Electrocardiographic imaging to guide ablation of ventricular arrhythmias shows a higher benefit in patients with low intraprocedural burden

Abstract

Abstract Background and aims Electrocardiographic imaging (ECGI) provides a non-invasive activation map of focal ventricular arrhythmias that has shown good accuracy regardless of the type of cardiac source used. Pre-procedure diagnosis in cases that are expected to be difficult and management of infrequent or poorly tolerated or multiple arrhythmias are some situations that may benefit the most from having an ECGI performed before the procedure. This study aimed to assess the benefit of the ECGI in patients with low intraprocedural burden. Methods We performed 81 ECGI procedures in 64 consecutive patients referred for ablation of ventricular arrhythmias (VAs). Ablations were performed with remote magnetic navigation or manually. The localization of the VAs based on the ECGI and invasive electroanatomic mapping was performed using a segmental model of the ventricles. A perfect match (PM) was defined as a predicted location within the same anatomic segment, whereas a near match (NM) was defined as a predicted location within the same segment or a contiguous one. The agreement between the ECGI and the invasive map was evaluated. The benefit of the ECGI in the subgroup of patients with intraprocedural infrequent VAs, defined as less than 1 VA complex /min, was assessed in terms of the success of the procedure. Results The ECGI was performed with the AMYCARD 01 only, in 26 patients, with the VIVO only, in 21 patients, and with both systems in 17 patients. Fifty-one patients underwent ablation. 65 ECGI procedures were performed before ablation in those 51 patients, 37 with Amycard with a rate of PM of 79% and NM of 97%, and 28 ECGI procedures with VIVO with 82% of PM and 93% of NM, not significantly different, respectively, p=0.764 and 0.573. The overall success rate was 80%. The low intraprocedural burden group included 28 patients (2 examples shown in the figure). The success rate was 86%, higher than the overall success rate, and much higher than the previously reported in the literature for this group of patients. Conclusions The ECGI was useful in predicting the location of the VA in general but was especially helpful in cases that are usually challenging, like patients with intraprocedural infrequent VAs.