Noninvasive epicardial and endocardial mapping of premature ventricular contractions

The aim of the present study was to estimate the accuracy of a novel non-invasive epicardial and endocardial electrophysiology system (NEEES) for mapping ectopic ventricular depolarizations. The study enrolled 20 patients with monomorphic premature ventricular contractions (PVCs) or ventricular tach...

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Bibliographic Details
Published in:	Europace (London, England) Vol. 19; no. 5; pp. 843 - 849
Main Authors:	Wissner, Erik, Revishvili, Amiran, Metzner, Andreas, Tsyganov, Alexey, Kalinin, Vitaly, Lemes, Christine, Saguner, Ardan M, Maurer, Tilman, Deiss, Sebastian, Sopov, Oleg, Labarkava, Eugene, Chmelevsky, Mikhail, Kuck, Karl-Heinz
Format:	Journal Article
Language:	English
Published:	England Oxford University Press 01-05-2017
Subjects:	Adult Aged Body Surface Potential Mapping - instrumentation Body Surface Potential Mapping - methods Clinical Research Diagnosis, Differential Endocardium Equipment Design Equipment Failure Analysis Female Humans Male Middle Aged Pericardium Preoperative Care - methods Reproducibility of Results Sensitivity and Specificity Tachycardia, Ventricular - diagnosis Tachycardia, Ventricular - surgery Ventricular Premature Complexes - diagnosis Ventricular Premature Complexes - surgery Ventricular arrhythmias Premature ventricular contraction Ventricular tachycardia Non-invasive imaging Non-invasive epicardial and endocardial electrophysiology system
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Summary:	The aim of the present study was to estimate the accuracy of a novel non-invasive epicardial and endocardial electrophysiology system (NEEES) for mapping ectopic ventricular depolarizations. The study enrolled 20 patients with monomorphic premature ventricular contractions (PVCs) or ventricular tachycardia (VT). All patients underwent pre-procedural computed tomography or magnetic resonance imaging of the heart and torso. Radiographic data were semi-automatically processed by the NEEES to reconstruct a realistic 3D model of the heart and torso. In the electrophysiology laboratory, body-surface electrodes were connected to the NEEES followed by unipolar EKG recordings during episodes of PVC/VT. The body-surface EKG data were processed by the NEEES using its inverse-problem solution software in combination with anatomical data from the heart and torso. The earliest site of activation as denoted on the NEEES 3D heart model was compared with the PVC/VT origin using a 3D electroanatomical mapping system. The site of successful catheter ablation served as final confirmation. A total of 21 PVC/VT morphologies were analysed and ablated. The chamber of interest was correctly diagnosed non-invasively in 20 of 21 (95%) PVC/VT cases. In 18 of the 21 (86%) cases, the correct ventricular segment was diagnosed. Catheter ablation resulted in acute success in 19 of the 20 (95%) patients, whereas 1 patient underwent successful surgical ablation. During 6 months of follow-up, 19 of the 20 (95%) patients were free from recurrence off antiarrhythmic drugs. The NEEES accurately identified the site of PVC/VT origin. Knowledge of the potential site of the PVC/VT origin may aid the physician in planning a successful ablation strategy.
Bibliography:	ObjectType-Article-2 SourceType-Scholarly Journals-1 ObjectType-Feature-1 content type line 23
ISSN:	1099-5129 1532-2092
DOI:	10.1093/europace/euw103