BACKGROUND: Radiofrequency catheter ablation of idiopathic ventricular arrhythmias (VA) is performed to eliminate symptoms and to prevent or reverse arrhythmia-induced cardiomyopathy. Pre-procedural prediction of the chamber of VA origin is critical for patient counseling, procedure planning and guidance of invasive mapping. OBJECTIVE: We aimed to assess the performance of manual expert versus automated 12-lead ECG analysis in the prediction of VA origin. METHODS: Patients with ablation of idiopathic VA and sustained success were included. The VA origin was defined as the site where ablation caused arrhythmia suppression. Standard baseline 12-lead ECGs with documentation of the VA were analyzed manually in a blinded fashion by 3 electrophysiologists and 3 electrophysiology fellows. In addition, the same standard 12-lead ECG was analyzed by an automated computer algorithm using a vectorcardiographic approach. RESULTS: Thirty-eight patients (median age 47 [IQR 37-58]; 68% female) were enrolled. The VA originated from the right ventricle in 24 (63%) and the left ventricle in 14 (37%) patients. The electrophysiologists and EP fellows identified the VA chamber of origin with a similar accuracy of 73% and 72% (p=0.72). The automated algorithm showed a higher accuracy of 89% (p=0.03 compared to electrophysiologists and EP fellows). This resulted in a sensitivity of 95% and specificity of 86%. CONCLUSION: While the manual ECG analysis of the standard 12-lead ECG by both electrophysiologists and EP fellows correctly identified the chamber of VA origin in around 75% of cases, an automated vectorcardiographic computer algorithm achieved an accuracy of 89% with clinically acceptable diagnostic parameters. This article is protected by copyright. All rights reserved. This article is protected by copyright. All rights reserved.
BACKGROUND: Radiofrequency catheter ablation of idiopathic ventricular arrhythmias (VA) is performed to eliminate symptoms and to prevent or reverse arrhythmia-induced cardiomyopathy. Pre-procedural prediction of the chamber of VA origin is critical for patient counseling, procedure planning and guidance of invasive mapping. OBJECTIVE: We aimed to assess the performance of manual expert versus automated 12-lead ECG analysis in the prediction of VA origin. METHODS:Patients with ablation of idiopathic VA and sustained success were included. The VA origin was defined as the site where ablation caused arrhythmia suppression. Standard baseline 12-lead ECGs with documentation of the VA were analyzed manually in a blinded fashion by 3 electrophysiologists and 3 electrophysiology fellows. In addition, the same standard 12-lead ECG was analyzed by an automated computer algorithm using a vectorcardiographic approach. RESULTS: Thirty-eight patients (median age 47 [IQR 37-58]; 68% female) were enrolled. The VA originated from the right ventricle in 24 (63%) and the left ventricle in 14 (37%) patients. The electrophysiologists and EP fellows identified the VA chamber of origin with a similar accuracy of 73% and 72% (p=0.72). The automated algorithm showed a higher accuracy of 89% (p=0.03 compared to electrophysiologists and EP fellows). This resulted in a sensitivity of 95% and specificity of 86%. CONCLUSION: While the manual ECG analysis of the standard 12-lead ECG by both electrophysiologists and EP fellows correctly identified the chamber of VA origin in around 75% of cases, an automated vectorcardiographic computer algorithm achieved an accuracy of 89% with clinically acceptable diagnostic parameters. This article is protected by copyright. All rights reserved. This article is protected by copyright. All rights reserved.
Authors: Shijie Zhou; Amir AbdelWahab; John L Sapp; Eric Sung; Konstantinos N Aronis; James W Warren; Paul J MacInnis; Rushil Shah; B Milan Horáček; Ronald Berger; Harikrishna Tandri; Natalia A Trayanova; Jonathan Chrispin Journal: JACC Clin Electrophysiol Date: 2020-11-25