Noninvasive electrocardiographic mapping to guide ablation of outflow tract ventricular arrhythmias

Abstract

BackgroundLocalizing the origin of outflow tract ventricular tachycardias (OTVT) is hindered by lack of accuracy of electrocardiographic (ECG) algorithms and infrequent spontaneous premature ventricular complexes (PVCs) during electrophysiological studies.ObjectivesTo prospectively assess the performance of noninvasive electrocardiographic mapping (ECM) in the pre-/periprocedural localization of OTVT origin to guide ablation and to compare the accuracy of ECM with that of published ECG algorithms.MethodsPatients with symptomatic OTVT/PVCs undergoing clinically indicated ablation were recruited. The OTVT/PVC origin was mapped preprocedurally by using ECM, and 3 published ECG algorithms were applied to the 12-lead ECG by 3 blinded electrophysiologists. Ablation was guided by using ECM. The OTVT/PVC origin was defined as the site where ablation caused arrhythmia suppression. Acute success was defined as abolition of ectopy after ablation. Medium-term success was defined as the abolition of symptoms and reduction of PVC to less than 1000 per day documented on Holter monitoring within 6 months.ResultsIn 24 patients (mean age 50 ± 18 years) recruited ECM successfully identified OTVT/PVC origin in 23/24 (96%) (right ventricular outflow tract, 18; left ventricular outflow tract, 6), sublocalizing correctly in 100% of this cohort. Acute ablation success was achieved in 100% of the cases with medium-term success in 22 of 24 patients. PVC burden reduced from 21,837 ± 23,241 to 1143 ± 4039 (P < .0001). ECG algorithms identified the correct chamber of origin in 50%–88% of the patients and sublocalized within the right ventricular outflow tract (septum vs free-wall) in 37%–58%.ConclusionsECM can accurately identify OTVT/PVC origin in the left and the right ventricle pre- and periprocedurally to guide catheter ablation with an accuracy superior to that of published ECG algorithms.

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. Jamil-Copley and coworkers 10 conducted a prospective single-center study, which included 24 patients, most of whom had idiopathic PVCs emanating from the outflow tracts (Fig.…”

“…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]. …”

Utility of Noninvasive Arrhythmia Mapping in Patients with Adult Congenital Heart Disease

“…In the first case, pacing is required via the mapping catheter and encompasses the epicardial mapping of the pacing spike with the ECVUE. 21 As only the site of earliest activation is informative for revealing the position of the mapping catheter, only the pacing spike is used for this approach. Moreover, pace match was visually evaluated to compare the isopotential map of the paced beat with that of a spontaneous beat (Fig.…”

Feasibility and Accuracy of Cardiac Magnetic Resonance Imaging–Based Whole‐Heart Inverse Potential Mapping of Sinus Rhythm and Idiopathic Ventricular Foci

“…The most frequently used IPM method is based on a homogeneous volume conductor model (VCM) constructed from computed tomography images 1. This technique is being applied increasingly for analysis of idiopathic ventricular foci and guidance of catheter ablation 2, 3…”