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Updated: Apr 28, 2026
10:17
Real-Time Cardiac Mapping with a Noninvasive Imageless Electrocardiographic Imaging System
Published on: April 11, 2025
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New diagnostic criteria for identifying left-sided ventricular ectopy using non-contact mapping and virtual unipolar
Nicola Trevisi1, John Silberbauer2, Andrea Radinovic2
1Arrhythmia Unit and Electrophysiology Laboratories, Ospedale San Raffaele, Via Olgettina 60, Milan, Italy trevisi.nicola@hsr.it.
Summary
Non-contact mapping effectively ablates outflow tract premature ventricular contractions (PVCs) and ventricular tachycardia (VT). New virtual unipolar electrogram criteria accurately distinguish left from right-sided foci, improving ablation guidance.
Area of Science:
- Cardiac Electrophysiology
- Interventional Cardiology
- Medical Device Technology
Background:
- Outflow tract premature ventricular contractions (PVCs) and ventricular tachycardia (VT) are common arrhythmias.
- Catheter ablation is a primary treatment, but precise localization of the arrhythmogenic focus can be challenging.
- Non-contact mapping offers a potential solution for improved visualization and targeting of these foci.
Purpose of the Study:
- To evaluate the efficacy of non-contact mapping for outflow tract PVC/VT ablation in patients without structural heart disease.
- To determine the diagnostic accuracy of novel virtual unipolar electrogram criteria for differentiating left from right-sided arrhythmogenic foci.
- To assess the reproducibility of these criteria in guiding ablation procedures.
Main Methods:
- A multi-electrode array was used for non-contact mapping within the right ventricular outflow tract.
- Virtual unipolar electrograms were analyzed for early activation (EA) and break out (BO) characteristics.
- Voltage (EA-V20) and timing (BO-QRS) parameters were developed and validated to distinguish left from right-sided foci.
- Prospective assessment of these criteria was performed in a separate patient cohort.
Main Results:
- Non-contact mapping achieved excellent success rates for outflow tract PVC/VT ablation.
- The virtual unipolar electrogram criteria, specifically voltage at 20 ms after early activation (EA-V20) and time from break out to QRS onset (BO-QRS), demonstrated high diagnostic accuracy (AUC > 0.94).
- These criteria showed excellent inter-beat and inter-observer reproducibility, confirming their reliability.
Conclusions:
- Non-contact mapping is an effective strategy for outflow tract PVC/VT ablation, yielding high success rates.
- Virtual unipolar electrogram analysis provides an accurate and reproducible method for localizing arrhythmogenic foci.
- These findings support the use of non-contact mapping and virtual electrogram criteria to guide ablation procedures for improved patient outcomes.
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