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

Publisher DOI
PubMed ID
23727090
Abstract
OBJECTIVES

This study prospectively evaluated the role of a novel 3-dimensional, noninvasive, beat-by-beat mapping system, Electrocardiographic Mapping (ECM), in facilitating the diagnosis of atrial tachycardias (AT).

BACKGROUND

Conventional 12-lead electrocardiogram, a widely used noninvasive tool in clinical arrhythmia practice, has diagnostic limitations.

METHODS

Various AT (de novo and post-atrial fibrillation ablation) were mapped using ECM followed by standard-of-care electrophysiological mapping and ablation in 52 patients. The ECM consisted of recording body surface electrograms from a 252-electrode-vest placed on the torso combined with computed tomography-scan-based biatrial anatomy (CardioInsight Inc., Cleveland, Ohio). We evaluated the feasibility of this system in defining the mechanism of AT-macro-re-entrant (perimitral, cavotricuspid isthmus-dependent, and roof-dependent circuits) versus centrifugal (focal-source) activation-and the location of arrhythmia in centrifugal AT. The accuracy of the noninvasive diagnosis and detection of ablation targets was evaluated vis-à-vis subsequent invasive mapping and successful ablation.

RESULTS

Comparison between ECM and electrophysiological diagnosis could be accomplished in 48 patients (48 AT) but was not possible in 4 patients where the AT mechanism changed to another AT (n = 1), atrial fibrillation (n = 1), or sinus rhythm (n = 2) during the electrophysiological procedure. ECM correctly diagnosed AT mechanisms in 44 of 48 (92%) AT: macro-re-entry in 23 of 27; and focal-onset with centrifugal activation in 21 of 21. The region of interest for focal AT perfectly matched in 21 of 21 (100%) AT. The 2:1 ventricular conduction and low-amplitude P waves challenged the diagnosis of 4 of 27 macro-re-entrant (perimitral) AT that can be overcome by injecting atrioventricular node blockers and signal averaging, respectively.

CONCLUSIONS

This prospective multicenter series shows a high success rate of ECM in accurately diagnosing the mechanism of AT and the location of focal arrhythmia. Intraprocedural use of the system and its application to atrial fibrillation mapping is under way.
Date Issued
2013-09-03
Publication Type
Article
Subject(s)
Subjects
ablation
•
atrial tachycardia
•
electrocardiomapping
•
noninvasive mapping
Language(s)
en
Author(s)
Shah, Ashok J.
Hocini, Meleze
Xhaet, Olivier
Pascale, Patrizio
Wilton, Stephen B.
Linton, Nick
Scherr, Daniel
Miyazaki, Shinsuke
Jadidi, Amir S.
Liu, Xingpeng
Forclaz, Andrei
Nault, Isabelle
Rivard, Lena
Pedersen, Michala E. F.
Derval, Nicolas
Sacher, Frederic
Knecht, Sebastien
Jais, Pierre
Dubois, Remi
Eliautou, Sandra
Bokan, Ryan
Strom, Maria
Ramanathan, Charu
Cakulev, Ivan
Sahadevan, Jayakumar
Lindsay, Bruce
Waldo, Albert L.
Haissaguerre, Michel
Additional Credits
Journal
Journal of the American College of Cardiology
Publisher
Elsevier
ISSN
0735-1097
Access(Rights)
metadata.only
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