Validation of the mapping accuracy of a novel non-invasive epicardial and endocardial electrophysiology system

Abstract

AimsUse of a non-invasive electrocardiographic mapping system may aid in rapid diagnosis of atrial or ventricular arrhythmias or the detection of ventricular dyssynchrony. The aim of the present study was to validate the mapping accuracy of a novel non-invasive epi- and endocardial electrophysiology system (NEEES).Methods and resultsPatients underwent pre-procedural computed tomography or magnetic resonance imaging of the heart and torso. Radiographic data were merged with the data obtained from the NEEES during pacing from implanted pacemaker leads or pacing from endocardial sites using an electroanatomical mapping system (CARTO 3, Biosense Webster). The earliest activation as denoted on the NEEES three-dimensional heart model was compared with the true anatomic location of the tip of the pacemaker lead or the annotated pacing site on the CARTO 3 map. Twenty-nine patients [mean age: 62 ± 11 years, 6/29 (11%) female, 21/29 (72%) with ischaemic cardiomyopathy] were enrolled into the pacemaker verification group. The mean distance from the non-invasively predicted pacing site to the anatomic reference site was 10.8 ± 5.4 mm for the right atrium, 7.7 ± 5.8 mm for the right ventricle, and 7.9 ± 5.7 mm for the left ventricle activated via the coronary sinus lead. Five patients [mean age 65 ± 4 years, 2 (33%) females] underwent CARTO 3 verification study. The mean distance between non-invasively reconstructed pacing site and the reference pacing site was 7.4 ± 2.7 mm for the right atrium, 6.9 ± 2.3 mm for the left atrium, 6.5 ± 2.1 mm for the right ventricle, and 6.4 ± 2.2 for the left ventricle, respectively.ConclusionThe novel NEEES was able to correctly identify the site of pacing from various endo- and epicardial sites with high accuracy.

First-in-Man Analysis of the Relationship Between Electrical Rotors From Noninvasive Panoramic Mapping and Atrial Fibrosis From Magnetic Resonance Imaging in Patients With Persistent Atrial Fibrillation

“…20 The Amycard 01C EP laboratory (EP Solutions SA, Yverdon-les-Bains, Switzerland) was used for noninvasive ECG imaging. A total of 224 MRI-compatible body surface mapping electrodes were applied on the patient's torso and connected to the multichannel ECG amplifier (EP Solutions SA).…”

“…Mean value of total observation time for NEEES was 18.9 s; mean (SD) value of ECG fragment length was 561 ms (154 ms). The median (interquartile range, 25%-75%) number of revealed rotors per patient was n=20 (14-30), n=20 (11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22), and n=44 (24-56) for the RA, LA, and total, respectively. The majority of the rotors in the LA was located along the inferior wall n=66 (minimal 1-17 maximal rotor(s) at this location) and in vicinity to the right superior pulmonary vein (PV) n=35 (0-10).…”

Innovations in Clinical Cardiac Electrophysiology: Challenges and Upcoming Solutions in 2018 and Beyond

“…Catheters with close inter-electrode Two hundred twenty-four unipolar surface electrodes are used to acquire electrograms that are projected on magnetic resonance imaging atrial shells to detect rotors. 132,133 FIRM: focal impulse and rotor mapping; 3D: three-dimensional. spacing resulting in improved spatial resolution may enhance our ability to detect rotors with confidence.…”

New approaches to predicting the risk of sudden death

“…There may also be a role in supporting ventricular tachycardia ablation. 51 As yet, the role of ECG imaging in risk evaluation remains in research but it appears to offer a highly accurate, multi-dimensional assessment of arrhythmia characterisation and localisation, which sets it apart from other non-invasive ECG markers.…”