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Aims: J-wave syndrome in patients with arrhythmogenic right ventricular cardiomyopathy (ARVC) has been linked to an increased risk of ventricular arrhythmia. We investigated the significance of J waves with respect to substrate manifestations and ablation outcomes in patients with ARVC.Methods and Results: Forty-five patients with ARVC undergoing endocardial/epicardial mapping/ablation were studied. Patients were classified into two groups: 13 (28.9%) and 32 (71.1%) patients with and without J waves, respectively. The baseline characteristics, electrophysiological features, ventricular substrate, and recurrent ventricular tachycardia/fibrillation (VT/VF) were compared. Among the 13 patients with J waves, only the inferior J wave was observed. More ARVC patients with J waves fulfilled the major criteria of ventricular arrhythmias (76.9% vs. 21.9%, P = 0.003). Similar endocardial and epicardial substrate characteristics were observed between the two groups. However, patients with J waves had longer epicardial total activation time than those without (224.7 ± 29.9 vs. 200.8 ± 21.9 ms, P = 0.005). Concordance of latest endo/epicardial activation sites was observed in 29 (90.6%) patients without J waves and in none among those with J waves (P < 0.001). Complete elimination of endocardial/epicardial abnormal potentials resulted in the disappearance of the J wave in 8 of 13 (61.5%) patients. The VT/VF recurrences were not different between ARVC patients with and without J waves.Conclusion: The presence of J waves was associated with the discordance of endocardial/epicardial activation pattern in terms of transmural depolarization discrepancy in patients with ARVC. [ABSTRACT FROM AUTHOR]

Aims The aim of this study is to evaluate the benefit of manually controlled steerable sheath, which provides greater flexibility and stability, in mapping and ablation procedure of ventricular tachycardia. Methods and results We retrospectively reviewed 40 patients who underwent epicardial mapping and conclusive ablation. The first attempt to reach the primary endpoint defined as successful creation of detailed map of entire epicardial space and was achieved in 16 patients. Among the remaining 24 patients, we used the steerable sheath and achieved further success to create an entire map in all patients. After the delivery of RF energy, final procedural success was defined as complete abolishment of late potential and no more induction of any VT, and that was obtained in 10 out of 16 patients mapped with conventional sheath and 21 out of 24 patients with steerable sheath. The advantage of the steerable sheath seemed to be consistent, regardless of the site of ablation. There was no procedure-related adverse event. Conclusions The manually controlled steerable sheath was safe and effective to achieve procedural success in patients with epicardial VT. [ABSTRACT FROM PUBLISHER]