Abstract 13989: Automated VT Localization System Based on Patient-Specific Integration of Two-Dimensional (2D) Intracardiac Echocardiography (ICE) and 3DElectroanatomic (EA) Mapping

Abstract

Introduction: We have previously developed an intraprocedural automated localization system to identify VT-exit sites projected onto a patient-specific CT geometry using 12-lead ECGs. However, the accuracy of the system depends on a registered reconstruction of the cardiac surface. Objective: To assess the feasibility of using a registered integration of 2D ICE and 3D EA mapping to perform intraprocedural localization, while avoiding errors being introduced by registration of the CT geometry and EA map. Methods: Four patients with 7 VTs (5 LV VTs, 2 RV VTs) were enrolled. A 3D patient-specific shell of both ventricles that combines ICE and EA map was reconstructed during the ablation procedure. It was imported into the automated localization system post-procedure for offline analysis. The system was used to estimate the location of VT-exit sites on the reconstructed 3D geometry. Localization accuracy was quantified for the VT-exit sites by comparing the distance of the calculated site to the site of successful ablation or that of best pacing site match. Results: Five reentrant VT-exit sites were identified using activation and entrainment mapping, supplemented by pace-mapping at the scar margin; two focal VTs were identified by pace mapping. The proposed system achieved mean localization accuracy of 6.4 mm for 7 VTs. Conclusions: ICE and EA mapping can be successfully integrated for intraprocedural automated localization of ventricular activation in both ventricular chambers and may avoid registration errors of CT geometry integration.