male, 27% ischemic heart disease) were evaluated. High-density substrate mapping during sinus rhythm (median, 2524 points) was performed using the CARTO3 system before VT induction. Critical sites for reentry were identified by direct termination by radiofrequency catheter ablation in 21 VTs or by pace mapping in 12 VTs. Among them, RAP was present in 70% of the 33 VTs. Four VTs had no RAP at the critical sites during sinus rhythm, but it became visible in the mappings with different wavefront directions. Six VTs, in which intramural or epicardial isthmus was suspected, were rendered noninducible by radiofrequency catheter ablation to the endocardial surface without RAP. RAP had a sensitivity and specificity of 70% and 89%, respectively, for predicting the elements in the critical zone for VT. CONCLUSIONS: The critical zone of VT appears to correspond to an area characterized by the RAP with slow conduction during sinus rhythm, which facilitates targeting areas specific for reentry. However, this may not be applicable to intramural VT substrates and might be affected by the direction of wavefront propagation to the scar during mapping. Graphic Abstract: A graphic abstract is available for this article.

Influence of peroxide treatment on bovine enamel surface--cross-sectional analysis.

Carbamide peroxide and hydrogen peroxide are used as the main agents in vital tooth bleaching. In this study, the influence of peroxide treatment on cross-sectional morphology and mechanical property was investigated. A 3 x 5-mm window of enamel on the labial surface of a bovine tooth was exposed to immersion in 10% or 30% carbamide peroxide or hydrogen peroxide for 30 or 180 min. After immersion, the cross-sectional structure of each specimen was examined by nanoindentation and SEM. Nanohardness in the enamel showed a decrease at 2 microm below the surface, but none at 50 microm. High concentrations of peroxide caused erosion to a depth of 5 microm below the surface. In conclusion, decrease in nanohardness and change in morphology were limited to an area less than 50 microm below the surface, regardless of either concentration of peroxide or period of immersion.