Abstract
Invasive electroanatomical mapping of polymorphic and unstable ventricular arrhythmias is a complex and laborious task. Noninvasive epi-endocardial ElectroCardioGraphic Imaging (ECGI) is a novel beat-to-beat mapping technique. The present work is a second part of single-center single-blind cross-sectional study to verify epi-endocardial ECGI accuracy. This part is particularly dedicated to investigate ECGI accuracy during right ventricular endocardial pacing followed by polygon model quality assessment and detailed analysis of cumulative effect of many different factors.Methods.37 patients with previously implanted pacemakers were enrolled in the study. All patients underwent epiendocardial ECGI mapping (Amycard 01C EP Lab, Amycard LLC, Russia - EP Solutions SA, Switzerland) during right endocardial ventricular pacing. The data obtained from torso and ECG-gated cardiac computed tomography (Somatom Definition 128, Siemens AG, Germany) were used to create three-dimensional ventricular models. Geodesic distance between noninvasively reconstructed early activate zone on the isopotential maps and RV reference pacing site were measured to evaluate ECGI accuracy for each patient.Results.The mean (SD) geodesic distance between noninvasively reconstructed and reference pacing site was 23 (14) mm for RV epicardial models and 9 (12) for RV endocardial surface of epi-endocardial models, median (25-75% IQR) - 21 (11-32) мм and 4 (2-8) mm respectively. ECGI accuracy on RV endocardial surface of epi-endocardial models was significantly better than on epicardial models (p <0,001). At the same time, there were no significant associations between cardiac CT, pacing parameters, clinical characteristics and accuracy values.Conclusions.The main results showed a possibility of novel epi-endocardial ECGI mapping to detect RV focal arrhythmias with high accuracy (median 3 mm) and to recognize endocardial localization with high percent of probability (more than 94%) comparable with invasive electroanatomical mapping. Therefore, this study confirms sufficient accuracy of epi-endocardial ECGI mapping technology for non-invasive topical diagnosis of RV focal arrhythmias.
Highlights
The present work is a second part of single-center single-blind cross-sectional study to verify epi-endocardial ElectroCardioGraphic Imaging (ECGI) accuracy. This part is dedicated to investigate ECGI accuracy during right ventricular endocardial pacing followed by polygon model quality assessment and detailed analysis of cumulative effect of many different factors
There were no significant associations between cardiac CT, pacing parameters, clinical characteristics and accuracy values
The main results showed a possibility of novel epi-endocardial ECGI mapping to detect RV focal arrhythmias with high accuracy and to recognize endocardial localization with high percent of probability comparable with invasive electroanatomical mapping
Summary
Оценка точности НЭФК проводилась на основе измерений геодезического расстояния от кончика ПЖ электрода до центра зоны ранней активации на изопотенциальных картах трехмерных полигональных эпи- и эпи-эндокардиальных моделей желудочков каждого пациента. Данное исследование является первым клиническим исследованием точности НЭФК на эпикардиальной и эндокардиальной поверхности желудочков сердца, учитывающим качество построения полигональных моделей и совокупное влияние разных факторов на используемый алгоритм решения обратной задачи ЭКГ. Результаты исследования показали возможность НЭФК с высокой точностью (медиана 3 мм) распознавать зону ранней активации фокусных аритмий в эндокардиальной области верхушки ПЖ, а также с высокой вероятностью (более 94%) распознавать эндокардиальную локализацию, что сопоставимо с инвазивным электроанатомическим картированием. The present work is a second part of single-center single-blind cross-sectional study to verify epi-endocardial ECGI accuracy. This part is dedicated to investigate ECGI accuracy during right ventricular endocardial pacing followed by polygon model quality assessment and detailed analysis of cumulative effect of many different factors
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