Document Detail


Validation of novel 3D electrocardiographic mapping of atrial tachycardias by invasive mapping and ablation: A multicenter study.
MedLine Citation:
PMID:  23727090     Owner:  NLM     Status:  Publisher    
Abstract/OtherAbstract:
OBJECTIVES: We prospectively evaluated the role of a novel three-dimensional(3D), non-invasive, beat by beat mapping system, Electrocardiographic Mapping(ECM), in facilitating the diagnosis of atrial tachycardias(AT). BACKGROUND: Conventional 12-lead electrocardiogram, a widely used non-invasive tool in clinical arrhythmia practice, has diagnostic limitations. METHODS: Various ATs (de novo and post atrial fibrillation(AF) ablation) were mapped using ECM followed by standard of care electrophysiological(EP) 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 CT-scan-based biatrial anatomy (CardioInsight Inc., USA). We evaluated the feasibility of this system in defining 1) the mechanism of AT: macroreentrant (perimitral, cavotricuspid isthmus-dependent and roof-dependent circuits) vs. centrifugal (focal-source) activation and 2) the location of arrhythmia in centrifugal ATs. The accuracy of the non-invasive diagnosis and detection of ablation targets was evaluated vis-a-vis subsequent invasive mapping and successful ablation. RESULTS: Comparison between ECM and EP diagnosis could be accomplished in 48 patients (48 ATs) but was not possible in 4 patients where the AT mechanism changed to another AT (1), AF (1) or sinus rhythm (2) during the EP procedure. ECM correctly diagnosed AT mechanisms in 44/48 (92%) ATs; macroreentry: 23/27, focal-onset with centrifugal activation: 21/21. The region of interest for focal ATs perfectly matched in 21/21 (100%) ATs. The 2:1 ventricular conduction and low-amplitude P waves challenged the diagnosis of 4/27 macroreentrant (perimitral) ATs that can be overcome by injecting atrioventricular node blockers and signal averaging, respectively. CONCLUSIONS: This prospective multicenter series shows 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 AF mapping is underway.
Authors:
Ashok J Shah; Meleze Hocini; Olivier Xhaet; Patrizio Pascale; Laurent Roten; Stephen B Wilton; Nick Linton; Daniel Scherr; Shinsuke Miyazaki; Amir S Jadidi; Xingpeng Liu; Andrei Forclaz; Isabelle Nault; Lena Rivard; Michala Ef Pedersen; Nicolas Derval; Frederic Sacher; Sebastien Knecht; Pierre Jais; Remi Dubois; Sandra Eliautou; Ryan Bokan; Maria Strom; Charu Ramanathan; Ivan Cakulev; Jayakumar Sahadevan; Bruce Lindsay; Albert L Waldo; Michel Haissaguerre
Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2013-5-30
Journal Detail:
Title:  Journal of the American College of Cardiology     Volume:  -     ISSN:  1558-3597     ISO Abbreviation:  J. Am. Coll. Cardiol.     Publication Date:  2013 May 
Date Detail:
Created Date:  2013-6-3     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  8301365     Medline TA:  J Am Coll Cardiol     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
Copyright Information:
Copyright © 2013 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.
Affiliation:
Department of Rhythmologie, Hôpital Cardiologique du Haut-Lévêque and the Université Bordeaux II, Bordeaux, France. Electronic address: drashahep@gmail.com.
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