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Premature Ventricular Contractions and Ultra-High-Definition Mapping. Contribution and Limits
Philippe Maury1,2, Quentin Voglimacci-Stephanopoli1, Benjamin Monteil1
1Department of Cardiology, University Hospital Rangueil, Toulouse, France.
Journal of Atrial Fibrillation
|December 24, 2021
Summary
Ultra-high definition mapping (UHDM) for premature ventricular contractions (PVC) ablation did not show superior results compared to conventional methods. While UHDM identified activation features, conventional mapping was faster and yielded similar long-term success rates.
Area of Science:
- Cardiac Electrophysiology
- Interventional Cardiology
- Medical Imaging Technology
Background:
- The effectiveness of ultra-high definition mapping (UHDM) in guiding ablation procedures for premature ventricular contractions (PVCs) is not well-established.
- This study aimed to evaluate UHDM for PVC ablation and compare its efficacy against conventional mapping techniques.
Purpose of the Study:
- To investigate the utility of UHDM in the ablation of premature ventricular contractions (PVCs).
- To compare the electrophysiological characteristics, procedural outcomes, and long-term success of UHDM versus conventional fluoroscopy-guided mapping for PVC ablation.
Main Methods:
- Prospective analysis of 20 patients undergoing PVC ablation with UHDM.
- Comparison of electrophysiological data and ablation results with 40 patients treated using conventional fluoroscopy-only mapping.
- Detailed analysis of electrograms, activation patterns, scar characteristics, pace-mapping concordance, and procedural parameters.
Main Results:
- UHDM recorded extensive electrograms (EGMs) and PVC beats, revealing detailed isochronal activation surfaces and local scar/block characteristics.
- Procedural and fluoroscopy times were significantly shorter with conventional mapping (190±51 min vs 100±36 min; 24±9 min vs 15±9 min, respectively).
- Acute success rates were comparable (65% UHDM vs 72% conventional), with similar long-term success (65% vs 68%) after 19 months, despite a lower residual PVC burden in the conventional group.
Conclusions:
- Ultra-high definition mapping may offer insights into complex PVC mechanisms and activation patterns not readily apparent with conventional methods.
- Despite potential visualization benefits, conventional mapping demonstrated comparable clinical outcomes while being more time-efficient.
- In this cohort, conventional mapping was faster and achieved similar clinical success to UHDM for premature ventricular contraction ablation.
