Ablation of premature ventricular complexes originating from the left ventricular outflow tract using a novel automated pace-mapping software

Abstract

Pace-mapping is an important tool during the ablation of premature ventricular complexes (PVCs) or ventricular tachycardia. The automated pace mapping system software (PaSo module, CARTO XP v9, Biosense/Webster) allows direct comparisons between paced ECGs and the acquired PVC ECG during ablation in a reasonable time. We report our experience with the automated pace mapping system during the ablation of PVCs in the left ventricular outflow tract (LVOT). A 67-year-old male patient was referred to our Department because of recurrent resting atypical chest pain. A 12 lead ECG showed frequent PVCs with LVOT morphology and a 24-hour Holter ECG revealed, that 31% of the total beats were monomorphic PVCs. We decided to perform a radiofrequency catheter ablation. After recording an electroanatomic and an activation map during PVCs, pace-mapping was performed with the PaSo module of the CARTO system. The best percent match area (89.0%) was found in the LVOT, where we performed multiple ablations and PVCs disappeared. According to our initial experience, automated pace-mapping systems might be useful during ablation of PVCs or ventricular tachycardias. Appropriate use of the software allows more objective and faster comparisons compared with conventional manual techniques.

In vivo validation of a novel algorithm for automatic premature ventricular contractions recognition

“…Comparable algorithm suites in clinical practice require manual input for annotation and analysis of PVC morphology . Bogun et al .…”

“…Comparable algorithm suites in clinical practice require manual input for annotation and analysis of PVC morphology. 8 Bogun et al 9 first reported an algorithm for pace mapping which they validated versus conventional pace-matching and activation mapping. Although the authors showed that automated template matching correlated with earliest activation, 5 they concluded that activation mapping was the superior method as it afforded a higher spatial resolution-the reported pace mapping resolution was 1.6 cm 2 , which is equivalent to the ability to discriminate between points 14 mm apart.…”