Confirmation of Novel Noninvasive High-Density Electrocardiographic Mapping With Electrophysiology Study

Abstract

Background— Twelve lead ECGs have limited value in precisely identifying atrial and ventricular activation during arrhythmias, including accessory atrioventricular conduction activation. The aim of this study was to report a single center’s clinical experience validating a novel, noninvasive, whole heart, beat-by-beat, 3-dimensional mapping technology with invasive electrophysiological studies, including ablation, where applicable. Methods and Results— Using an electrocardiographic mapping (ECM) system in 27 patients, 3-dimensional epicardial activation maps were generated from >250 body surface ECGs using heart–torso geometry obtained from computed tomographic images. ECM activation maps were compared with clinical diagnoses, and confirmed with standard invasive electrophysiological studies mapping. (1) In 6 cases of Wolff–Parkinson–White syndrome, ECM accurately identified the ventricular insertion site of an accessory atrioventricular connection. (2) In 10 patients with premature ventricular complexes, ECM accurately identified their ventricular site of origin in 8 patients. In 2 of 10 patients transient premature ventricular complex suppression was observed during ablation at the site predicted by ECM as the earliest. (3) In 10 cases of atrial tachycardia/atrial flutter, ECM accurately identified the chamber of origin in all 10, and distinguished isthmus from nonisthmus dependent atrial flutter. (4) In 1 patient with sustained exercise induced ventricular tachycardia, ECM accurately identified the focal origin in the left ventricular outflow tract. Conclusions— ECM successfully provided valid activation sequence maps obtained noninvasively in a variety of rhythm disorders that correlated well with invasive electrophysiological studies.

Ablation of Premature Ventricular Complexes Exclusively Guided by Three-Dimensional Noninvasive Mapping

“…[10][11][12] Specifically, two studies compared accuracy of PVC mapping using ECVUE with the standard 12-lead body surface ECG. 10,11 In both studies, ECVUE was first used to localize the PVC origin to either the right or left chamber, and second to sublocalize the origin within the ventricular chambers.…”

“…AMC, aortomitral continuity; epi, epicardial; LCC, left coronary cusp; LV, left ventricle; NCC, noncoronary cusp; PH, parahissian; RCC, right coronary cusp; RV, right ventricle; TV, tricuspid valve. (Data from Refs [10][11][12]. …”

Noninvasive Diagnostic Mapping of Supraventricular Arrhythmias (Wolf-Parkinson-White Syndrome and Atrial Arrhythmias)

“…3,20 Because the system used high-density recording, needed only 1 beat for analysis, provided activation times superimposed on the cardiac anatomic shell derived from CT imaging, and showed promise in eliciting the mechanism and defining the location of the arrhythmia, our group used it in patients with various atrial and ventricular arrhythmias. 15 In this report, in all 10 patients with an atrial tachyarrhythmia, ECM was able to identify whether the arrhythmia was coming from the left or right atrium and whether the arrhythmia was focal or reentrant. The most robust and clinically relevant use of noninvasive mapping in atrial arrhythmias was reported in 2013.…”

“…Using the same system and technology, we reported our experience in 27 patients with various atrial and ventricular rhythm disorders. 15 Of 6 patients with WPW syndrome, 4 had ECGs suggestive of a septal ventricular insertion of the AACV per published 12-lead ECG-based algorithms. 14 In all of these patients, the ECG was indeterminate as far as whether the ventricular insertion was on the left or right side of the ventricular septum.…”

Noninvasive Electrocardiographic Mapping: Are We Ready for Prime Time?

“…Aside from their noninvasive feature and ability to be applied at bedside, current BSP mapping technologies also permit 3‐dimensional integration with computed tomography or magnetic resonance imaging modalities. The initial experiences using this innovative mapping approach have demonstrated improved efficacy and reduced procedural duration 6, 7, 8. Furthermore, a noninvasive electrocardiographic imaging system (ECVUE; CardioInsight Technologies, Inc) was recently approved for clinical use in Europe.…”