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Penela D, Falasconi G, Carreño JM, Soto-Iglesias D, Fernández-Armenta J, Acosta J, Martí-Almor J, Benito B, Bellido A, Chauca A, Scherer C, Viveros D, Alderete J, Silva E, Ordoñez A, Francisco-Pascual J, Rivas-Gandara N, Meca-Santamaria J, Franco P, De Lucia C, Ali H, Cappato R, Cámara O, Francia P, Berruezo A. A hybrid clinical and electrocardiographic score to predict the origin of outflow tract ventricular arrhythmias. J Interv Card Electrophysiol 2023; 66:1877-1888. [PMID: 36795268 DOI: 10.1007/s10840-023-01507-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2022] [Accepted: 02/04/2023] [Indexed: 02/17/2023]
Abstract
BACKGROUND To predict the outflow tract ventricular arrhythmias (OTVA) site of origin (SOO) before the ablation procedure has important practical implications. The present study sought to prospectively evaluate the accuracy of a clinical and electrocardiographic hybrid algorithm (HA) for the prediction of OTVAs-SOO, and at the same time to develop and to prospectively validate a new score with improved discriminatory capacity. METHODS In this multicenter study, we prospectively enrolled consecutive patients referred for OTVA ablation (N = 202), and we divided them in a derivation sample and a validation cohort. Surface ECGs during OTVA were analyzed to compare previous published ECG-only criteria and to develop a new score. RESULTS In the derivation sample (N = 105), the correct prediction rate of HA and ECG-only criteria ranged from 74 to 89%. R-wave amplitude in V3 was the best ECG parameter for discriminating LVOT origin in V3 precordial transition (V3PT) patients, and was incorporated to the novel weighted hybrid score (WHS). WHS correctly classified 99 (94.2%) patients, presenting 90% sensitivity and 96% specificity (AUC 0.97) in the entire population; WHS mantained a 87% sensitivity and 91% specificity (AUC 0.95) in patients with V3PT subgroup. The high discriminatory capacity was confirmed in the validation sample (N = 97): the WHS exhibited an AUC (0.93), and a WHS ≥ 2 allowed a correct prediction of LVOT origin in 87 (90.0%) cases, yielding a sensitivity of 87% and specificity of 90%; moreover, the V3PT subgroup showed an AUC of 0.92, and a punctuation ≥ 2 predicted an LVOT origin with a sensitivity of 94% and specificity of 78%. CONCLUSIONS The novel hybrid score has proved to accurately anticipate the OTVA's origin, even in those with a V3 precordial transition. A Weighted hybrid score. B Typical examples of the use of the weighted hybrid score. C ROC analysis of WHS and previous ECG criteria for prediction of LVOT origin in the derivation cohort. D ROC analysis of WHS and previous ECG criteria for prediction of LVOT origin in the V3 precordial transition OTVA subgroup.
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Affiliation(s)
- Diego Penela
- Heart Institute, Teknon Medical Centre, C/ Vilana, 12; 08022, Barcelona, Spain
| | - Giulio Falasconi
- Heart Institute, Teknon Medical Centre, C/ Vilana, 12; 08022, Barcelona, Spain
- University of Barcelona, Campus Clínic, Barcelona, Spain
| | - Jose Miguel Carreño
- Heart Institute, Teknon Medical Centre, C/ Vilana, 12; 08022, Barcelona, Spain
| | - David Soto-Iglesias
- Heart Institute, Teknon Medical Centre, C/ Vilana, 12; 08022, Barcelona, Spain
| | | | - Juan Acosta
- Virgen del Rocío University Hospital, Sevilla, Spain
| | - Julio Martí-Almor
- Heart Institute, Teknon Medical Centre, C/ Vilana, 12; 08022, Barcelona, Spain
| | - Begoña Benito
- Hospital Vall d'Hebron, Barcelona, Spain
- Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Aldo Bellido
- Heart Institute, Teknon Medical Centre, C/ Vilana, 12; 08022, Barcelona, Spain
| | - Alfredo Chauca
- Heart Institute, Teknon Medical Centre, C/ Vilana, 12; 08022, Barcelona, Spain
| | - Claudia Scherer
- Heart Institute, Teknon Medical Centre, C/ Vilana, 12; 08022, Barcelona, Spain
| | - Daniel Viveros
- Heart Institute, Teknon Medical Centre, C/ Vilana, 12; 08022, Barcelona, Spain
- University of Barcelona, Campus Clínic, Barcelona, Spain
| | - Jose Alderete
- Heart Institute, Teknon Medical Centre, C/ Vilana, 12; 08022, Barcelona, Spain
- University of Barcelona, Campus Clínic, Barcelona, Spain
| | | | - Augusto Ordoñez
- Heart Institute, Teknon Medical Centre, C/ Vilana, 12; 08022, Barcelona, Spain
| | | | | | | | - Paula Franco
- Heart Institute, Teknon Medical Centre, C/ Vilana, 12; 08022, Barcelona, Spain
| | | | - Hussam Ali
- IRCCS Multimedica Group, Sesto San Giovanni, Italy
| | | | | | - Pietro Francia
- Cardiology, Department of Clinical and Molecular Medicine, St. Andrea Hospital, Sapienza University, Rome, Italy
| | - Antonio Berruezo
- Heart Institute, Teknon Medical Centre, C/ Vilana, 12; 08022, Barcelona, Spain.
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Weng S, Tang M, Zhou B, Ding L, Yu F, Qi Y, Zhang H, Jia Y, Hua W, Zhang S. Spatial Distribution of Idiopathic Ventricular Arrhythmias Originating Around the Pulmonary Root: Lessons From Intracardiac Echocardiography. JACC Clin Electrophysiol 2022; 8:665-676. [PMID: 35589180 DOI: 10.1016/j.jacep.2022.01.020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Revised: 01/18/2022] [Accepted: 01/23/2022] [Indexed: 12/24/2022]
Abstract
OBJECTIVES The purpose of this study was to investigate the spatial distribution of ventricular arrhythmias (VAs) and their relationship with anatomic landmarks in the right ventricular outflow tract (RVOT). BACKGROUND Although controversy has mainly focused on whether VAs ablated in the RVOT originate above or below the pulmonary sinus, little is known about their actual distribution. METHODS We performed mapping and ablation in the reconstructed RVOT using intracardiac echocardiography (ICE) and summarized the spatial electroanatomic characteristics of RVOT-VAs. RESULTS A total of 50 VAs were recruited and were distributed among the 3 subregions: the pulmonary sinuses (19 of 50, 38%), sinus junctions (18 of 50, 36%), and infundibulum (13 of 50, 26%). In total, 70% (35 of 50) of ablation targets were within 10 mm (mean 4.3 ± 2.7 mm) of the pulmonary valve hinge point. An ablation target with both amplitude ≤1.14 mV and duration ≥101.5 milliseconds predicted an origin above the pulmonary sinus with a sensitivity of 84.2% and specificity of 84.4%. For the ablation targets (13 of 50, 26%) located in the infundibulum of the RVOT, 4 were surrounded by trabeculations, whereas only 1 ablation target in the sinus junction abutted the trabeculation (30.8% vs 5.6%). CONCLUSIONS Ablation targets of RVOT-VAs were mainly distributed around the hinge point of the pulmonary valve and the trabeculation of the infundibulum. ICE can clearly and precisely locate those anatomic landmarks of the RVOT.
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Affiliation(s)
- Sixian Weng
- Department of Cardiology, State Key Laboratory of Cardiovascular Disease, Cardiovascular Institute, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, and Peking Union Medical College, Beijing, China
| | - Min Tang
- Department of Cardiology, State Key Laboratory of Cardiovascular Disease, Cardiovascular Institute, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, and Peking Union Medical College, Beijing, China.
| | - Bin Zhou
- Department of Cardiology, Laboratory of Heart Center, Zhujiang Hospital, Southern Medical University, Guangzhou, China
| | - Lei Ding
- Department of Cardiology, State Key Laboratory of Cardiovascular Disease, Cardiovascular Institute, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, and Peking Union Medical College, Beijing, China
| | - Fengyuan Yu
- Department of Cardiology, State Key Laboratory of Cardiovascular Disease, Cardiovascular Institute, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, and Peking Union Medical College, Beijing, China
| | - Yingjie Qi
- Department of Cardiology, State Key Laboratory of Cardiovascular Disease, Cardiovascular Institute, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, and Peking Union Medical College, Beijing, China
| | - Hongda Zhang
- Department of Cardiology, State Key Laboratory of Cardiovascular Disease, Cardiovascular Institute, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, and Peking Union Medical College, Beijing, China
| | - Yuhe Jia
- Department of Cardiology, State Key Laboratory of Cardiovascular Disease, Cardiovascular Institute, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, and Peking Union Medical College, Beijing, China
| | - Wei Hua
- Department of Cardiology, State Key Laboratory of Cardiovascular Disease, Cardiovascular Institute, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, and Peking Union Medical College, Beijing, China
| | - Shu Zhang
- Department of Cardiology, State Key Laboratory of Cardiovascular Disease, Cardiovascular Institute, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, and Peking Union Medical College, Beijing, China
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Gabriels JK, Abdelrahman M, Nambiar L, Kim J, Ip JE, Thomas G, Liu CF, Markowitz SM, Lerman BB, Cheung JW. Reappraisal of electrocardiographic criteria for localization of idiopathic outflow region ventricular arrhythmias. Heart Rhythm 2021; 18:1959-1965. [PMID: 34375724 DOI: 10.1016/j.hrthm.2021.08.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Revised: 07/20/2021] [Accepted: 08/01/2021] [Indexed: 11/25/2022]
Abstract
BACKGROUND Electrocardiographic (ECG) criteria have been proposed to localize the site of origin of outflow region ventricular arrhythmias (VAs). Many factors influence the QRS morphology of VAs and may limit the accuracy of these criteria. OBJECTIVE The purpose of this study was to assess the accuracy of ECG criteria that differentiate right from left outflow region VAs and localize VAs within the aortic sinus of Valsalva (ASV). METHODS One hundred one patients (mean age 52 ± 16 years; 55 [54%] women) undergoing catheter ablation of right ventricular outflow tract (RVOT) or ASV VAs with a left bundle branch block, inferior axis morphology were studied. ECG measurements including V2 transition ratio, transition zone index, R-wave duration index, R/S amplitude index, V2S/V3R index, V1-3 QRS morphology, R-wave amplitude in the inferior leads were tabulated for all VAs. Comparisons were made between the predicted site of origin using these criteria and the successful ablation site. RESULTS Patients had successful ablation of 71 RVOT and 38 ASV VAs. For the differentiation of RVOT from ASV VAs, the positive predictive values and negative predictive values for all tested ECG criteria ranged from 42% to 75% and from 71% to 82%, respectively, with the V2S/V3R index having the largest area under the curve of 0.852. Morphological QRS criteria in leads V1 through V3 did not localize ASV VAs. The maximum R-wave amplitude in the inferior leads was the sole criterion demonstrating a significant difference between right ASV, right-left ASV commissure, and left ASV sites. CONCLUSION ECG criteria for differentiating right from left ventricular outflow region VAs and for localizing ASV VAs have a limited accuracy.
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Affiliation(s)
- James K Gabriels
- Division of Cardiology, Department of Medicine, Weill Cornell Medicine - New York Presbyterian Hospital, New York, New York
| | - Mohamed Abdelrahman
- Division of Cardiology, Department of Medicine, Weill Cornell Medicine - New York Presbyterian Hospital, New York, New York
| | - Lakshmi Nambiar
- Division of Cardiology, Department of Medicine, Weill Cornell Medicine - New York Presbyterian Hospital, New York, New York
| | - Jiwon Kim
- Division of Cardiology, Department of Medicine, Weill Cornell Medicine - New York Presbyterian Hospital, New York, New York
| | - James E Ip
- Division of Cardiology, Department of Medicine, Weill Cornell Medicine - New York Presbyterian Hospital, New York, New York
| | - George Thomas
- Division of Cardiology, Department of Medicine, Weill Cornell Medicine - New York Presbyterian Hospital, New York, New York
| | - Christopher F Liu
- Division of Cardiology, Department of Medicine, Weill Cornell Medicine - New York Presbyterian Hospital, New York, New York
| | - Steven M Markowitz
- Division of Cardiology, Department of Medicine, Weill Cornell Medicine - New York Presbyterian Hospital, New York, New York
| | - Bruce B Lerman
- Division of Cardiology, Department of Medicine, Weill Cornell Medicine - New York Presbyterian Hospital, New York, New York
| | - Jim W Cheung
- Division of Cardiology, Department of Medicine, Weill Cornell Medicine - New York Presbyterian Hospital, New York, New York.
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Santoro A, Baiocchi C, D'Ascenzi F, Mondillo S, Valente S. Zero-fluoroscopy catheter ablation of premature ventricular contractions at left coronary cusp near left main coronary artery. Clin Case Rep 2020; 8:1952-1956. [PMID: 33088527 PMCID: PMC7562889 DOI: 10.1002/ccr3.3035] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Revised: 05/20/2020] [Accepted: 05/26/2020] [Indexed: 11/16/2022] Open
Abstract
The left coronary cusp is the commonest site of origin for coronary cusp PVC. Catheter ablation without fluoroscopy is highly effective, feasible, and safe but it could be related to risks because of proximity to the coronary arteries. The use of ICE integration allowed an improvement in the safety and efficiency of these procedures.
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Affiliation(s)
- Amato Santoro
- Cardiology Department Azienda Ospedaliera Universitaria Senese Viale Bracci 1, Siena Italy
| | - Claudia Baiocchi
- Cardiology Department Azienda Ospedaliera Universitaria Senese Viale Bracci 1, Siena Italy
| | - Flavio D'Ascenzi
- Cardiology Department Azienda Ospedaliera Universitaria Senese Viale Bracci 1, Siena Italy
| | - Sergio Mondillo
- Cardiology Department Azienda Ospedaliera Universitaria Senese Viale Bracci 1, Siena Italy
| | - Serafina Valente
- Cardiology Department Azienda Ospedaliera Universitaria Senese Viale Bracci 1, Siena Italy
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5
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Anderson RD, Kumar S, Binny S, Prabhu M, Al-Kaisey A, Parameswaran R, Sugumar H, Chieng D, Hawson J, Campbell T, Joshi S, Lui E, Sparks PB, Joseph SA, Morton JB, McLellan A, Lipton J, Pathik B, Kistler PM, Kalman J, Lee G. Modified Precordial Lead R-Wave Deflection Interval Predicts Left- and Right-Sided Idiopathic Outflow Tract Ventricular Arrhythmias. JACC Clin Electrophysiol 2020; 6:1405-1419. [DOI: 10.1016/j.jacep.2020.07.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Revised: 07/14/2020] [Accepted: 07/16/2020] [Indexed: 11/16/2022]
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Doste R, Sebastian R, Gomez JF, Soto-Iglesias D, Alcaine A, Mont L, Berruezo A, Penela D, Camara O. In silico pace-mapping: prediction of left vs. right outflow tract origin in idiopathic ventricular arrhythmias with patient-specific electrophysiological simulations. Europace 2020; 22:1419-1430. [PMID: 32607538 DOI: 10.1093/europace/euaa102] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2019] [Accepted: 04/09/2020] [Indexed: 11/12/2022] Open
Abstract
AIMS A pre-operative non-invasive identification of the site of origin (SOO) of outflow tract ventricular arrhythmias (OTVAs) is important to properly plan radiofrequency ablation procedures. Although some algorithms based on electrocardiograms (ECGs) have been developed to predict left vs. right ventricular origins, their accuracy is still limited, especially in complex anatomies. The aim of this work is to use patient-specific electrophysiological simulations of the heart to predict the SOO in OTVA patients. METHODS AND RESULTS An in silico pace-mapping procedure was designed and used on 11 heart geometries, generating for each case simulated ECGs from 12 clinically plausible SOO. Subsequently, the simulated ECGs were compared with patient ECG data obtained during the clinical tachycardia using the 12-lead correlation coefficient (12-lead ρ). Left ventricle (LV) vs. right ventricle (RV) SOO was estimated by computing the LV/RV ratio for each patient, obtained by dividing the average 12-lead ρ value of the LV- and RV-SOO simulated ECGs, respectively. Simulated ECGs that had virtual sites close to the ablation points that stopped the arrhythmia presented higher correlation coefficients. The LV/RV ratio correctly predicted LV vs. RV SOO in 10/11 cases; 1.07 vs. 0.93 P < 0.05 for 12-lead ρ. CONCLUSION The obtained results demonstrate the potential of the developed in silico pace-mapping technique to complement standard ECG for the pre-operative planning of complex ventricular arrhythmias.
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Affiliation(s)
- Ruben Doste
- Department of Information and Communication Technologies, Physense, Universitat Pompeu Fabra, Barcelona, Spain
| | - Rafael Sebastian
- Department of Computer Science, Computational Multiscale Simulation Lab (CoMMLab), Universitat de Valencia, Valencia, Spain
| | | | | | - Alejandro Alcaine
- Department of Information and Communication Technologies, Physense, Universitat Pompeu Fabra, Barcelona, Spain
| | - Lluis Mont
- Department of Cardiology, Unitat de Fibril lacio Auricular (UFA), Hospital Clínic, Universitat de Barcelona, Barcelona, Spain
| | | | - Diego Penela
- Heart Institute, Teknon Medical Center, Barcelona, Spain
| | - Oscar Camara
- Department of Information and Communication Technologies, Physense, Universitat Pompeu Fabra, Barcelona, Spain
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7
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Kapa S, Mehra N, Deshmukh AJ, Friedman PA, Asirvatham SJ. Left sinus of Valsalva—Electroanatomic basis and outcomes with ablation for outflow tract arrhythmias. J Cardiovasc Electrophysiol 2020; 31:952-959. [DOI: 10.1111/jce.14388] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2019] [Revised: 02/03/2020] [Accepted: 02/06/2020] [Indexed: 11/30/2022]
Affiliation(s)
- Suraj Kapa
- Department of CardiologyMayo Clinic College of Medicine Rochester Minnesota
| | - Nandini Mehra
- Department of CardiologyMayo Clinic College of Medicine Rochester Minnesota
| | | | - Paul A. Friedman
- Department of CardiologyMayo Clinic College of Medicine Rochester Minnesota
| | - Samuel J. Asirvatham
- Department of CardiologyMayo Clinic College of Medicine Rochester Minnesota
- Division of Pediatric Cardiology, Department of Pediatric and Adolescent MedicineMayo Clinic College of Medicine Rochester Minnesota
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8
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Kim Y, Chen S, Ernst S, Guzman CE, Han S, Kalarus Z, Labadet C, Lin Y, Lo L, Nogami A, Saad EB, Sapp J, Sticherling C, Tilz R, Tung R, Kim YG, Stiles MK. 2019 APHRS expert consensus statement on three-dimensional mapping systems for tachycardia developed in collaboration with HRS, EHRA, and LAHRS. J Arrhythm 2020; 36:215-270. [PMID: 32256872 PMCID: PMC7132207 DOI: 10.1002/joa3.12308] [Citation(s) in RCA: 54] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2020] [Accepted: 01/20/2020] [Indexed: 12/24/2022] Open
Affiliation(s)
- Young‐Hoon Kim
- Department of Internal MedicineArrhythmia CenterKorea University Medicine Anam HospitalSeoulRepublic of Korea
| | - Shih‐Ann Chen
- Division of CardiologyDepartment of MedicineTaipei Veterans General HospitalTaipeiROC
| | - Sabine Ernst
- Department of CardiologyRoyal Brompton and Harefield HospitalImperial College LondonLondonUK
| | | | - Seongwook Han
- Division of CardiologyDepartment of Internal MedicineKeimyung University School of MedicineDaeguRepublic of Korea
| | - Zbigniew Kalarus
- Department of CardiologyMedical University of SilesiaKatowicePoland
| | - Carlos Labadet
- Cardiology DepartmentArrhythmias and Electrophysiology ServiceClinica y Maternidad Suizo ArgentinaBuenos AiresArgentina
| | - Yenn‐Jian Lin
- Division of CardiologyDepartment of MedicineTaipei Veterans General HospitalTaipeiROC
| | - Li‐Wei Lo
- Division of CardiologyDepartment of MedicineTaipei Veterans General HospitalTaipeiROC
| | - Akihiko Nogami
- Department of CardiologyFaculty of MedicineUniversity of TsukubaTsukubaJapan
| | - Eduardo B. Saad
- Center for Atrial FibrillationHospital Pro‐CardiacoRio de JaneiroBrazil
| | - John Sapp
- Division of CardiologyDepartment of MedicineQEII Health Sciences CentreDalhousie UniversityHalifaxNSCanada
| | | | - Roland Tilz
- Medical Clinic II (Department of Cardiology, Angiology and Intensive Care Medicine)University Hospital Schleswig‐Holstein (UKSH) – Campus LuebeckLuebeckGermany
| | - Roderick Tung
- Center for Arrhythmia CarePritzker School of MedicineUniversity of Chicago MedicineChicagoILUSA
| | - Yun Gi Kim
- Department of Internal MedicineArrhythmia CenterKorea University Medicine Anam HospitalSeoulRepublic of Korea
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Abstract
Arrhythmias arising from the ventricular outflow tracts are commonly encountered. Although largely benign, they can also present with heart failure and sudden cardiac death. Mapping and ablation of these arrhythmias is commonly performed in the electrophysiology laboratory with a high success rate, but occasionally can prove challenging to abolish. This article discusses the mapping and ablation of outflow tract arrhythmias and the challenges that can be overcome by a systematic approach.
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Affiliation(s)
- Magdi M Saba
- Cardiology Clinical Academic Group, St. George's University of London, Cranmer Terrace, London SW17 OQT, UK.
| | - Anthony Li
- Cardiology Clinical Academic Group, St. George's University of London, Cranmer Terrace, London SW17 OQT, UK
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10
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Doste R, Soto-Iglesias D, Bernardino G, Alcaine A, Sebastian R, Giffard-Roisin S, Sermesant M, Berruezo A, Sanchez-Quintana D, Camara O. A rule-based method to model myocardial fiber orientation in cardiac biventricular geometries with outflow tracts. INTERNATIONAL JOURNAL FOR NUMERICAL METHODS IN BIOMEDICAL ENGINEERING 2019; 35:e3185. [PMID: 30721579 DOI: 10.1002/cnm.3185] [Citation(s) in RCA: 46] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/31/2017] [Revised: 10/23/2018] [Accepted: 01/05/2019] [Indexed: 06/09/2023]
Abstract
Rule-based methods are often used for assigning fiber orientation to cardiac anatomical models. However, existing methods have been developed using data mostly from the left ventricle. As a consequence, fiber information obtained from rule-based methods often does not match histological data in other areas of the heart such as the right ventricle, having a negative impact in cardiac simulations beyond the left ventricle. In this work, we present a rule-based method where fiber orientation is separately modeled in each ventricle following observations from histology. This allows to create detailed fiber orientation in specific regions such as the endocardium of the right ventricle, the interventricular septum, and the outflow tracts. We also carried out electrophysiological simulations involving these structures and with different fiber configurations. In particular, we built a modeling pipeline for creating patient-specific volumetric meshes of biventricular geometries, including the outflow tracts, and subsequently simulate the electrical wavefront propagation in outflow tract ventricular arrhythmias with different origins for the ectopic focus. The resulting simulations with the proposed rule-based method showed a very good agreement with clinical parameters such as the 10 ms isochrone ratio in a cohort of nine patients suffering from this type of arrhythmia. The developed modeling pipeline confirms its potential for an in silico identification of the site of origin in outflow tract ventricular arrhythmias before clinical intervention.
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Affiliation(s)
- Ruben Doste
- Physense, ETIC, Universitat Pompeu Fabra, Barcelona, Spain
| | | | | | | | - Rafael Sebastian
- Computational Multiscale Simulation Lab (CoMMLab), Department of Computer Science, Universitat de Valencia, Valencia, Spain
| | | | | | - Antonio Berruezo
- Arrhythmia Section, Cardiology Department, Thorax Institute, Hospital Clinic, Universitat de Barcelona, Barcelona, Spain
| | - Damian Sanchez-Quintana
- Department of Anatomy and Cell Biology, Faculty of Medicine, University of Extremadura, Badajoz, Spain
| | - Oscar Camara
- Physense, ETIC, Universitat Pompeu Fabra, Barcelona, Spain
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11
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Lv W, Zhou X, Yiming G, Zhang L, Zhou Q, Li Y, Xing Q, Zhang J, Lu Y, Wang H, Cao G, Tang B. Idiopathic premature ventricular complexes originating from the distal great cardiac vein: Clinical, cardiac and electrophysiological characteristics and catheter ablation outcome. Life Sci 2018; 202:61-69. [PMID: 29625195 DOI: 10.1016/j.lfs.2018.04.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2017] [Revised: 03/07/2018] [Accepted: 04/02/2018] [Indexed: 10/17/2022]
Abstract
AIMS Although catheter ablation for idiopathic ventricular arrhythmia (VA) has been generally well-established, VA originating from the great cardiac vein (GCV) may be clinically challenging due to its epicardial origin, proximity to coronary arteries and limited accessibility. The purpose of this study was to explore its electrophysiological characteristics and identify effective mapping/ablation strategies for idiopathic premature ventricular complexes (PVCs) originating from the GCV. MATERIALS AND METHODS Between January 2013 to January 2018, 12 patients (who were diagnosed with PVCs originating from the GCV) among the 305 patients with idiopathic left ventricular outflow tract tachycardia were included. The origin of the ectopy was localized by mapping, the characteristics of the electrocardiogram (ECG) were analyzed, and all the patients with PVCs originating from GCV were treated by radiofrequency catheter ablation (RFCA). The safety and efficacy of RFCA were evaluated. KEY FINDINGS The origin of the ectopy was successfully localized in GCV for all 12 patients by mapping, and access to GCV via the coronary sinus was feasible. Successful RFCA was achieved in 11 of 12 patients (91.67% acute procedural success) without perioperative complications. During a median follow-up of 12.6 ± 6.5 months, only one patient had recurrent VA (recurrence rate: 9.1%). SIGNIFICANCE ECG characteristics may be helpful for identifying patients with PVCs originating from the GCV. RFCA within the coronary venous system appears to be safe and effective for these patients, and should be considered when routine RFCA from the endocardium or aortic sinus of the Valsalva is not effective.
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Affiliation(s)
- Wenkui Lv
- Department of Pacing and Electrophysiological, First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang 830011, PR China
| | - Xianhui Zhou
- Department of Pacing and Electrophysiological, First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang 830011, PR China
| | - Gulinuer Yiming
- Department of Cardiac Function, First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang 830011, PR China
| | - Ling Zhang
- Department of Pacing and Electrophysiological, First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang 830011, PR China
| | - Qina Zhou
- Department of Pacing and Electrophysiological, First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang 830011, PR China
| | - Yaodong Li
- Department of Pacing and Electrophysiological, First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang 830011, PR China
| | - Qiang Xing
- Department of Pacing and Electrophysiological, First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang 830011, PR China
| | - Jianghua Zhang
- Department of Pacing and Electrophysiological, First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang 830011, PR China
| | - Yanmei Lu
- Department of Pacing and Electrophysiological, First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang 830011, PR China
| | - Hongli Wang
- Department of Pacing and Electrophysiological, First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang 830011, PR China
| | - Guiqiu Cao
- Department of Cardiology, Fifth Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang 830011, PR China.
| | - Baopeng Tang
- Department of Pacing and Electrophysiological, First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang 830011, PR China.
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12
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Stevenson WG, Abraham RL. So Close Yet Too Far. JACC Clin Electrophysiol 2018; 4:364-365. [DOI: 10.1016/j.jacep.2017.12.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2017] [Revised: 12/11/2017] [Accepted: 12/14/2017] [Indexed: 10/17/2022]
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Bansal N, Kobayashi D, Karpawich PP. Pulmonary damage following right ventricular outflow tachycardia ablation in a child: When electroanatomical mapping isn't good enough. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2017; 41:561-565. [PMID: 29127709 DOI: 10.1111/pace.13236] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/11/2017] [Revised: 10/14/2017] [Accepted: 10/29/2017] [Indexed: 11/27/2022]
Abstract
A 14-year-old female was referred for severe pulmonary valve insufficiency after undergoing radiofrequency ablation for a right ventricular outflow tract tachycardia that originated in the proximal pulmonary artery at 10 years of age. Clinical records indicated that ablation was guided solely by electrograms and electroanatomical mapping. Due to myocardial tissue extensions, mapping failed to identify the level of the pulmonary valve annulus, which resulted in delivery of energy on the valve proper and into the pulmonary artery. She developed severe pulmonary valve insufficiency and moderate proximal pulmonary artery stenosis necessitating intravascular stent placement 4 years later with an associated transcatheter valve. Although the nonfluoroscopic approach during ablation has gained wide acceptance for use in children, this report highlights the benefits of adjunctive imaging to identify the precise location of the pulmonary valve when ablation therapy is contemplated in the right ventricle outflow tract.
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Affiliation(s)
- Neha Bansal
- Division of Cardiology, Carman and Ann Adams Department of Pediatrics, Children's Hospital of Michigan, Wayne State University School of Medicine, Detroit, MI, USA
| | - Daisuke Kobayashi
- Division of Cardiology, Carman and Ann Adams Department of Pediatrics, Children's Hospital of Michigan, Wayne State University School of Medicine, Detroit, MI, USA
| | - Peter P Karpawich
- Division of Cardiology, Carman and Ann Adams Department of Pediatrics, Children's Hospital of Michigan, Wayne State University School of Medicine, Detroit, MI, USA
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14
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Alcaine A, Soto-Iglesias D, Acosta J, Korshunov V, Penela D, Martínez M, Linhart M, Andreu D, Fernández-Armenta J, Laguna P, Martínez JP, Camara O, Berruezo A. Automatic activation mapping and origin identification of idiopathic outflow tract ventricular arrhythmias. J Electrocardiol 2017; 51:239-246. [PMID: 29242053 DOI: 10.1016/j.jelectrocard.2017.10.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2017] [Indexed: 11/17/2022]
Abstract
PURPOSE Activation mapping is used to guide ablation of idiopathic outflow tract ventricular arrhythmias (OTVAs). Isochronal activation maps help to predict the site of origin (SOO): left vs right outflow tract (OT). We evaluate an algorithm for automatic activation mapping based on the onset of the bipolar electrogram (EGM) signal for predicting the SOO and the effective ablation site in OTVAs. METHODS Eighteen patients undergoing ablation due to idiopathic OTVAs were studied (12 with left ventricle OT origin). Right ventricle activation maps were obtained offline with an automatic algorithm and compared with manual annotation maps obtained during the intervention. Local activation time (LAT) accuracy was assessed, as well as the performance of the 10ms earliest activation site (EAS) isochronal area in predicting the SOO. RESULTS High correlation was observed between manual and automatic LATs (Spearman's: 0.86 and Lin's: 0.85, both p<0.01). The EAS isochronal area were closely located in both map modalities (5.55 ± 3.56mm) and at a similar distance from the effective ablation site (0.15±2.08mm difference, p=0.859). The 10ms isochronal area longitudinal/perpendicular diameter ratio measured from automatic maps showed slightly superior SOO identification (67% sensitivity, 100% specificity) compared with manual maps (67% sensitivity, 83% specificity). CONCLUSIONS Automatic activation mapping based on the bipolar EGM onset allows fast, accurate and observer-independent identification of the SOO and characterization of the spreading of the activation wavefront in OTVAs.
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Affiliation(s)
- Alejandro Alcaine
- BSICoS Group, Aragón Institute of Engineering Research (I3A), IIS Aragón, Universidad de Zaragoza, Zaragoza, Spain; CIBER en Bioingeniería, Biomateriales y Nanomedicina (CIBER-BBN), Madrid, Spain
| | - David Soto-Iglesias
- Arrhythmia Section, Cardiology Dept., Thorax Institute, Hospital Clínic, Universitat de Barcelona, Barcelona, Spain; IDIBAPS (Institut d'Investigació Agustí Pi i Sunyer), Barcelona, Spain
| | - Juan Acosta
- IDIBAPS (Institut d'Investigació Agustí Pi i Sunyer), Barcelona, Spain
| | - Viatcheslav Korshunov
- Arrhythmia Section, Cardiology Dept., Thorax Institute, Hospital Clínic, Universitat de Barcelona, Barcelona, Spain; IDIBAPS (Institut d'Investigació Agustí Pi i Sunyer), Barcelona, Spain
| | - Diego Penela
- IDIBAPS (Institut d'Investigació Agustí Pi i Sunyer), Barcelona, Spain
| | - Mikel Martínez
- Arrhythmia Section, Cardiology Dept., Thorax Institute, Hospital Clínic, Universitat de Barcelona, Barcelona, Spain; IDIBAPS (Institut d'Investigació Agustí Pi i Sunyer), Barcelona, Spain
| | - Markus Linhart
- Arrhythmia Section, Cardiology Dept., Thorax Institute, Hospital Clínic, Universitat de Barcelona, Barcelona, Spain; IDIBAPS (Institut d'Investigació Agustí Pi i Sunyer), Barcelona, Spain
| | - David Andreu
- IDIBAPS (Institut d'Investigació Agustí Pi i Sunyer), Barcelona, Spain
| | | | - Pablo Laguna
- BSICoS Group, Aragón Institute of Engineering Research (I3A), IIS Aragón, Universidad de Zaragoza, Zaragoza, Spain; CIBER en Bioingeniería, Biomateriales y Nanomedicina (CIBER-BBN), Madrid, Spain
| | - Juan Pablo Martínez
- BSICoS Group, Aragón Institute of Engineering Research (I3A), IIS Aragón, Universidad de Zaragoza, Zaragoza, Spain; CIBER en Bioingeniería, Biomateriales y Nanomedicina (CIBER-BBN), Madrid, Spain
| | - Oscar Camara
- Physense Group, Dept. of Information and Communication Technologies, Universitat Pompeu Fabra, Barcelona, Spain
| | - Antonio Berruezo
- Arrhythmia Section, Cardiology Dept., Thorax Institute, Hospital Clínic, Universitat de Barcelona, Barcelona, Spain; IDIBAPS (Institut d'Investigació Agustí Pi i Sunyer), Barcelona, Spain.
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15
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Wang Y, Liang Z, Wu S, Han Z, Ren X. Idiopathic ventricular arrhythmias originating from the right coronary sinus: Prevalence, electrocardiographic and electrophysiological characteristics, and catheter ablation. Heart Rhythm 2017; 15:81-89. [PMID: 28917557 DOI: 10.1016/j.hrthm.2017.09.008] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2017] [Indexed: 10/18/2022]
Abstract
BACKGROUND Ventricular arrhythmias (VAs) of the right coronary cusp (RCC) are not fully characterized. OBJECTIVES To investigate the electrocardiographic and electrophysiological characteristics, mapping and ablation of RCC-VAs. METHODS Among 256 consecutive patients undergoing electrophysiological evaluation and ablation of VAs of ventricular outflow tract origin, data were compared among 27 RCC-VAs, 50 VAs of the septal aspect of right ventricular outflow tract (RVOT), including from pulmonary artery, and 9 VAs of left coronary cusp (LCC). RESULTS The only electrocardiographic characteristic that differentiated VAs originating from the RCC and RVOT was the amplitude of the R wave in lead I. During VAs of the RCC, the earliest activation site (EAS) in the right ventricle was localized in the middle-posterior septal region of the RVOT. The distance between the His bundle and the EAS in the RVOT in the RCC group was shorter than that in the RVOT and LCC group; the distance ≤ 29.4 mm, which rules out an RVOT and LCC origin, had 92.6% sensitivity and 100% specificity for RCC-origin speculation. Double or complex potentials were recorded in RVOT middle-posterior septal area surrounding the EAS in 20 of 27 RCC-VA patients (70%). Most of the successful ablation sites (24/27) were located in the anterior and upper margin of the RCC, close to the middle-posterior septal region of the RVOT. The prepotential (P1) amplitude and the P1-to-QRS complex interval may be indicators of successful RCC-VA ablation sites. CONCLUSIONS RCC-VAs are not uncommon and have unique electrocardiographic and electrophysiological characteristics that distinguish an RCC origin of VA from RVOT and LCC origins. Most RCC-VAs were ablated successfully in the anterior and upper aspects of the RCC.
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Affiliation(s)
- Yunlong Wang
- Department of Cardiology, Beijing Anzhen Hospital, an affiliate of Capital Medical University, Beijing, China
| | - Zhuo Liang
- Department of Cardiology, Beijing Anzhen Hospital, an affiliate of Capital Medical University, Beijing, China
| | - Shaoqin Wu
- Department of Radiology, Beijing Anzhen Hospital, an affiliate of Capital Medical University, Beijing, China
| | - Zhihong Han
- Department of Cardiology, Beijing Anzhen Hospital, an affiliate of Capital Medical University, Beijing, China
| | - Xuejun Ren
- Department of Cardiology, Beijing Anzhen Hospital, an affiliate of Capital Medical University, Beijing, China.
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16
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Suzuki M, Nitta J, Hayashi Y, Lee K, Watanabe K, Hirao T, Kato N, Inamura Y, Sato A, Goya M, Hirao K, Isobe M. The Efficacy of Isochronal 3D Mapping-Based Ablation of Ventricular Arrhythmia. Int Heart J 2017; 58:495-499. [PMID: 28717114 DOI: 10.1536/ihj.16-552] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Treatment of ventricular arrhythmias (VAs) commonly involves ablating sites showing electrograms with the earliest activity relative to the VA, but there is no threshold value for prematurity guaranteeing success. Ablation of sites with great prematurity can still result in failure.We hypothesized that isochronal map area (ISCA), derived from isochrones indicating electrogram prematurity, could help identify ablation targets in VA patients, as well as predict outcome. Specifically, we hypothesized that smaller ICSA for a given prematurity value would indicate a shallower arrhythmogenic focus leading to a higher likelihood of successful ablation.We studied ICSA in 29 patients (12 males, 57 [17-65] years old) undergoing VA ablation. The VAs originated from the right and left ventricles in 11 and 18 patients, respectively. The earliest activation site of the VAs, ECG morphology of sinus beats and premature ventricular complexes (PVCs), and ISCA of activation preceding PVCs were evaluated.RF ablation at the site showing earliest prematurity resulted in VA elimination in 21 patients (success group). The 5-ms ISCA was smaller in the success group than in the failure group (0.2 [0.1-0.6] versus 1.0 [0.8-1.5] cm2, respectively; P < 0.01). No significant difference was noted in prematurity itself (36 [30-45] versus 30 [29-33] ms, respectively; P = 0.07). The cut-off value of the 5 ms ISCA for successful RF ablation was 0.7 cm2 with 87.5% sensitivity and 85.6% specificity.Isochrones of activity preceding PVCs appear to contain information beyond prematurity values and may help dictate suitable areas for successful ablation of VAs.
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Affiliation(s)
- Masahito Suzuki
- Department of Cardiology, Saitama Red Cross Hospital.,Department of Cardiovascular Medicine, Tokyo Medical and Dental University
| | - Junichi Nitta
- Department of Cardiology, Saitama Red Cross Hospital
| | | | - Kikou Lee
- Department of Cardiology, Saitama Red Cross Hospital
| | | | | | - Nobutaka Kato
- Department of Cardiology, Saitama Red Cross Hospital
| | | | - Akira Sato
- Department of Cardiology, Saitama Red Cross Hospital
| | - Masahiko Goya
- Department of Cardiovascular Medicine, Tokyo Medical and Dental University
| | - Kenzo Hirao
- Department of Cardiovascular Medicine, Tokyo Medical and Dental University
| | - Mitsuaki Isobe
- Department of Cardiovascular Medicine, Tokyo Medical and Dental University
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17
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Soto Iglesias D, Duchateau N, Kostantyn Butakov CB, Andreu D, Fernandez-Armenta J, Bijnens B, Berruezo A, Sitges M, Camara O. Quantitative Analysis of Electro-Anatomical Maps: Application to an Experimental Model of Left Bundle Branch Block/Cardiac Resynchronization Therapy. IEEE JOURNAL OF TRANSLATIONAL ENGINEERING IN HEALTH AND MEDICINE-JTEHM 2016; 5:1900215. [PMID: 29164019 PMCID: PMC5477765 DOI: 10.1109/jtehm.2016.2634006] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/10/2016] [Revised: 08/08/2016] [Accepted: 11/14/2016] [Indexed: 01/02/2023]
Abstract
Electro-anatomical maps (EAMs) are commonly acquired in clinical routine for guiding
ablation therapies. They provide voltage and activation time information on a 3-D
anatomical mesh representation, making them useful for analyzing the electrical
activation patterns in specific pathologies. However, the variability between the
different acquisitions and anatomies hampers the comparison between different maps.
This paper presents two contributions for the analysis of electrical patterns in EAM
data from biventricular surfaces of cardiac chambers. The first contribution is an
integrated automatic 2-D disk representation (2-D bull’s eye plot) of the left
ventricle (LV) and right ventricle (RV) obtained with a quasi-conformal mapping from
the 3-D EAM meshes, that allows an analysis of cardiac resynchronization therapy
(CRT) lead positioning, interpretation of global (total activation time), and local
indices (local activation time (LAT), surrogates of conduction velocity,
inter-ventricular, and transmural delays) that characterize changes in the electrical
activation pattern. The second contribution is a set of indices derived from the
electrical activation: speed maps, computed from LAT values, to study the electrical
wave propagation, and histograms of isochrones to analyze regional electrical
heterogeneities in the ventricles. We have applied the proposed methods to look for
the underlying physiological mechanisms of left bundle branch block (LBBB) and CRT,
with the goal of optimizing the therapy by improving CRT response. To better
illustrate the benefits of the proposed tools, we created a set of synthetically
generated and fully controlled activation patterns, where the proposed representation
and indices were validated. Then, the proposed analysis tools are used to analyze EAM
data from an experimental swine model of induced LBBB with an implanted CRT device.
We have analyzed and compared the electrical activation patterns at baseline, LBBB,
and CRT stages in four animals: two without any structural disease and two with an
induced infarction. By relating the CRT lead location with electrical dyssynchrony,
we evaluated current hypotheses about lead placement in CRT and showed that optimal
pacing sites should target the RV lead close to the apex and the LV one distant from
it.
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Affiliation(s)
- David Soto Iglesias
- PhySense, Information and Communication Technologies DepartmentUniversitat Pompeu Fabra.,Cardiology DepartmentThorax Institute, Hospital Clinic
| | | | | | - David Andreu
- Cardiology DepartmentThorax Institute, Hospital Clinic
| | | | - Bart Bijnens
- PhySense, Information and Communication Technologies DepartmentUniversitat Pompeu Fabra.,Catalan Institution for Research and Advanced Studies
| | | | - Marta Sitges
- Cardiology DepartmentThorax Institute, Hospital Clinic
| | - Oscar Camara
- PhySense, Information and Communication Technologies DepartmentUniversitat Pompeu Fabra
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18
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Peinado R, Ruiz-Mateas F, Izquierdo M, Arana E, Robledo M, Arias MA, Jiménez-Jáimez J, Rodríguez-Mañero M, Chimeno J. Selección de temas de actualidad en arritmias y estimulación cardiaca 2015. Rev Esp Cardiol 2016. [DOI: 10.1016/j.recesp.2015.11.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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19
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Peinado R, Ruiz-Mateas F, Izquierdo M, Arana E, Robledo M, Arias MA, Jiménez-Jáimez J, Rodríguez-Mañero M, Chimeno J. Cardiac Arrhythmias and Pacing 2015: A Selection of Topical Issues. ACTA ACUST UNITED AC 2016; 69:167-75. [PMID: 26778594 DOI: 10.1016/j.rec.2015.11.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2015] [Accepted: 11/02/2015] [Indexed: 10/22/2022]
Affiliation(s)
- Rafael Peinado
- Unidad de Arritmias y Electrofisiología Cardiaca, Servicio de Cardiología, Hospital Universitario La Paz, Madrid, Spain.
| | - Francisco Ruiz-Mateas
- Unidad de Estimulación Cardiaca, Área de Cardiología, Hospital Costa del Sol, Marbella, Malaga, Spain
| | - Maite Izquierdo
- Unidad de Arritmias, Servicio de Cardiología, Hospital Clínico Universitario de Valencia, Valencia, Spain
| | - Eduardo Arana
- Unidad de Arritmias, Servicio de Cardiología, Hospital Universitario Virgen del Rocío, Seville, Spain
| | - Maria Robledo
- Sección de Arritmias, Servicio de Cardiología, Hospital Universitario Araba, Vitoria, Álava, Spain
| | - Miguel Angel Arias
- Unidad de Arritmias y Electrofisiología Cardiaca, Servicio de Cardiología, Hospital Virgen de la Salud, Toledo, Spain
| | - Juan Jiménez-Jáimez
- Unidad de Arritmias, Servicio de Cardiología, Hospital Universitario Virgen de las Nieves, Granada, Spain
| | - Moisés Rodríguez-Mañero
- Unidad de Arritmias, Departamento de Cardiología, Complejo Universitario de Santiago de Compostela, Santiago de Compostela, A Coruña, Spain
| | - Javier Chimeno
- Sección de Cardiología, Hospital Virgen de la Concha, Zamora, Spain
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20
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21
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Anatomical Basis for the Cardiac Interventional Electrophysiologist. BIOMED RESEARCH INTERNATIONAL 2015; 2015:547364. [PMID: 26665006 PMCID: PMC4668306 DOI: 10.1155/2015/547364] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/13/2015] [Accepted: 09/28/2015] [Indexed: 12/11/2022]
Abstract
The establishment of radiofrequency catheter ablation techniques as the mainstay in the treatment of tachycardia has renewed new interest in cardiac anatomy. The interventional arrhythmologist has drawn attention not only to the gross anatomic details of the heart but also to architectural and histological characteristics of various cardiac regions that are relevant to the development or recurrence of tachyarrhythmias and procedural related complications of catheter ablation. In this review, therefore, we discuss some anatomic landmarks commonly used in catheter ablations including the terminal crest, sinus node region, Koch's triangle, cavotricuspid isthmus, Eustachian ridge and valve, pulmonary venous orifices, venoatrial junctions, and ventricular outflow tracts. We also discuss the anatomical features of important structures in the vicinity of the atria and pulmonary veins, such as the esophagus and phrenic nerves. This paper provides basic anatomic information to improve understanding of the mapping and ablative procedures for cardiac interventional electrophysiologists.
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Affiliation(s)
- ROBERT H. ANDERSON
- Institute of Medical Genetics, Newcastle University; Newcastle-upon-Tyne; United Kingdom
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