Noninvasive electrocardiographic mapping to guide ablation of outflow tract ventricular arrhythmias.

Abstract

BACKGROUND:

Localizing the origin of outflow tract ventricular tachycardias (OTVT) is hindered by lack of accuracy of electrocardiographic (ECG) algorithms and infrequent spontaneous premature ventricular complexes (PVCs) during electrophysiological studies.

OBJECTIVES:

To prospectively assess the performance of noninvasive electrocardiographic mapping (ECM) in the pre-/periprocedural localization of OTVT origin to guide ablation and to compare the accuracy of ECM with that of published ECG algorithms.

METHODS:

Patients with symptomatic OTVT/PVCs undergoing clinically indicated ablation were recruited. The OTVT/PVC origin was mapped preprocedurally by using ECM, and 3 published ECG algorithms were applied to the 12-lead ECG by 3 blinded electrophysiologists. Ablation was guided by using ECM. The OTVT/PVC origin was defined as the site where ablation caused arrhythmia suppression. Acute success was defined as abolition of ectopy after ablation. Medium-term success was defined as the abolition of symptoms and reduction of PVC to less than 1000 per day documented on Holter monitoring within 6 months.

RESULTS:

In 24 patients (mean age 50 ± 18 years) recruited ECM successfully identified OTVT/PVC origin in 23/24 (96%) (right ventricular outflow tract, 18; left ventricular outflow tract, 6), sublocalizing correctly in 100% of this cohort. Acute ablation success was achieved in 100% of the cases with medium-term success in 22 of 24 patients. PVC burden reduced from 21,837 ± 23,241 to 1143 ± 4039 (P < .0001). ECG algorithms identified the correct chamber of origin in 50%-88% of the patients and sublocalized within the right ventricular outflow tract (septum vs free-wall) in 37%-58%.

CONCLUSIONS:

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.

• Authors: Shahnaz Jamil-Copley, Ryan Bokan, Pipin Kojodjojo, Norman Qureshi, Michael Koa-Wing, Sajad Hayat, Andreas Kyriacou, Belinda Sandler, Afzal Sohaib, Ian Wright, David Wyn Davies, Zachary Whinnett, Nicholas S Peters, Prapa Kanagaratnam, Phang Boon Lim
• Journal: Heart rhythm (Heart Rhythm) Vol. 11 Issue 4 Pg. 587-94 (Apr 2014) ISSN: 1556-3871 [Electronic] United States
• PMID: 24440381 (Publication Type: Comparative Study, Journal Article, Research Support, Non-U.S. Gov't)
• Copyright: Copyright © 2014 Heart Rhythm Society. Published by Elsevier Inc. All rights reserved.

Topics

• Body Surface Potential Mapping (methods)
• Catheter Ablation (methods)
• Electrocardiography
• Humans
• Middle Aged
• Prospective Studies
• Tachycardia, Ventricular (surgery)