CardioInsight Bibliography Cardiac Mapping

Non-Invasive Electrocardiographic Mapping to Guide Ablation of Outflow Tract Ventricular Arrhythmias

Jamil-Copley S, Bokan R, Kojodjojo P, Qureshi N, Koa-Wing M, Hayat S, et al. Noninvasive electrocardiographic mapping to guide ablation of outflow tract ventricular arrhythmias. Heart Rhythm. 2014;11:587-594.

Aims

Assess the performance of non-invasive mapping (ECM) in the pre-/periprocedural localization of OTVT origin to guide ablation and to compare the accuracy of ECM with that of published pre-procedure ECG algorithms.

Methods

• Prospective, non-randomized
• n=24
• Noninvasive ECM (CIT) vs. to pre-procedure ECG algorithms

ECM: Potential Map, Pacing Spike Voltage Map, & Activation Maps

Study Author's Conclusion

“ECM can accurately identify OTVT/PVC origin in the left and the right ventricle pre- and periprocedurally to guide catheter ablation with an accuracy superior to that of published ECG algorithms.”

Clinical impact of a novel three-dimensional electrocardiographic imaging for non-invasive mapping of ventricular arrhythmias — a prospective randomized trial 

Erkapic D, Greiss H, Pajitnev D, Zaltsberg S, Deubner N, Berkowitsch A, et al. Clinical impact of a novel three-dimensional electrocardiographic imaging for non-invasive mapping of ventricular arrhythmias-a prospective randomized trial. Europace. 2015;17:591-597.

Aims

Evaluate use of non-invasive 3D Mapping (ECM) in routine clinical mapping and ablation of ventricular arrhythmias (VAs)

Methods

• Prospective, non-randomized ECVUE vs 12 lead ECG
• PVC with or without monomorphic VT
• n=42

Results

*=P-value ≤ 0.005

Outcomes

• 3 month success rate: 
  • ECVUE (95.2%) 
  • ECG (100%)

Study Authors' Conclusion

“ECVUE^TM technology offers a clinically useful tool to map VAs with high accuracy and more targeted ablations superior to body surface ECG, but had significantly higher radiation exposure due to computer tomography scan.”

Validation of novel 3-dimensional electrocardiographic mapping of atrial tachycardias by invasive mapping and ablation: A multicenter study

Shah AJ, Hocini M, Xhaet O, Pascale P, Roten L, Wilton SB, et al. Validation of novel 3-dimensional electrocardiographic mapping of atrial tachycardias by invasive mapping and ablation: a multicenter study. J Am Coll Cardiol. 2013;62:889-897.

Aims

Prospective evaluation of the role of a 3D non-invasive mapping system (ECM), in facilitating the diagnosis of atrial tachycardias (AT).

Methods

• Multicenter, Prospective, non-randomized
• 3 centers, n=52
• ECM with CIT compared to intracardiac 3D Mapping with Carto/Ensite for patients with Atrial Tachycardia

Results

ECM and EP Diagnosis achieved in 48/52 pts (92%)

In 4 patients clinical AT converted to another rhythm (AT, AF, or sinus) before invasive mapping could be completed therefore pts excluded from analysis.

ECM correctly diagnosed AT mechanisms in 44/48 (92%)

The 2:1 ventricular conduction and low-amplitude P waves challenged the diagnosis of 4/27 macroreentrant ATs that could be overcome by injecting AV node blockers and signal averaging, respectively.

Accuracy of Electrocardiomapping in Defining Ablation Targets

Accuracy for a) unablated atria — 100% (25/25); b) previously ablated atria — 83% (19/23).

Study Authors' Conclusion

"This prospective multicenter series shows high success rate of ECM in accurately diagnosing the mechanism of AT and the location of focal arrhythmia."

Focal Arrhythmia Ablation Determined by High-Resolution Noninvasive Maps: Multicenter Feasibility Study

Hocini M, Shah AJ, Neumann T, Kuniss M, Erkapic D, Chaumeil A, et al. Focal Arrhythmia Ablation Determined by High-Resolution Noninvasive Maps: Multicenter Feasibility Study. J Cardiovasc Electrophysiol. 2015;26:754-760.

Aims

Prospective evaluation of the role of a high resolution non-invasive mapping system for patients with PVC’s, AT’s, and WPW.

Methods

• Multicenter, Prospective, non-randomized
• 3 centers, n=33

Results

Successful ablation in 32/33 patients (97%) without complications.

Procedure Metrics

• Average time from catheterization to arrhythmia termination: 16 min
• Average RF Ablation time: 3.98 min
• Average Procedure time (skin-to-skin): 71 min
• Average Fluro time: 11.9 min

Average cumulative radiation exposure (CT scan and fluoro): 7.57 mSv

Procedure Data

Study Authors' Conclusion

“ECVUE^TM is a noninvasive tool allowing pre-procedural localization of the origin of the arrhythmia and direct RF delivery to the focal source without the need for intracardiac mapping.”

Non-invasive cardiac mapping in clinical practice: Application to the ablation of cardiac arrhythmias

Dubois, R., Shah, A.J., Hocini, M., Denis, A., Derval, N., Cochet, H., Sacher, F., Bear, L., Duchateau, J., Jais, P. and Haissaguerre, M., 2015. Non-invasive cardiac mapping in clinical practice: Application to the ablation of cardiac arrhythmias. Journal of Electrocardiology, 48(6), pp.966-974.

Aims

Description of clinical experience in using non-invasive mapping technique to identify the sources of electrical disorders and guide catheter ablation of atrial and ventricular arrhythmias.

Methods/Background

• Prospective, non-randomized
• Patients mapped non-invasively:
  • 23 Paraoxysmal AF
  • 103 Persistent AF
  • 52 with various clinical ATs 
• Using the driver-density map as a guide, point-by-point lesions applied at area of reentrant or focal drivers of PeAF, starting with region of highest driver density and proceeding in decreasing order.

Results

• PAF: 657 drivers mapped; termination achieved in all
• PeAF: Acute termination = 80%; driver-based ablation guided by non-invasive mapping achieved similar 12-month clinical outcomes to traditional approach but with half the amount of ablation
• AT: all 48 evaluable clinical ATs were successfully terminated by ablation

Upper & Middle Panels: The endpoint of local ablation is increase in local cycle length and transformation of rapid and complex signals into slower local rhythm.

Lower Panel: It is not desirable to achieve complete electrogram abolition locally which results in tissue scarring post-ablation.

Study Authors' Conclusion

“Various atrial and ventricular arrhythmias including complex fibrillatory processes can be mapped non-invasively to guide catheter ablation. The pre- and peri-procedural utility of the system in panoramic 3D mapping expresses its potential to reduce invasive procedural, fluoroscopic and ablation times.”