Shijie Zhou1, Amir AbdelWahab2, John L Sapp3, Eric Sung4, Konstantinos N Aronis5, James W Warren6, Paul J MacInnis6, Rushil Shah7, B Milan Horáček8, Ronald Berger5, Harikrishna Tandri5, Natalia A Trayanova4, Jonathan Chrispin5. 1. Department of Biomedical Engineering, Johns Hopkins University, Baltimore, Maryland, USA; Alliance for Cardiovascular Diagnostic and Treatment Innovation, Johns Hopkins University, Baltimore, Maryland, USA. Electronic address: shijie.zhou@jhu.edu. 2. Division of Cardiology, Department of Medicine, Queen Elizabeth II Health Sciences Centre, Halifax, Nova Scotia, Canada. 3. Division of Cardiology, Department of Medicine, Queen Elizabeth II Health Sciences Centre, Halifax, Nova Scotia, Canada; Department of Physiology and Biophysics, Dalhousie University, Halifax, Nova Scotia, Canada. 4. Department of Biomedical Engineering, Johns Hopkins University, Baltimore, Maryland, USA; Alliance for Cardiovascular Diagnostic and Treatment Innovation, Johns Hopkins University, Baltimore, Maryland, USA. 5. Alliance for Cardiovascular Diagnostic and Treatment Innovation, Johns Hopkins University, Baltimore, Maryland, USA; Section of Cardiac Electrophysiology, Division of Cardiology, Department of Medicine, Johns Hopkins Hospital, Baltimore, Maryland, USA. 6. Department of Physiology and Biophysics, Dalhousie University, Halifax, Nova Scotia, Canada. 7. Section of Cardiac Electrophysiology, Division of Cardiology, Department of Medicine, Johns Hopkins Hospital, Baltimore, Maryland, USA. 8. School of Biomedical Engineering, Dalhousie University, Halifax, Nova Scotia, Canada.
Abstract
OBJECTIVES: The objective of this study was to present a new system, the Automatic Arrhythmia Origin Localization (AAOL) system, which used incomplete electroanatomic mapping (EAM) for localization of idiopathic ventricular arrhythmia (IVA) origin on the patient-specific geometry of left ventricular, right ventricular, and neighboring vessels. The study assessed the accuracy of the system in localizing IVA source sites on cardiac structures where pace mapping is challenging. BACKGROUND: An intraprocedural automated site of origin localization system was previously developed to identify the origin of early left ventricular activation by using 12-lead electrocardiograms (ECGs). However, it has limitations, as it could not identify the site of origin in the right ventricle and relied on acquiring a complete EAM. METHODS: Twenty patients undergoing IVA catheter ablation had a 12-lead ECG recorded during clinical arrhythmia and during pacing at various locations identified on EAM geometries. The new system combined 3-lead (III, V2, and V6) 120-ms QRS integrals and patient-specific EAM geometry with pace mapping to predict the site of earliest ventricular activation. The predicted site was projected onto EAM geometry. RESULTS: Twenty-three IVA origin sites were clinically identified by activation mapping and/or pace mapping (8, right ventricle; 15, left ventricle, including 8 from the posteromedial papillary muscle, 2 from the aortic root, and 1 from the distal coronary sinus). The new system achieved a mean localization accuracy of 3.6 mm for the 23 mapped IVAs. CONCLUSIONS: The new intraprocedural AAOL system achieved accurate localization of IVA origin in ventricles and neighboring vessels, which could facilitate ablation procedures for patients with IVAs.
OBJECTIVES: The objective of this study was to present a new system, the Automatic Arrhythmia Origin Localization (AAOL) system, which used incomplete electroanatomic mapping (EAM) for localization of idiopathic ventricular arrhythmia (IVA) origin on the patient-specific geometry of left ventricular, right ventricular, and neighboring vessels. The study assessed the accuracy of the system in localizing IVA source sites on cardiac structures where pace mapping is challenging. BACKGROUND: An intraprocedural automated site of origin localization system was previously developed to identify the origin of early left ventricular activation by using 12-lead electrocardiograms (ECGs). However, it has limitations, as it could not identify the site of origin in the right ventricle and relied on acquiring a complete EAM. METHODS: Twenty patients undergoing IVA catheter ablation had a 12-lead ECG recorded during clinical arrhythmia and during pacing at various locations identified on EAM geometries. The new system combined 3-lead (III, V2, and V6) 120-ms QRS integrals and patient-specific EAM geometry with pace mapping to predict the site of earliest ventricular activation. The predicted site was projected onto EAM geometry. RESULTS: Twenty-three IVA origin sites were clinically identified by activation mapping and/or pace mapping (8, right ventricle; 15, left ventricle, including 8 from the posteromedial papillary muscle, 2 from the aortic root, and 1 from the distal coronary sinus). The new system achieved a mean localization accuracy of 3.6 mm for the 23 mapped IVAs. CONCLUSIONS: The new intraprocedural AAOL system achieved accurate localization of IVA origin in ventricles and neighboring vessels, which could facilitate ablation procedures for patients with IVAs.
Authors: Stephan Hohmann; Maryam E Rettmann; Hiroki Konishi; Anna Borenstein; Songyun Wang; Atsushi Suzuki; Gregory J Michalak; Kristi H Monahan; Kay D Parker; L Katie Newman; Douglas L Packer Journal: Circ Arrhythm Electrophysiol Date: 2019-11-11
Authors: Adam J Graham; Michele Orini; Ernesto Zacur; Gurpreet Dhillon; Holly Daw; Neil T Srinivasan; Claire Martin; Jem Lane; Josephine S Mansell; Alex Cambridge; Jason Garcia; Francesca Pugliese; Oliver Segal; Syed Ahsan; Martin Lowe; Malcolm Finlay; Mark J Earley; Anthony Chow; Simon Sporton; Mehul Dhinoja; Ross J Hunter; Richard J Schilling; Pier D Lambiase Journal: Circ Arrhythm Electrophysiol Date: 2020-01-14
Authors: Edmond M Cronin; Frank M Bogun; Philippe Maury; Petr Peichl; Minglong Chen; Narayanan Namboodiri; Luis Aguinaga; Luiz Roberto Leite; Sana M Al-Khatib; Elad Anter; Antonio Berruezo; David J Callans; Mina K Chung; Phillip Cuculich; Andre d'Avila; Barbara J Deal; Paolo Della Bella; Thomas Deneke; Timm-Michael Dickfeld; Claudio Hadid; Haris M Haqqani; G Neal Kay; Rakesh Latchamsetty; Francis Marchlinski; John M Miller; Akihiko Nogami; Akash R Patel; Rajeev Kumar Pathak; Luis C Saenz Morales; Pasquale Santangeli; John L Sapp; Andrea Sarkozy; Kyoko Soejima; William G Stevenson; Usha B Tedrow; Wendy S Tzou; Niraj Varma; Katja Zeppenfeld Journal: Heart Rhythm Date: 2019-05-10 Impact factor: 6.343
Authors: John L Sapp; Meir Bar-Tal; Adam J Howes; Jonathan E Toma; Ahmed El-Damaty; James W Warren; Paul J MacInnis; Shijie Zhou; B Milan Horáček Journal: JACC Clin Electrophysiol Date: 2017-07-17
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: J Am Heart Assoc Date: 2021-10-06 Impact factor: 5.501