Premature ventricular contractions cause a position shift in 3D mapping systems: analysis, quantification, and correction by hybrid activation mapping

Abstract

Aims Using a modified CARTO 3D mapping system, we studied if premature ventricular contractions (PVCs) cause position shifts within the 3D co-ordinate system. We quantified magnitude of the phenomenon and corrected for it, by creating both an activation map that represents the conventional local activation time (LAT) and one corrected for this position shift (hybrid LAT map). Methods and results We prospectively enrolled patients planned for PVC ablation. Distances between the earliest LAT, the earliest hybrid-LAT, and the best pacemap positions were calculated in a 3D model. Ablation was performed at the best hybrid-LAT location. Efficacy was evaluated by acute response to ablation as well as clinical outcome on 24-h Holter at 1 year. One hundred and twenty-seven LAT-hybrid pairs were studied in 18 patients (age 48.3 ± 18.0 years, 12 female). Baseline PVC burden was 16 ± 12%. The mean position shift between LAT-hybrid and its associated LAT position was 8.9 ± 5.5 mm. The mean position shift between best LAT-hybrid and best pacemap was 6.2 ± 5.0 mm and the mean shift between best conventional LAT and best pacemap was 13.5 ± 7.0 mm (P < 0.0001 for all pairwise comparisons). Exclusive targeting of best LAT-hybrid position resulted in acute abolition of PVC activity in all patients. After 1-year follow-up, mean PVC burden reduction was 16% (baseline) to <1%. Conclusion Premature ventricular contractions cause a position shift in 3D mapping systems compared with the same endocardial position in sinus rhythm. An approach to account for this phenomenon, correct it and target exclusively the adjusted 3D position is feasible and highly efficient in terms of acute and 1-year clinical outcome after radiofrequency ablation.

Novel mapping algorithm during catheter ablation for ventricular parasystole originating from left anterior fascicle

“…Geometry of the presystolic ventricle is likely to differ during VPCs versus sinus rhythm and creating a map that corrects for this position shift has been effective for VPC ablation 4 . Here, we used the LAT-Hybrid system to automatically adjust for this displacement.…”

“…[1][2][3] However, recent studies show that VPCs cause a position shift in three-dimensional (3D) mapping systems compared with the same endocardial position during sinus rhythm. 4 We report the successful treatment of a ventricular parasystole originating from the left anterior fascicle (LAF) aided by accurate evaluation of LAF conductions using a novel mapping algorithm: parallel mapping and LAT hybrid system.…”

Impact of age on catheter ablation of premature ventricular contractions

“…It is a safe and effective method, yet has up to a 30% recurrence rate even at very experienced centers 2 . Commonly encountered reasons for failure include inaccurate mapping or poor catheter contact 3‐7 . Elderly patients have increased number of comorbidities and significant structural and electrical cardiac remodeling, potentially making the CA procedure riskier or less successful.…”

Spatial Correction Improves Accuracy of Catheter Positioning During Ablation of Premature Ventricular Contractions: Differences Between Ventricular Outflow Tracts And Other Localizations.

“…A novel mapping software tool (CARTO III, Software Version 7 Carto Prime, Biosense Webster) integrates an algorithm for correction of the aforementioned shift: for each registered PVC, the electrogram during the ectopic beat is paired with the location of the preceding sinus beat. This novel mapping algorithm is referred to as "hybrid mapping" [8]. Recently, rst clinical results have been published for mapping and ablation using hybrid mapping [8,9].…”

“…This novel mapping algorithm is referred to as "hybrid mapping" [8]. Recently, rst clinical results have been published for mapping and ablation using hybrid mapping [8,9]. However, the extent and in uencing factors of spatial displacement remain unclear.…”