Prospective Assessment of an Automated Intraprocedural 12-Lead ECG-Based System for Localization of Early Left Ventricular Activation. (July 2020)

• Record Type: Journal Article
• Authors: Zhou, Shijie; AbdelWahab, Amir; Horáček, B. Milan; MacInnis, Paul J.; Warren, James W.; Davis, Jason S.; Elsokkari, Ihab; Lee, David C.; MacIntyre, Ciorsti J.; Parkash, Ratika; Gray, Chris J.; Gardner, Martin J.; Marcoux, Curtis; Choudhury, Rajin; Trayanova, Natalia A.; Sapp, John L.
• Is Part Of: Circulation. Volume 13:Number 7(2020)
• Publication Date: 2020-07
• Subjects: arrhythmias -- catheter ablation -- electrocardiography -- electrophysiology -- human -- ventricular tachycardia; Arrhythmia -- Periodicals; Heart -- Electric properties -- Periodicals; 616.128
• DOI: 10.1161/CIRCEP.119.008262
• Languages: English
• ISSNs: 1941-3149

Abstract

Abstract : Background: To facilitate ablation of ventricular tachycardia (VT), an automated localization system to identify the site of origin of left ventricular activation in real time using the 12-lead ECG was developed. The objective of this study was to prospectively assess its accuracy. Methods: The automated site of origin localization system consists of 3 steps: (1) localization of ventricular segment based on population templates, (2) population-based localization within a segment, and (3) patient-specific site localization. Localization error was assessed by the distance between the known reference site and the estimated site. Results: In 19 patients undergoing 21 catheter ablation procedures of scar-related VT, site of origin localization accuracy was estimated using 552 left ventricular endocardial pacing sites pooled together and 25 VT-exit sites identified by contact mapping. For the 25 VT-exit sites, localization error of the population-based localization steps was within 10 mm. Patient-specific site localization achieved accuracy of within 3.5 mm after including up to 11 pacing (training) sites. Using 3 remotes (67.8±17.0 mm from the reference VT-exit site), and then 5 close pacing sites, resulted in localization error of 7.2±4.1 mm for the 25 identified VT-exit sites. In 2 emulated clinical procedure with 2 induced VTs, the site of origin localization system achieved accuracy within 4 mm. Conclusions: In this prospective validation study, the automated localization system achieved estimated accuracy within 10 mm and could thus provide clinical utility.