MP-453088-7 PROOF-OF-CONCEPT FORWARD-SOLUTION MAPPING OF A FOCAL ATRIAL TACHYCARDIA ORIGIN USING THE OUTPATIENT 12-LEAD ELECTROCARDIOGRAM

Abstract

Arrhythmia source mapping is essential to the delivery of targeted catheter ablation for cardiac arrhythmias. Whether mapping may be performed using outpatient 12-lead electrocardiogram (ECG) data was unknown. The objective of this proof-of-concept study was to evaluate the feasibility, temporal efficiency, and accuracy for forward-solution mapping using clinical ECG data obtained outside the electrophysiology laboratory. The patient is a 24-year-old female with recurrent, symptomatic focal atrial tachycardia (focal AT) diagnosed by 12-lead ECG in the outpatient clinic. After unsuccessful medical therapy, she elected to proceed with catheter ablation at Kaiser Santa Clara Medical Center. 12-lead ECG data from the clinical ECG database (Muse, GE Medical) was exported and transferred to the forward-solution mapping system (vMap, Vektor Medical). After data upload and system confirmation of acceptable data quality, a selection window was placed around the focal AT P-wave of interest (Figure A). The mapping process was initiated and the probabilistic source locations for the focal AT were displayed by the system. These results were then compared to the results of invasive activation mapping. Results from the forward-solution analysis demonstrated a highest probability focal AT source at the anterior base of the left atrial appendage (Figure B). Total processing time following upload of the ECG data into the clinical system was less than 3 minutes. Invasive activation mapping using the electroanatomic mapping system (Carto, Biosense-Webster) also demonstrated the site of early activation at the anterior base of the left atrial appendage (Figure C). Center-to-center spatial error between the forward-solution result and the site of early activation by invasive mapping was 8.8 mm. Forward-solution arrhythmia source mapping using data from a commercial ECG system obtained outside the electrophysiology laboratory is feasible, time-efficient, and demonstrates excellent agreement with invasive electroanatomic mapping. Future studies are required to determine whether this process may facilitate the delivery of targeted arrhythmia therapy in larger populations.