Format

Send to

Choose Destination
Heart Rhythm. 2014 Apr;11(4):587-94. doi: 10.1016/j.hrthm.2014.01.013. Epub 2014 Jan 17.

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

Author information

1
Imperial College London, London, United Kingdom.
2
Cardioinsight Technologies, Cleveland, Ohio.
3
Department of Cardiac Electrophysiology, St. Mary's and Hammersmith Hospitals, Imperial College NHS Healthcare Trust.
4
Imperial College London, London, United Kingdom. Electronic address: pblim@imperial.ac.uk.

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.

KEYWORDS:

Outflow tract tachycardia; Premature ventricular complex; Ventricular tachycardia

PMID:
24440381
PMCID:
PMC4067940
DOI:
10.1016/j.hrthm.2014.01.013
[Indexed for MEDLINE]
Free PMC Article

Supplemental Content

Full text links

Icon for Elsevier Science Icon for PubMed Central
Loading ...
Support Center