Usefulness of the Contact Force Sensing Catheter to Assess the Areas of Myocardial Scar in Patients With Ventricular Tachycardia

Muñoz, Juan José Sánchez; Peñafiel-Verdú, Pablo; Sánchez, Juan Martínez; Alcaraz, Mariela Salar; Chávarri, Mariano Valdés; Alberola, Arcadio García

doi:10.1016/j.rec.2014.09.011

Cited by 5 publications

(13 citation statements)

References 5 publications

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“…The database to be analyzed came from 11 patients (8 males) with age 64.9 (38-80) years [5], where 1161 EGM cases were obtained. This database consisted of recordings in surface ECG and intracardiac EGM sampled at 1KHz and recordings of the force sensor sampled at 85 Hz.…”

Section: Patients and Egm Databasementioning

confidence: 99%

“…During electrophysiological studies, an X-ray camera is used in order to determine if the catheter is properly located on the interior of the heart. In addition, these studies are also supported by intracardiac navigation systems, such as NavX R or Carto R [4,5].…”

Section: Introductionmentioning

confidence: 99%

“…The manufacturers of the equipment used for this type of studies have suggested that the catheter has to take a reading above or equal to 5g [5], the rationale for using this threshold being that the catheter is surrounded by blood, which produces a force of less than 5g interacting with the sensor. In a recent study [5], the use of the catheter with the force sensor was used to correct a voltaje map of the left ventricle obtained from navigation systems, with the purpose of determining areas of myocardial scar. The used criteria on the electrogram (EGM) amplitude were to distinguish among scar (< 0.5 mV), low voltage (0.5 − 1.5 mV), and normal (> 1.5 mV), with a reference to force higher than 5g.…”

Section: Introductionmentioning

confidence: 99%

“…We first performed a correlation analysis of EGM morphology in terms of the force threshold, and then we made a multivariable analysis based on the Fisher discriminant criterion. For this purpose we used a database of 1161 EGM from 11 patients, previously assembled in [5].…”

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

A Quantitative Analysis on the Intracardiac Electrogram Contact During Ventricular Tachycardia Ablation

Rivas

Huerta

Sanromán‐Junquera

et al. 2016

2016 Computing in Cardiology Conference (CinC)

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Cardiac arrhythmias are currently treated with ablation procedures, which are guided by X-ray cameras and intracardiac electrograms (EGM) recordings. Recently, the use of catheters with force sensors have been proposed for improving the contact of the sensing catheter over the heart wall, aiming to guarantee the reliability of electrical measurements. Manufacturers of the equipment used for this type of studies have suggested that the catheter has to take a reading above or equal to 5g. We aimed to determine whether the waveform of the EGM can provide us with some information about the good contact conditions of the catheter on the endocardium, by using the recorded force as a gold standard. We first performed a correlation analysis of EGM morphology in terms of the force threshold, and then we made a multivariable analysis based on the Fisher discriminant. The database to be analyzed came from 11 patients (8 males) with mean age of 64.9 years, where 1161 EGM signals were obtained. The EGM set corresponded to the voltage maps of the left ventricle during sinus rhythm. The correlation coefficient between consecutive EGM beats larger and lower than 0.8 in EGM morphology showed similar ratios of averaged force in those beats with larger force (49% vs 46% for force>5g), 29% vs 28% for force<5g. Fisher discriminant analysis yielded error probability larger than 0.3 for the best discrimination case. These previous results show that the EGM morphology seems to have limited information about the catheter contact when scrutinized with simple signal processing methods.

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Section: Patients and Egm Databasementioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

A Quantitative Analysis on the Intracardiac Electrogram Contact During Ventricular Tachycardia Ablation

Rivas

Huerta

Sanromán‐Junquera

et al. 2016

2016 Computing in Cardiology Conference (CinC)

View full text Add to dashboard Cite

show abstract

“…This procedure allows the clinician to identify the arrhythmia mechanism and to supply an adequate therapy [ 10 , 11 ]. Systems LocaLisa and Carto

3 are widely used examples of this type of equipment, and they basically consist of a positioning subsystem, a set of advanced catheters, and data storage and processing equipment [ 12 , 13 ].…”

Section: Introductionmentioning

confidence: 99%

Force Trends and Pulsatility for Catheter Contact Identification in Intracardiac Electrograms during Arrhythmia Ablation

Rivas

Muñoz-Romero

Huerta

et al. 2018

Sensors

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The intracardiac electrical activation maps are commonly used as a guide in the ablation of cardiac arrhythmias. The use of catheters with force sensors has been proposed in order to know if the electrode is in contact with the tissue during the registration of intracardiac electrograms (EGM). Although threshold criteria on force signals are often used to determine the catheter contact, this may be a limited criterion due to the complexity of the heart dynamics and cardiac vorticity. The present paper is devoted to determining the criteria and force signal profiles that guarantee the contact of the electrode with the tissue. In this study, we analyzed 1391 force signals and their associated EGM recorded during 2 and 8 s, respectively, in 17 patients (82 ± 60 points per patient). We aimed to establish a contact pattern by first visually examining and classifying the signals, according to their likely-contact joint profile and following the suggestions from experts in the doubtful cases. First, we used Principal Component Analysis to scrutinize the force signal dynamics by analyzing the main eigen-directions, first globally and then grouped according to the certainty of their tissue-catheter contact. Second, we used two different linear classifiers (Fisher discriminant and support vector machines) to identify the most relevant components of the previous signal models. We obtained three main types of eigenvectors, namely, pulsatile relevant, non-pulsatile relevant, and irrelevant components. The classifiers reached a moderate to sufficient discrimination capacity (areas under the curve between 0.84 and 0.95 depending on the contact certainty and on the classifier), which allowed us to analyze the relevant properties in the force signals. We conclude that the catheter-tissue contact profiles in force recordings are complex and do not depend only on the signal intensity being above a threshold at a single time instant, but also on time pulsatility and trends. These findings pave the way towards a subsystem which can be included in current intracardiac navigation systems assisted by force contact sensors, and it can provide the clinician with an estimate of the reliability on the tissue-catheter contact in the point-by-point EGM acquisition procedure.

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Accuracy of standard bipolar amplitude voltage thresholds to identify late potential channels in ventricular tachycardia ablation

Roca‐Luque

Zaraket

Garre

et al. 2022

J Interv Card Electrophysiol

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Background Ventricular tachycardia (VT) is caused by the presence of a slow conduction channel (CC) of border zone (BZ) tissue inside the scar-core tissue. Electroanatomic mapping can depict this tissue by voltage mapping. Areas of slow conduction can be detected as late potentials (LPs) and their abolition is the most accepted ablation endpoint. In the current guidelines, bipolar voltage thresholds for BZ and core scar are 1.5 and 0.5 mV respectively. The performance of these values is controversial. The aim of the study is to analyze the diagnostic yield of current amplitude thresholds in voltage map to define VT substrate in terms of CCs of LPs. Predictors of usefulness of current thresholds will be analyzed. Methods All patients with structural heart disease who underwent VT ablation in Hospital Clinic in 2016–2017 were included. Maps with delineation of CCs based on LPs were created with contact force sensor catheter. Thresholds were adjusted for every patient based on CCs. Diagnostic yield and predictors of performance of conventional thresholds were analyzed. Results During study period, 57 consecutive patients were included (age: 60.4 ± 8.5; 50.2% ischemic cardiomyopathy, LVEF 39.8 ± 13.5%). Cutoff voltages that better identified the scar and BZ according to the LP channels were 0.32 (0.02–2 mV) and 1.84 (0.3–6 mV) respectively. Current voltage thresholds identified correctly core and BZ in 87.7% and 42.1% of the patients respectively. Accuracy was worse in non-ischemic cardiomyopathy (NICM) especially for BZ (28.6% vs 55.2%, p = 0.042). Conclusions Accuracy of standard voltage thresholds for scar and BZ is poor in terms of LPs detection. Diagnostic yield is worse in NICM patients specially for border zone.

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Usefulness of the Contact Force Sensing Catheter to Assess the Areas of Myocardial Scar in Patients With Ventricular Tachycardia

Cited by 5 publications

References 5 publications

A Quantitative Analysis on the Intracardiac Electrogram Contact During Ventricular Tachycardia Ablation

A Quantitative Analysis on the Intracardiac Electrogram Contact During Ventricular Tachycardia Ablation

Force Trends and Pulsatility for Catheter Contact Identification in Intracardiac Electrograms during Arrhythmia Ablation

Accuracy of standard bipolar amplitude voltage thresholds to identify late potential channels in ventricular tachycardia ablation

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