Noninvasive epicardial and endocardial mapping of premature ventricular contractions

Abstract

AimsThe aim of the present study was to estimate the accuracy of a novel non-invasive epicardial and endocardial electrophysiology system (NEEES) for mapping ectopic ventricular depolarizations.Methods and resultsThe study enrolled 20 patients with monomorphic premature ventricular contractions (PVCs) or ventricular tachycardia (VT). All patients underwent pre-procedural computed tomography or magnetic resonance imaging of the heart and torso. Radiographic data were semi-automatically processed by the NEEES to reconstruct a realistic 3D model of the heart and torso. In the electrophysiology laboratory, body-surface electrodes were connected to the NEEES followed by unipolar EKG recordings during episodes of PVC/VT. The body-surface EKG data were processed by the NEEES using its inverse-problem solution software in combination with anatomical data from the heart and torso. The earliest site of activation as denoted on the NEEES 3D heart model was compared with the PVC/VT origin using a 3D electroanatomical mapping system. The site of successful catheter ablation served as final confirmation. A total of 21 PVC/VT morphologies were analysed and ablated. The chamber of interest was correctly diagnosed non-invasively in 20 of 21 (95%) PVC/VT cases. In 18 of the 21 (86%) cases, the correct ventricular segment was diagnosed. Catheter ablation resulted in acute success in 19 of the 20 (95%) patients, whereas 1 patient underwent successful surgical ablation. During 6 months of follow-up, 19 of the 20 (95%) patients were free from recurrence off antiarrhythmic drugs.ConclusionThe NEEES accurately identified the site of PVC/VT origin. Knowledge of the potential site of the PVC/VT origin may aid the physician in planning a successful ablation strategy.

First-in-Man Analysis of the Relationship Between Electrical Rotors From Noninvasive Panoramic Mapping and Atrial Fibrosis From Magnetic Resonance Imaging in Patients With Persistent Atrial Fibrillation

“…Mean value of total observation time for NEEES was 18.9 s; mean (SD) value of ECG fragment length was 561 ms (154 ms). The median (interquartile range, 25%-75%) number of revealed rotors per patient was n=20 (14-30), n=20 (11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22), and n=44 (24-56) for the RA, LA, and total, respectively. The majority of the rotors in the LA was located along the inferior wall n=66 (minimal 1-17 maximal rotor(s) at this location) and in vicinity to the right superior pulmonary vein (PV) n=35 (0-10).…”

Arrhythmia induction using isoproterenol or epinephrine during electrophysiology study for supraventricular tachycardia

“…Because of its nearly pure beta‐adrenergic stimulation, isoproterenol is the sympathomimetic drug of choice for infusion during EPS. To date, the largest series of cases involving tilt table testing, EPS and supraventricular tachycardia (SVT) ablation, and premature ventricular contraction ablation have all used isoproterenol as the primary provocative drug . Even under conditions of deep sedation or general anesthesia, isoproterenol is effective for arrhythmia induction .…”

“…To date, the largest series of cases involving tilt table testing, EPS and supraventricular tachycardia (SVT) ablation, and premature ventricular contraction ablation have all used isoproterenol as the primary provocative drug. [9][10][11][12][13][14][15][16] Even under conditions of deep sedation or general anesthesia, isoproterenol is effective for arrhythmia induction. 17 However, as noted in prior publications, 18 a dramatic price increase in March 2015 19 resulted in the wholesale acquisition cost of isoproterenol increasing from $26.20 to $1,790.11 per milligram.…”

Simultaneous Non‐Invasive Epicardial and Endocardial Mapping in Patients With Brugada Syndrome: New Insights Into Arrhythmia Mechanisms

“…The results of this study were limited by only epicardially reconstructed EGs. However, methods of noninvasive reconstruction not only for epicardial, but for endocardial EGs as well have been developed recently …”

“…However, methods of noninvasive reconstruction not only for epicardial, but for endocardial EGs as well have been developed recently. [18][19][20][21] The present study investigated the morphology of local unipolar EGs and other electrophysiological properties of the heart in patients with BrS using a novel noninvasive epi-and endocardial electrophysiology system (NEEES), which allows simultaneous recording from the epi-and endocardium.…”