{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,4]],"date-time":"2026-09-04T00:08:58Z","timestamp":1788480538119,"version":"build-2803163510"},"reference-count":25,"publisher":"Wiley","issue":"4","license":[{"start":{"date-parts":[[2019,1,15]],"date-time":"2019-01-15T00:00:00Z","timestamp":1547510400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Cardiovasc electrophysiol"],"published-print":{"date-parts":[[2019,4]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>Noninvasive electrocardiographic mapping of ventricular tachycardia (VT) and ablation using stereotactic radiotherapy was recently reported. This strategy does not directly evaluate the critical diastolic components and assumes that the epicardial exit site of VT subtends closely over the endocardial mid\u2010diastolic isthmus.<\/jats:p><\/jats:sec><jats:sec><jats:title>Objective<\/jats:title><jats:p>To determine if the epicardial exit site of VT spatially corresponds to the critical diastolic components of ischemic scar\u2010related VT.<\/jats:p><\/jats:sec><jats:sec><jats:title>Materials and methods<\/jats:title><jats:p>Intraoperative simultaneous endocardial and epicardial mapping were performed during VT using a 112\u2010bipole endocardial balloon and 112\u2010bipole epicardial sock array. In eight patients, nine VTs having entire diastolic circuit mapped were included in the study. The diastolic path and VT\u2010exit sites (epicardial and endocardial) were determined.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>The diastolic path was mapped in the endocardium for all nine VTs (median length, 50; interquartile range [IQR], 28\u2009mm). The tachycardia cycle length ranged from 210\u2010500\u2009ms. The VT\u2010exit site was early in the endocardium for six VTs and on the epicardium for three VTs. The mid\u2010diastolic isthmus and endocardial exit site of the six endocardial VTs were spatially distant from their epicardial exit site by a median distance of 32 and 27\u2009mm, respectively. For the three VTs with an early epicardial exit, the isthmus and endocardial exit sites were distant from the epicardial exit site by a median distance of 34 and 38\u2009mm, respectively.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>The epicardial exit site and the mid\u2010diastolic isthmus sites were spatially distant and discrepant. Surface electrocardiography (ECG)\u2010derived strategy in identifying epicardial exit site to select noninvasive ablation targets is prone to identify epicardial exit sites and may not identify critical targets in ischemic scar VT.<\/jats:p><\/jats:sec>","DOI":"10.1111\/jce.13843","type":"journal-article","created":{"date-parts":[[2019,1,7]],"date-time":"2019-01-07T09:36:28Z","timestamp":1546853788000},"page":"520-527","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":15,"title":["Exit sites on the epicardium rarely subtend critical diastolic path of ischemic VT on the endocardium: Implications for noninvasive ablation"],"prefix":"10.1111","volume":"30","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-2963-4907","authenticated-orcid":false,"given":"Abhishek","family":"Bhaskaran","sequence":"first","affiliation":[{"name":"Division of Cardiology Peter Munk Cardiac Centre, Toronto General Hospital, University Health Network 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