Prospective Multicenter Assessment of a New Intraprocedural Automated System for Localizing Idiopathic Ventricular
Shijie Zhou1, Amir AbdelWahab2, John L Sapp3
1Department of Biomedical Engineering, Johns Hopkins University, Baltimore, Maryland, USA; Alliance for Cardiovascular Diagnostic and Treatment Innovation, Johns Hopkins University, Baltimore, Maryland, USA.
JACC. Clinical Electrophysiology
|March 19, 2021
Summary
A new Automatic Arrhythmia Origin Localization (AAOL) system accurately pinpoints idiopathic ventricular arrhythmia (IVA) origins using incomplete electroanatomic mapping. This innovation aids catheter ablation by precisely locating arrhythmia sources in the ventricles and adjacent vessels.
Area of Science:
- Cardiovascular Electrophysiology
- Medical Device Technology
- Cardiac Imaging
Background:
- Previous automated systems for arrhythmia origin localization had limitations, including inability to identify right ventricular origins and reliance on complete electroanatomic mapping (EAM).
- Idiopathic ventricular arrhythmias (IVA) often require precise localization for effective catheter ablation, especially in challenging cardiac structures.
Purpose of the Study:
- To introduce and evaluate the Automatic Arrhythmia Origin Localization (AAOL) system for precise localization of IVA origins.
- To assess the accuracy of the AAOL system using incomplete EAM on patient-specific cardiac geometry.
- To determine the system's utility in localizing arrhythmia sources where traditional pace mapping is difficult.
Main Methods:
- The AAOL system integrated 12-lead electrocardiogram (ECG) data (specifically 120-ms QRS integrals from leads III, V2, and V6) with patient-specific EAM geometry.
- Pacing data from various locations on the EAM were used in conjunction with ECG integrals to predict the earliest ventricular activation site.
- The predicted activation site was then projected onto the patient's EAM geometry for visualization.
Main Results:
- The study included 20 patients undergoing IVA catheter ablation, with 23 distinct IVA origin sites identified.
- The AAOL system demonstrated a high mean localization accuracy of 3.6 mm for the identified IVA origins.
- Identified origins included sites in the right ventricle (8) and left ventricle (15), encompassing challenging locations like the posteromedial papillary muscle and aortic root.
Conclusions:
- The novel intraprocedural AAOL system provides accurate localization of IVA origins within the ventricles and neighboring vessels.
- This system has the potential to significantly facilitate and improve the success of catheter ablation procedures for patients suffering from IVAs.
Related Concept Videos
01:30Dysrhythmias V: Evaluating Dysrhythmias
184
Dysrhythmias, also known as arrhythmias, are disturbances in the heart's rhythm that range from benign to life-threatening. A thorough evaluation is crucial for appropriate management and involves a comprehensive medical history, physical examination, and various diagnostic tests.Medical HistorySymptoms: Collect detailed information on palpitations, dizziness, syncope, chest pain, and fatigue. Note their onset, frequency, and triggers.Previous Cardiac Issues: Document any history of heart...
184
01:28Cardiac Catheterization I: Pre-Procedure Overview
444
Cardiac catheterization is an invasive diagnostic technique used to identify and evaluate structural and functional diseases of the heart and major blood vessels. This technique diagnoses congenital heart disease, coronary artery disease, valvular heart disease, and coronary spasms and assesses ventricular function. It helps guide treatment decisions, including the need for revascularization procedures like percutaneous coronary intervention (PCI) or coronary artery bypass grafting (CABG) and...
444