Assessment of wave front activation duration and speed across the right ventricular outflow tract using electrocardiographic imaging as predictors of the origin of the premature ventricular contractions: A validation study

Parreira, Leonor; Carmo, Pedro; Marinheiro, Rita; Mesquita, Dinis; Chmelevsky, Mikhail; Ferreira, Alexandre Oliveira; Marqués, L. Pons; Pinho, Joana; Chambel, D; Nunes, Silvia; Amador, Pedro; Gonçalves, Pedro Araújo; Marques, Hugo; Caria, Rui; Adragão, Pedro

doi:10.1016/j.jelectrocard.2022.05.005

Cited by 4 publications

(3 citation statements)

References 16 publications

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“…The DPs were mostly recorded at LVAs, which also displayed abnormal electrophysiological properties, namely a slower propagation speed both in sinus rhythm 32 and in PVC. 33 Using electrocardiographic imaging, we were able to demonstrate the presence of a dispersion of the activation-recovery interval, a known surrogate of the action potential duration across the RVOT in patients with PVCs. 34 There is an increasing trend to go for substrate ablation in the majority of arrhythmias.…”

Section: Discussionmentioning

confidence: 93%

A simplified approach to radiofrequency catheter ablation of idiopathic ventricular outflow tract premature ventricular contractions

Parreira

Carmo

Marinheiro

et al. 2022

Cardiovasc electrophysiol

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Introduction: Frequently, low voltage areas (LVAs) and diastolic potentials (DPs) are present at ablation sites in sinus rhythm in patients with idiopathic premature ventricular contractions (PVCs).Objective: Validate these findings as substrates for PVCs and evaluate the feasibility of a simplified substrate approach based on LVAs and DPs for ablation of idiopathic outflow tract PVCs, in patients with a low PVC burden during the procedure.Methods: Prospective single-arm clinical trial at two centers with comparison with a historical group, matched to age and gender. The study group consisted of consecutive patients referred for ablation of frequent idiopathic PVCs with inferior axis, that presented with less than two PVCs/min in first 5 min of the procedure. The ablation was based on fast mapping of the right ventricular outflow tract in sinus rhythm looking for LVAs and DPs, defined as isolated small amplitude potentials occurring after the T wave of the surface echocardiogram. The area with LVAs and DPs was tagged, and a simplified activation mapping of the PVCs was done in that area. The procedure time, success rate, and recurrence rate were compared with the historical group in whom ablation was performed based on activation and pace mapping only. A validation group without PVCs was also studied to assess the prevalence of LVAs and DPs in the general population. Results:The study (n = 38), historical (n = 38), and validation (n = 38) groups did not differ in relation to age or gender. Prevalence of LVAs and DPs was significantly higher in the study group in comparison with the validation group, respectively, 71% versus 11%, p < 0.0001 and 87% versus 8%, p < 0.0001. Procedure time was significantly lower in the study group when comparing to the historical group, 130 (100-164) versus 183 (160-203) min, p < 0.0001 and the success rate was significantly higher, 90% versus 64%, p = 0.013. The recurrence rate in patients with a successful ablation was not significantly different between both groups, Logrank = 0.125.

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Section: Discussionmentioning

confidence: 93%

A simplified approach to radiofrequency catheter ablation of idiopathic ventricular outflow tract premature ventricular contractions

Parreira

Carmo

Marinheiro

et al. 2022

Cardiovasc electrophysiol

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“…A search of the literature exhibits a large number of works devoted to ECGI and invasive mapping, mainly of the endocardium and, to a lesser extent, of the epicardium in ventricular arrhythmias [ 7 , 9 , 10 , 14 , 15 , 16 , 17 , 18 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 ]. The majority of such works used the invasive 3D mapping CARTO system (Biosense Webster, Irvine, CA, USA) [ 7 , 8 , 9 , 10 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 ], which could be easily explained by its overwhelming market presence. However, there are also some other systems, such as EnSite NavX Precision (Abbott, Chicago, IL, USA), which we use daily in our work.…”

Section: Discussionmentioning

confidence: 99%

“…A search of the literature exhibits a large number of works devoted to ECGI and invasive mapping, mainly of the endocardium and, to a lesser extent, of the epicardium in ventricular arrhythmias [7,9,10,[14][15][16][17][18][20][21][22][23][24][25][26][27][28]. The majority of such works used the invasive 3D mapping CARTO system (Biosense Webster, Irvine, CA, USA) [7][8][9][10][14][15][16][17][18][19][20][21][22][23][24][25][26][27][28][29][30][31], which could be easily explained by its overwhelming market presence.…”

Section: Discussionmentioning

confidence: 99%

Fusion Imaging of Non-Invasive and Invasive Cardiac Electroanatomic Mapping in Patients with Ventricular Ectopic Beats: A Feasibility Analysis in a Case Series

Muça,

Zubarev,

Bastian

et al. 2024

Diagnostics

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In patients with premature ventricular contractions (PVCs), non-invasive mapping could locate the PVCs’ origin on a personalized 3-dimensional (3D) heart model and, thus, facilitate catheter ablation therapy planning. The aim of our report is to evaluate its accuracy compared to invasive mapping in terms of assessing the PVCs’ early activation zone (EAZ). For this purpose, non-invasive electrocardiographic imaging (ECGI) was performed using the Amycard 01C system (EP Solutions SA, Switzerland) in three cases. In the first step, a multichannel ECG (up to 224 electrodes) was recorded, and the dominant PVCs were registered. Afterward, a cardiac computed tomography (in two cases) or magnetic resonance imaging (in one case) investigation was carried out acquiring non-contrast torso scans for 8-electrode strip visualization and contrast heart acquisition. For the reconstructed epi/endocardial meshes of the heart, non-invasive isochronal maps were generated for the selected multichannel ECG fragments. Then, the patients underwent an invasive electrophysiological study, and the PVCs’ activation was evaluated by a 3D mapping system (EnSite NavX Precision, Abbott). Finally, using custom-written software, we performed 3D fusion of the non-invasive and invasive models and compared the resulting isochronal maps. A qualitative analysis in each case showed the same early localization of the dominant PVC on the endocardial surface when comparing the non-invasive and invasive isochronal maps. The distance from the EAZ to the mitral or tricuspid annulus was comparable in the invasive/non-invasive data (36/41 mm in case N1, 73/75 mm in case N2, 9/12 mm in case N3). The area of EAZ was also similar between the invasive/non-invasive maps (4.3/4.5 cm2 in case N1, 7.1/7.0 cm2 in case N2, 0.4/0.6 cm2 in case N3). The distances from the non-invasive to invasive earliest activation site were 4 mm in case N1, 7 mm in case N2, and 4 mm in case N3. Such results were appropriate to trust the clinical value of the preoperative data in these cases. In conclusion, the non-invasive identification of PVCs before an invasive electrophysiological study can guide clinical and interventional decisions, demonstrating appropriate accuracy in the estimation of focus origin.

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The “Hand as Foot” teaching method in anatomy of the right ventricular outflow tract

Liu

Sun

2022

Asian Journal of Surgery

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Assessment of wave front activation duration and speed across the right ventricular outflow tract using electrocardiographic imaging as predictors of the origin of the premature ventricular contractions: A validation study

Cited by 4 publications

References 16 publications

A simplified approach to radiofrequency catheter ablation of idiopathic ventricular outflow tract premature ventricular contractions

A simplified approach to radiofrequency catheter ablation of idiopathic ventricular outflow tract premature ventricular contractions

Fusion Imaging of Non-Invasive and Invasive Cardiac Electroanatomic Mapping in Patients with Ventricular Ectopic Beats: A Feasibility Analysis in a Case Series

The “Hand as Foot” teaching method in anatomy of the right ventricular outflow tract

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