Abstract
Introduction: The precise localization of the site of origin of a PVC or VT prior to ablation would facilitate the planning and execution of the electrophysiological procedure. Current electrocardiographic imaging (ECGI) techniques uses body surface mapping that is costly, complex, and requires as many as 256 leads to localize the PVC origin. We developed and tested a novel myocardial activation based ECGI technique utilizing the readily available 12 lead ECG to localize the PVC origin. Method: The myocardial activation based ECGI requires a patient specific model of the heart and thorax. For the PVC or VT origin localization, the fastest route algorithm is used on patient specific models created by newly developed morphing software. Result: Eight patients that underwent electrophysiological mapping and ablation of PVCs were studied. The PVCs origins were localized on the endocardium of the mid left lateral wall, the anterior RVOT, the LV superior septum, septal RVOT and mid wall of the RVOT. In one patient the PVC origin was located on the epicardial RVOT. PVC localization by the 12-lead ECGI was correlated to the site of successful ablation. All patients (8/8) had accurate prediction of the PVC origin. However, in two patients without patient specific models the localization was reversed between the RV free wall and septum of the RVOT. With patient specific models, these latter two cases would likely be localized correctly. Conclusion: This feasibility study of the modified myocardial activation based ECGI shows ability to localize the PVC origin based on only the standard 12 lead ECG. This ECGI method yields activation estimates of isochrones on both ventricles from which the PVC origin location is derived. This new ECGI technique can localize the PVC from any part of the ventricular endocardium, intra-myocardium or epicardium.
Published Version
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