Evaluation of ECG Imaging to Map Hemodynamically Stable and Unstable Ventricular Arrhythmias

Abstract

Background: ECG imaging (ECGI) has been used to guide treatment of ventricular ectopy and arrhythmias. However, the accuracy of ECGI in localizing the origin of arrhythmias during catheter ablation of ventricular tachycardia (VT) in structurally abnormal hearts remains to be fully validated. Methods: During catheter ablation of VT, simultaneous mapping was performed using electroanatomical mapping (CARTO, Biosense-Webster) and ECGI (CardioInsight, Medtronic) in 18 patients. Sites of entrainment, pace-mapping, and termination during ablation were used to define the VT site of origin (SoO). Distance between SoO and the site of earliest activation on ECGI were measured using co-registered geometries from both systems. The accuracy of ECGI versus a 12-lead surface ECG algorithm was compared. Results: A total of 29 VTs were available for comparison. Distance between SoO and sites of earliest activation in ECGI was 22.6, 13.9 to 36.2 mm (median, first to third quartile). ECGI mapped VT sites of origin onto the correct AHA segment with higher accuracy than a validated 12-lead ECG algorithm (83.3% versus 38.9%; P =0.015). Conclusions: This simultaneous assessment demonstrates that CardioInsight localizes VT circuits with sufficient accuracy to provide a region of interest for targeting mapping for ablation. Resolution is not sufficient to guide discrete radiofrequency lesion delivery via catheter ablation without concomitant use of an electroanatomical mapping system but may be sufficient for segmental ablation with radiotherapy.

Computational ECG mapping and respiratory gating to optimize stereotactic ablative radiotherapy workflow for refractory ventricular tachycardia

“…Contemporary studies have also shown limited accuracy of manual QRS morphology analysis (range 39%–82%) compared with invasive mapping. 17 …”

“…Contemporary studies have also shown limited accuracy of manual QRS morphology analysis (ranging 39-82%) compared with invasive mapping. 17 In prior work, ECGi systems have been used to map VT exit sites. 7 Unlike the ECGi workflow which requires use of a mapping vest and concurrent CT scan, the proposed SAbR workflow requires only the digital 12-lead ECG data of the ventricular arrhythmia and proprietary software to map VT targets, potentially enhancing access to SAbR therapy.…”

A Novel Use of Noninvasive Registered Electrocardiographic Imaging Map for Localization of VT and PVC

“…This case highlights the novel implementation of a noninvasive LAT map for pre-procedural SOO localization of ventricular arrhythmias and integration with a 3D mapping system to facilitate and guide PVC and VT ablations. Earlier studies showed the validity of the VIVO system ( 1 , 2 ) and registration of a currently commercially available 252-lead–based ECGi into an invasive EAM ( 3 ). To our knowledge, this represents the first case of co-registration between the VIVO 12-lead ECGi technology with a clinical mapping system.…”

The scar: the wind in the perfect storm—insights into the mysterious living tissue originating ventricular arrhythmias

“…Electrocardiographic imaging (ECGI), using up to 252 electrodes at torso level and heart reconstruction by thoracic computed tomography (CT), has been used to guide treatment of ventricular ectopy and localization of site of origin of VT for stereotactic radioablation [52]. Graham et al [53] showed that ECGI yielded higher accuracy in providing a region of interest for targeting mapping and ablation as compared to 12-lead ECG-based algorithm; however, it lacks adequate accuracy and precision to guide catheter ablation without ancillary detailed electroanatomical mapping.…”