Proof of concept study of a novel pacemapping algorithm as a basis to guide ablation of ventricular arrhythmias. Issue 10 (8th March 2018)

• Record Type: Journal Article
• Authors: Li, Anthony; Davis, Joseph Samuel; Grimster, Alexander; Wierwille, Jeremiah; Herold, Keith; Morgan, Dennis; Behr, Elijah R; Shorofsky, Stephen; Saba, Magdi
• Is Part Of: Europace. Volume 20:Issue 10(2018)
• Page Start: 1647
• Page End: 1656
• Publication Date: 2018-03-08
• Subjects: Pacemapping -- Ventricular tachycardia -- Ventricular ectopy -- Mapping -- Ablation; Arrhythmia -- Treatment -- Periodicals; Cardiac pacing -- Periodicals; Catheter ablation -- Periodicals; Heart -- Physiology -- Periodicals; Electrophysiology -- Periodicals; 617.4120645
• DOI: 10.1093/europace/euy024
• Languages: English
• ISSNs: 1099-5129

Abstract

Abstract: Aims: To determine if a software algorithm can use an individualized distance-morphology difference model, built from three initial pacemaps, to prospectively locate the exit site (ES) of ventricular arrhythmias (VA). Methods and results: Consecutive patients undergoing ablation of VA from a single centre were recruited. During mapping, three initial pacing points were collected in the chamber of interest and the navigation algorithm applied to predict the ES, which was corroborated by conventional mapping techniques. Thirty-two patients underwent ES prediction over 35 procedures. Structural heart disease was present in 16 (7 ischaemic cardiomyopathy, 9 non-ischaemic cardiomyopathy), median ejection fraction 45% [Interquartile range (IQR) 26]. The remainder had normal hearts. The navigation algorithm was applied to 46 VA (24 left ventricle, 11 right ventricular outflow tract, 5 left ventricular outflow tract, 4 right ventricle, 2 epicardial) and successfully located the site of best pacemap match in 45 within a median area of 196.5 mm 2 (IQR 161.3, range 46.6–1288.2 mm 2 ). Conclusions: In a diverse population of patients with and without structural heart disease, the ES of VA can be accurately and reliably identified to within a clinically useful target area using a simple software navigation algorithm based on pacemapping.