BACKGROUND: ECG imaging (ECGI) has been used to guide treatment of ventricular ectopy and arrhythmias. However, the accuracy of ECGI in localizing the origin of arrhythmias during catheter ablation of ventricular tachycardia (VT) in structurally abnormal hearts remains to be fully validated. METHODS: During catheter ablation of VT, simultaneous mapping was performed using electroanatomical mapping (CARTO, Biosense-Webster) and ECGI (CardioInsight, Medtronic) in 18 patients. Sites of entrainment, pace-mapping, and termination during ablation were used to define the VT site of origin (SoO). Distance between SoO and the site of earliest activation on ECGI were measured using co-registered geometries from both systems. The accuracy of ECGI versus a 12-lead surface ECG algorithm was compared. RESULTS: A total of 29 VTs were available for comparison. Distance between SoO and sites of earliest activation in ECGI was 22.6, 13.9 to 36.2 mm (median, first to third quartile). ECGI mapped VT sites of origin onto the correct AHA segment with higher accuracy than a validated 12-lead ECG algorithm (83.3% versus 38.9%; P=0.015). CONCLUSIONS: This simultaneous assessment demonstrates that CardioInsight localizes VT circuits with sufficient accuracy to provide a region of interest for targeting mapping for ablation. Resolution is not sufficient to guide discrete radiofrequency lesion delivery via catheter ablation without concomitant use of an electroanatomical mapping system but may be sufficient for segmental ablation with radiotherapy.
BACKGROUND: ECG imaging (ECGI) has been used to guide treatment of ventricular ectopy and arrhythmias. However, the accuracy of ECGI in localizing the origin of arrhythmias during catheter ablation of ventricular tachycardia (VT) in structurally abnormal hearts remains to be fully validated. METHODS: During catheter ablation of VT, simultaneous mapping was performed using electroanatomical mapping (CARTO, Biosense-Webster) and ECGI (CardioInsight, Medtronic) in 18 patients. Sites of entrainment, pace-mapping, and termination during ablation were used to define the VT site of origin (SoO). Distance between SoO and the site of earliest activation on ECGI were measured using co-registered geometries from both systems. The accuracy of ECGI versus a 12-lead surface ECG algorithm was compared. RESULTS: A total of 29 VTs were available for comparison. Distance between SoO and sites of earliest activation in ECGI was 22.6, 13.9 to 36.2 mm (median, first to third quartile). ECGI mapped VT sites of origin onto the correct AHA segment with higher accuracy than a validated 12-lead ECG algorithm (83.3% versus 38.9%; P=0.015). CONCLUSIONS: This simultaneous assessment demonstrates that CardioInsight localizes VT circuits with sufficient accuracy to provide a region of interest for targeting mapping for ablation. Resolution is not sufficient to guide discrete radiofrequency lesion delivery via catheter ablation without concomitant use of an electroanatomical mapping system but may be sufficient for segmental ablation with radiotherapy.
Entities:
Keywords:
catheter ablation; consensus; electrodes; magnetic resonance imaging; tachycardia, ventricular
Authors: C Pandozi; Marco Valerio Mariani; C Chimenti; V Maestrini; D Filomena; M Magnocavallo; M Straito; A Piro; M Russo; M Galeazzi; S Ficili; F Colivicchi; P Severino; M Mancone; F Fedele; C Lavalle Journal: J Interv Card Electrophysiol Date: 2022-01-24 Impact factor: 1.900
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
Authors: Gordon Ho; Todd F Atwood; Andrew R Bruggeman; Kevin L Moore; Elliot McVeigh; Christopher T Villongco; Frederick T Han; Jonathan C Hsu; Kurt S Hoffmayer; Farshad Raissi; Grace Y Lin; Amir Schricker; Christopher E Woods; Joey P Cheung; Al V Taira; Andrew McCulloch; Ulrika Birgersdotter-Green; Gregory K Feld; Arno J Mundt; David E Krummen Journal: Heart Rhythm O2 Date: 2021-09-20