Abstract 18237: Non-invasive Three Dimensional Imaging of Ventricular Arrhythmias: In-procedure Simultaneous Mapping of Ventricular Tachycardia and Premature Ventricular Complexes

Abstract

Introduction: Noninvasive activation imaging and the identification of initiation sites or reentrant circuits are highly desirable for aiding catheter ablative treatment of ventricular arrhythmia. While approaches are being developed to image epicardial potential, Cardiac Electrical Sparse Imaging (CESI), a 3-dimensional noninvasive activation imaging technique offers insight into intramural activation. In this study, we report the first clinical study of the CESI technique with in-procedure simultaneous mapping of Ventricular Tachycardia (VT) and Premature Ventricular Complexes (PVCs). Methods: Body surface potential maps (BSPMs) were recorded using 170±9 electrodes in 4 patients (2 males, 2 females, age 53±5) with VT and/or PVC in the EP lab simultaneously with CARTO mapping and ablation. CT or MRI images were obtained for individualized volume conductor modeling. Activation sequences were estimated using CESI upon the 40 isolated PVC or VT beats induced by programmed stimulation or isoproterenol infusion. Imaging results were compared with CARTO map and ablation sites/outcomes. Results: Good concordance was observed between the imaged results and the EP study. A Correlation Coefficient of 0.76±0.04 and Relative Error of 0.22±0.05 were found between the imaged activation sequences and the Local Activation Time maps from CARTO. The imaged initiation sites well co-localized with the ablation outcomes with Localization Error of 8±1.3mm from the last ablation site and 3.3±1.7mm from the nearest ablation site. Conclusions: We demonstrate for the first time that the beat-to-beat 3D activation imaging technique CESI can be applied clinically with simultaneous mapping in the EP lab. The noninvasive imaging results are in good agreement with the EP study and catheter ablation outcome. The promising results suggest CESI warrants further investigation and has the potential to become a clinically useful technology guiding ablation procedures in patients.