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Powers EM, Richardson TD. Reaching the LVOT: You take the high road and I'll take the low. J Cardiovasc Electrophysiol 2022; 33:557-558. [PMID: 35028989 DOI: 10.1111/jce.15364] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Accepted: 01/10/2022] [Indexed: 11/28/2022]
Abstract
The myocardium surrounding the coronary cusps is a common site of origin for ventricular arrhythmias (VA) both idiopathic and due to cardiomyopathy. The coronary cusps may also serve as a vantage point for ablation of the left ventricular summit and sites adjacent to the proximal conduction system.1,2 Supravalvular and infravalvular approaches to ablation in this region are commonplace and are typically utilized based on operator preference and proximity to site of earliest activation.3 While limited case series indicate that supravalvular ablation is safe and potentially effective, no data exist to assess the impact of intervening coronary cusp tissue on the biophysics of radiofrequency (RF) ablation.4 ventricular arrhythmias This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Edward M Powers
- Division of Cardiovascular Medicine, Vanderbilt University Medical Center, Nashville, TN
| | - Travis D Richardson
- Division of Cardiovascular Medicine, Vanderbilt University Medical Center, Nashville, TN
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Zhou S, AbdelWahab A, Sapp JL, Sung E, Aronis KN, Warren JW, MacInnis PJ, Shah R, Horáček BM, Berger R, Tandri H, Trayanova NA, Chrispin J. Assessment of an ECG-Based System for Localizing Ventricular Arrhythmias in Patients With Structural Heart Disease. J Am Heart Assoc 2021; 10:e022217. [PMID: 34612085 PMCID: PMC8751877 DOI: 10.1161/jaha.121.022217] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Background We have previously developed an intraprocedural automatic arrhythmia‐origin localization (AAOL) system to identify idiopathic ventricular arrhythmia origins in real time using a 3‐lead ECG. The objective was to assess the localization accuracy of ventricular tachycardia (VT) exit and premature ventricular contraction (PVC) origin sites in patients with structural heart disease using the AAOL system. Methods and Results In retrospective and prospective case series studies, a total of 42 patients who underwent VT/PVC ablation in the setting of structural heart disease were recruited at 2 different centers. The AAOL system combines 120‐ms QRS integrals of 3 leads (III, V2, V6) with pace mapping to predict VT exit/PVC origin site and projects that site onto the patient‐specific electroanatomic mapping surface. VT exit/PVC origin sites were clinically identified by activation mapping and/or pace mapping. The localization error of the VT exit/PVC origin site was assessed by the distance between the clinically identified site and the estimated site. In the retrospective study of 19 patients with structural heart disease, the AAOL system achieved a mean localization accuracy of 6.5±2.6 mm for 25 induced VTs. In the prospective study with 23 patients, mean localization accuracy was 5.9±2.6 mm for 26 VT exit and PVC origin sites. There was no difference in mean localization error in epicardial sites compared with endocardial sites using the AAOL system (6.0 versus 5.8 mm, P=0.895). Conclusions The AAOL system achieved accurate localization of VT exit/PVC origin sites in patients with structural heart disease; its performance is superior to current systems, and thus, it promises to have potential clinical utility.
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Affiliation(s)
- Shijie Zhou
- Alliance for Cardiovascular Diagnostic and Treatment Innovation Johns Hopkins University Baltimore MD
| | - Amir AbdelWahab
- Department of Medicine Queen Elizabeth II Health Sciences Centre Halifax NS Canada
| | - John L Sapp
- Department of Medicine Queen Elizabeth II Health Sciences Centre Halifax NS Canada.,Department of Physiology and Biophysics Dalhousie University Halifax NS Canada
| | - Eric Sung
- Alliance for Cardiovascular Diagnostic and Treatment Innovation Johns Hopkins University Baltimore MD.,Department of Biomedical Engineering Johns Hopkins University Baltimore MD
| | - Konstantinos N Aronis
- Division of Cardiology Department of Medicine Section of Cardiac Electrophysiology Johns Hopkins Hospital Baltimore MD.,Department of Biomedical Engineering Johns Hopkins University Baltimore MD
| | - James W Warren
- Department of Physiology and Biophysics Dalhousie University Halifax NS Canada
| | - Paul J MacInnis
- Department of Physiology and Biophysics Dalhousie University Halifax NS Canada
| | - Rushil Shah
- Division of Cardiology Department of Medicine Section of Cardiac Electrophysiology Johns Hopkins Hospital Baltimore MD
| | - B Milan Horáček
- School of Biomedical Engineering Dalhousie University Halifax NS Canada
| | - Ronald Berger
- Alliance for Cardiovascular Diagnostic and Treatment Innovation Johns Hopkins University Baltimore MD.,Division of Cardiology Department of Medicine Section of Cardiac Electrophysiology Johns Hopkins Hospital Baltimore MD
| | - Harikrishna Tandri
- Alliance for Cardiovascular Diagnostic and Treatment Innovation Johns Hopkins University Baltimore MD.,Division of Cardiology Department of Medicine Section of Cardiac Electrophysiology Johns Hopkins Hospital Baltimore MD
| | - Natalia A Trayanova
- Alliance for Cardiovascular Diagnostic and Treatment Innovation Johns Hopkins University Baltimore MD.,Department of Biomedical Engineering Johns Hopkins University Baltimore MD
| | - Jonathan Chrispin
- Alliance for Cardiovascular Diagnostic and Treatment Innovation Johns Hopkins University Baltimore MD.,Division of Cardiology Department of Medicine Section of Cardiac Electrophysiology Johns Hopkins Hospital Baltimore MD
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Zhou S, Sung E, Prakosa A, Aronis KN, Chrispin J, Tandri H, AbdelWahab A, Horáček BM, Sapp JL, Trayanova NA. Feasibility study shows concordance between image-based virtual-heart ablation targets and predicted ECG-based arrhythmia exit-sites. Pacing Clin Electrophysiol 2021; 44:432-441. [PMID: 33527422 DOI: 10.1111/pace.14181] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Revised: 01/05/2021] [Accepted: 01/24/2021] [Indexed: 12/20/2022]
Abstract
INTRODUCTION We recently developed two noninvasive methodologies to help guide VT ablation: population-derived automated VT exit localization (PAVEL) and virtual-heart arrhythmia ablation targeting (VAAT). We hypothesized that while very different in their nature, limitations, and type of ablation targets (substrate-based vs. clinical VT), the image-based VAAT and the ECG-based PAVEL technologies would be spatially concordant in their predictions. OBJECTIVE The objective is to test this hypothesis in ischemic cardiomyopathy patients in a retrospective feasibility study. METHODS Four post-infarct patients who underwent LV VT ablation and had pre-procedural LGE-CMRs were enrolled. Virtual hearts with patient-specific scar and border zone identified potential VTs and ablation targets. Patient-specific PAVEL based on a population-derived statistical method localized VT exit sites onto a patient-specific 238-triangle LV endocardial surface. RESULTS Ten induced VTs were analyzed and 9-exit sites were localized by PAVEL onto the patient-specific LV endocardial surface. All nine predicted VT exit sites were in the scar border zone defined by voltage mapping and spatially correlated with successful clinical lesions. There were 2.3 ± 1.9 VTs per patient in the models. All five VAAT lesions fell within regions ablated clinically. VAAT targets correlated well with 6 PAVEL-predicted VT exit sites. The distance between the center of the predicted VT-exit-site triangle and nearest corresponding VAAT ablation lesion was 10.7 ± 7.3 mm. CONCLUSIONS VAAT targets are concordant with the patient-specific PAVEL-predicted VT exit sites. These findings support investigation into combining these two complementary technologies as a noninvasive, clinical tool for targeting clinically induced VTs and regions likely to harbor potential VTs.
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Affiliation(s)
- Shijie Zhou
- Department of Biomedical Engineering, Johns Hopkins University, Baltimore, Maryland, USA.,Alliance for Cardiovascular Diagnostic and Treatment Innovation, Johns Hopkins University, Baltimore, Maryland, USA
| | - Eric Sung
- Department of Biomedical Engineering, Johns Hopkins University, Baltimore, Maryland, USA.,Alliance for Cardiovascular Diagnostic and Treatment Innovation, Johns Hopkins University, Baltimore, Maryland, USA
| | - Adityo Prakosa
- Department of Biomedical Engineering, Johns Hopkins University, Baltimore, Maryland, USA.,Alliance for Cardiovascular Diagnostic and Treatment Innovation, Johns Hopkins University, Baltimore, Maryland, USA
| | - Konstantinos N Aronis
- Section of Cardiac Electrophysiology, Division of Cardiology, Department of Medicine, Johns Hopkins Hospital, Baltimore, Maryland, USA.,Alliance for Cardiovascular Diagnostic and Treatment Innovation, Johns Hopkins University, Baltimore, Maryland, USA
| | - Jonathan Chrispin
- Section of Cardiac Electrophysiology, Division of Cardiology, Department of Medicine, Johns Hopkins Hospital, Baltimore, Maryland, USA.,Alliance for Cardiovascular Diagnostic and Treatment Innovation, Johns Hopkins University, Baltimore, Maryland, USA
| | - Harikrishna Tandri
- Section of Cardiac Electrophysiology, Division of Cardiology, Department of Medicine, Johns Hopkins Hospital, Baltimore, Maryland, USA.,Alliance for Cardiovascular Diagnostic and Treatment Innovation, Johns Hopkins University, Baltimore, Maryland, USA
| | - Amir AbdelWahab
- Department of Medicine, Queen Elizabeth II Health Sciences Centre, Halifax, Nova Scotia, Canada
| | - B Milan Horáček
- School of Biomedical Engineering, Dalhousie University, Halifax, Nova Scotia, Canada
| | - John L Sapp
- Department of Medicine, Queen Elizabeth II Health Sciences Centre, Halifax, Nova Scotia, Canada
| | - Natalia A Trayanova
- Department of Biomedical Engineering, Johns Hopkins University, Baltimore, Maryland, USA.,Alliance for Cardiovascular Diagnostic and Treatment Innovation, Johns Hopkins University, Baltimore, Maryland, USA
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