Background: The accuracy of ECG imaging (ECGI) in structural heart disease remains uncertain. This study aimed to provide a detailed comparison of ECGI and contact-mapping system (CARTO) electrograms. Methods: Simultaneous epicardial mapping using CARTO (Biosense-Webster, CA) and ECGI (CardioInsight) in 8 patients was performed to compare electrogram morphology, activation time (AT), and repolarization time (RT). Agreement between AT and RT from CARTO and ECGI was assessed using Pearson correlation coefficient, ρ AT and ρ RT , root mean square error, E AT and E RT , and Bland-Altman plots. Results: After geometric coregistration, 711 (439–905; median, first-third quartiles) ECGI and CARTO points were paired per patient. AT maps showed ρ AT =0.66 (0.53–0.73) and E AT =24 (21–32) ms, RT maps showed ρ RT =0.55 (0.41–0.71) and E RT =51 (38–70) ms. The median correlation coefficient measuring the morphological similarity between the unipolar electrograms was equal to 0.71 (0.65–0.74) for the entire signal, 0.67 (0.59–0.76) for QRS complexes, and 0.57 (0.35–0.76) for T waves. Local activation map correlation, ρ AT , was lower when default filters were used (0.60 (0.30–0.71), P =0.053). Small misalignment of the ECGI and CARTO geometries (below ±4 mm and ±4°) could introduce variations in the median ρ AT up to ±25%. Minimum distance between epicardial pacing sites and the region of earliest activation in ECGI was 13.2 (0.0–28.3) mm from 25 pacing sites with stimulation to QRS interval <40 ms. Conclusions: This simultaneous assessment demonstrates that ECGI maps activation and repolarization parameters with moderate accuracy. ECGI and contact electrogram correlation is sensitive to electrode apposition and geometric alignment. Further technological developments may improve spatial resolution.
Introduction: Preliminary data suggest that high power short duration (HPSD) ablation for pulmonary vein isolation (PVI) are safe. Limited data are available on its effectiveness. Aim was to evaluate HPSD ablation in atrial fibrillation ablation using a novel Qdot Micro catheter.Methods and Results: Prospective multicenter study evaluating safety and efficacy of PVI with HPSD ablation. First pass isolation (FPI) and sustained PVI was assessed.If FPI was not achieved additional ablation index (AI)-guided ablation with 45 W was performed and metrics predictive of this were determined. Sixty-five patients and 260 veins were treated. Procedural and LA dwell time was 93.9 ± 30.4 and 60.5 ± 23.1 min, respectively. FPI was achieved in 47 (72.3%) patients and 231 veins (88.8%) with an ablation duration of 4.6 ± 1.0 min. Twenty-nine veins required additional AI-guided ablation to achieve initial PVI with 24 anatomical sites ablated with the right posterior carina being the most common site (37.5%). A contact force of ≥8 g (area under the curve [AUC]: 0.81; p < 0.001) and catheter position variation of ≤1.2 mm (AUC: 0.79; p < 0.001) with HPSD were strongly predictive of not requiring additional AI-guided ablation. Out of the 260 veins, only 5 (1.9%) veins showed acute reconnection. HPSD ablation was associated with shorter procedure times (93.9 vs. 159.4 min; p < 0.001), ablation times (6.1 vs. 27.7 min; p < 0.001), and lower rates of PV reconnection (9.2% vs. 30.8%; p = 0.004) compared to moderate power cohort.
Background: Catheter ablation for supraventricular tachycardia (SVT) in adults with congenital heart disease (ACHD) is an important therapeutic option. Cavotricuspid isthmus (CTI) dependent intra-atrial re-entrant tachycardia (IART) is common. However, induction of sustained tachycardia at the time of ablation is not always possible. We hypothesised that performing an empiric CTI line in case of noninducibility leads to good outcomes.Objectives: Long-term outcomes of empiric versus entrained CTI ablation in CHD patients were examined.Methods: Retrospective, single-centre, case-control study over seven years.Arrhythmia free survival post empiric versus entrained CTI ablation were compared.Results: 87 CTI ablations were performed in 85 ACHD patients between 2010 and 2017. The mean age of the cohort was 43 years and 48% were men. Underlying etiology included ASD (31%), VSD (11.4%), AVSD (9.1%), AVR (4.8%), Fallot's tetralogy (18.4%), Ebstein's anomaly (2.3%), Fontan surgery (9.2%) and Mustard/Senning repair (13.8%). CTI dependent IART was entrained in 59 patients whereas it was non-inducible in 28. The latter had an empiric CTI-line ablation. 57% of procedures were performed without a general anaesthetic. There were no procedural complications. There was no significant difference in the mean procedure and fluoroscopy times between the groups (Empiric vs Entrained CTI; 169.1 vs 183.3 and 28.1 vs 19.9 min). After a mean follow-up of 21 months, arrhythmia-free survival was 64.3% versus 72.8% (p-value 0.44) in the empiric and entrained CTI groups. Conclusion:Long-term outcomes after empiric and entrained CTI line ablation for IART ACHD patients are comparable. This is a safe and effective therapeutic option.In the case of non-inducibility of IART, an empiric CTI line ablation should be performed in this cohort.
Lead parameters in ARVC patients were stable over medium-term follow up. In DCM patients, RV lead threshold and RV and LV APWP increased over time. These differential responses for DCM and ARVC were not explained by imaging indices, and may reflect distinct patterns of disease progression.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.
hi@scite.ai
10624 S. Eastern Ave., Ste. A-614
Henderson, NV 89052, USA
Copyright © 2024 scite LLC. All rights reserved.
Made with 💙 for researchers
Part of the Research Solutions Family.