Comparative spatial resolution of 12-lead electrocardiography and an automated algorithm

Abstract

The spatial resolution of pacemapping using 12-lead electrocardiography (ECG) or PaSo software is unknown. The purpose of this study was to determine the spatial resolution of traditional ECG pacemapping and pacemapping using the PaSo coefficients. Seventeen patients undergoing ablation of supraventricular tachycardias or atrioventricular node were included. After ablation, chamber (right ventricular outflow tract/rest of the right ventricle/left ventricle) geometry was created with Carto 3. Pacingwas performed from any point in these cardiac regions, the QRS morphology being the template and the point being considered as arrhythmia "origin." Subsequently, pacing was performed from points around the "origin" (1538 points). The QRS of these tagged points were compared by traditional ECG pacemapping and PaSo coefficients. The spatial resolution was calculated using correlations between the distance away from the origin (measured by 3 computational methods) and traditional ECG pacemapping and PaSo coefficients, independently. A 0.01-unit decrease in the PaSo coefficient resulted in 1.1 mm increased Cartesian distance (95% confidence interval [CI] 0.9-1.3 mm; P < .001) and 2.4 mm increased geodesic distance (95% CI 1.9-2.9 mm; P < .001) and 664 mm3 increase in convex hull volume (95% CI 423-906 mm3; P < .0001). For traditional ECG pacemapping, each decrease in lead match resulted in 1.7 mm increased Cartesian distance (95% CI 1.5-2.0 mm; P < .001) and 3.4 mm increased geodesic distance (95% CI 2.8-4.1 mm; P < .001) and 712 mm3 increase in convex hull volume (95% CI 599-830 mm3; P < .0001). Both PaSo coefficients and traditional pacemapping showed a significant inverse linear correlation with distance from the "origin." The resolution of mapping using the Paso software is better than that of traditional pacemapping.