scholarly journals Optimization of CRT programming using non‐invasive electrocardiographic imaging to assess the acute electrical effects of multipoint pacing

2019 ◽  
Vol 35 (2) ◽  
pp. 267-275 ◽  
Author(s):  
Benjamin J. Sieniewicz ◽  
Tom Jackson ◽  
Simon Claridge ◽  
Helder Pereira ◽  
Justin Gould ◽  
...  
Keyword(s):  
Electrocardiographic Imaging ◽  
Non Invasive ◽  
Multipoint Pacing

scholarly journals B-PO02-188 SYNCAVAND MULTIPOINT PACING IMPROVE LEFT VENTRICLE ACTIVATION AS EVALUATED BY ELECTROCARDIOGRAPHIC IMAGING

Heart Rhythm ◽  
2021 ◽  
Vol 18 (8) ◽  
pp. S174-S175
Author(s):  
Peter Henry Waddingham ◽  
Michele Orini ◽  
Jan Mangual ◽  
Amal G. Muthumala ◽  
Simon Sporton ◽  
...  
Keyword(s):  
Left Ventricle ◽  
Electrocardiographic Imaging ◽  
Multipoint Pacing

scholarly journals The Use of Electrocardiographic Imaging in Localising the Origin of Arrhythmias During Catheter Ablation of Ventricular Tachycardia

2021 ◽  
Vol 10 (3) ◽  
pp. 211-217
Author(s):  
Adam J Graham ◽  
Richard J Schilling
Keyword(s):  
Inverse Problem ◽  
Ventricular Arrhythmia ◽  
Clinical Tool ◽  
Electrocardiographic Imaging ◽  
Surface Electrodes ◽  
Non Invasive ◽  
Large Target ◽  
The Us ◽  
Activation Times ◽  
Unipolar Electrograms

Non-invasive electrocardiographic imaging (ECGI) is a novel clinical tool for mapping ventricular arrhythmia. Using multiple body surface electrodes to collect unipolar electrograms and conventional medical imaging of the heart, an epicardial shell can be created to display calculated electrograms. This calculation is achieved by solving the inverse problem and allows activation times to be calculated from a single beat. The technology was initially pioneered in the US using an experimental torso-shaped tank. Accuracy from studies in humans has varied. Early data was promising, with more recent work suggesting only moderate accuracy when reproducing cardiac activation. Despite these limitations, the system has been successfully used in pioneering work with non-invasive cardiac radioablation to treat ventricular arrhythmia. This suggests that the resolution may be sufficient for treatment of large target areas. Although untested in a well conducted clinical study it is likely that it would not be accurate enough to guide more discreet radiofrequency ablation.

P2567First experience of non-invasive and invasive activation maps merge in carto system for topical diagnosis of focal arrhythmias

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
M Budanova ◽  
M Chmelevsky ◽  
S Zubarev ◽  
D Potyagaylo ◽  
L Parreira ◽  
...  
Keyword(s):  
Ventricular Arrhythmias ◽  
Operation Time ◽  
Lateral Wall ◽  
Posterior Wall ◽  
Late Enhancement ◽  
Ablation Procedure ◽  
Electrocardiographic Imaging ◽  
Non Invasive ◽  
Topical Diagnosis ◽  
Endocardial Surface

Abstract Background Correct preoperative topical diagnostics of atrial and ventricular arrhythmias allows for operation time reduction by facilitating the ablation target localization, especially in case of several ectopic sources. Purpose To implement a non-invasive electrocardiographic imaging (ECGI) technique in CARTO system for aiming at topical diagnostics of focal arrhythmias improving. Methods Twelve patients (m/f – 10/2, age (min–max) – 50,5 (32–71)) with focal arrhythmias underwent ECGI in combination with CT or MR imaging. Two subjects had atrial premature contractions (PAC), while ten patients suffered from ventricular premature contractions (PVC) with indications for ablation. Before the ablation procedure Carto LAT mapping was performed in all patients. Using ECGI epi-/endocardial polygonal models of the heart were created, isopotential and activation maps were calculated, uploaded into the Carto system and merged with the CARTO FAM models (Figure 1). Results For six patients with PVC and two patients with PAC, earliest activation zones (EAZs) anatomical locations obtained by invasive and non-invasive methods were the same (RVOT septum, RVOT lateral-anterior and RV lateral-basal walls, right aortic cusp, LVOT, coronary sinus (CS), CS ostium, RA posterior wall), and arrhythmias ablation was successful. Two patients featured coherent EAZs (RV lateral-basal wall and RVOT septum) but a negative ablation outcome. In one patient, EAZs were situated in different anatomical regions: CARTO showed the PVC EAZ in RV septum, whereas Amycard system identified endocardial surface of lateral-basal RV wall. In this patient, PVC was ablated partially. For another patient with MRI late enhancement area in LV lateral wall the EAZs were in the same LV segment but with mismatch in epi/endocardial surface. Conclusion Non-invasive and invasive activation maps merge can improve localization of ablation targets in focal arrhythmias, potentially increasing effectiveness of the EP procedure and reducing operation time.

BENEFICIAL EFFECT OF MULTIPOINT PACING IN CRT PATIENTS BASED ON NON-INVASIVE HEMODYNAMIC ASSESSMENT: DATA OF THE COMPACT-MPP STUDY

2019 ◽  
Vol 73 (9) ◽  
pp. 546
Author(s):  
Antonio Curcio ◽  
Antonio Ruocco ◽  
Giuseppe Santarpia ◽  
Salvatore Crispo ◽  
Grazia Canciello ◽  
...  
Keyword(s):  
Beneficial Effect ◽  
Assessment Data ◽  
Non Invasive ◽  
Multipoint Pacing ◽  
Hemodynamic Assessment

scholarly journals A novel non-invasive electrocardiographic imaging technique facilitates the preprocedural diagnostic workup of patients with infrequent ventricular arrhythmias

EP Europace ◽  
2021 ◽  
Vol 23 (Supplement_3) ◽  
Author(s):  
K Lesina ◽  
MG Hoogendijk ◽  
A De Wit ◽  
E Peters ◽  
T Szili- Torok
Keyword(s):  
Ventricular Arrhythmias ◽  
Cardiac Computed Tomography ◽  
Treatment Success ◽  
Outpatient Setting ◽  
Anatomical Reconstruction ◽  
Patient Specific ◽  
Success Rates ◽  
Electrocardiographic Imaging ◽  
Non Invasive ◽  
Group A

Abstract Funding Acknowledgements Type of funding sources: None. Background Catheter ablation (CA) fails in considerable numbers of patients with ventricular arrhythmias (VAs). Possible reasons include absence and non-inducibility, multifocal origin and anatomically difficult locations of premature ventricular complexes (PVCs) and ventricular tachycardias (VTs). A novel non-invasive electrocardiographic imaging (ECGI) diagnostic tool may help to determine the best treatment strategy of these patients. Purpose To evaluate outpatient ECGI (VIVO, View Into Ventricular Onset, Catheter Precision, NJ) to tailor treatment of patients with infrequent ventricular arrhythmias referred for CA. Methods Thirteen patients in an outpatient setting with VAs were included in this pilot-study. All patients underwent ECGI mapping using VIVO. It is a novel technique that localize the origin of VAs using a combination of 12-lead ECG and a patient specific 3D anatomical reconstruction of the heart and thorax using cardiac magnetic resonance imaging (MRI) or cardiac computed tomography imaging (CT). The technique is based on virtual simulation of pace-mapping and has a unique feature that the imaging can be performed independently from recording of the arrhythmias. Suitability for ablation was based on the VIVO mapping in this cohort. Results Among the 13 patients enrolled (10 female, 3 male, age 39 ±15 years), a total of  16 PVC/VT morphologies were analyzed using VIVO. Ten of them had a low PVC burden (<8%). Ten patients underwent pre-procedural cardiac MRI and 4 had CT imaging. Seven of the patients had structurally normal hearts, while the remaining 6 had non-ischemic cardiomyopathy. Based on the VIVO mapping findings the patients were divided in two groups. Group A: 7 patients in whom ablation was considered suitable. In this group a VIVO based anatomy CA was attempted in 3 patients for  PVCs. Two out of these were successful. Three patients were offered CA but was declined by patient decision (suboptimal balance between burden, complaints and the offered success rates without procedural hard endpoint). Another patient is offered and is waiting for CA. The other group B: 6 patients in whom VIVO mapping was consistent with an unacceptable chance for treatment success were not offered CA. This included: 4 patients with a multifocal origin and a low burden of PVCs. One patient had different diagnosis (atrial fibrillation) and another had no PVC’s during 12-lead ECG monitoring. Conclusions Non-invasive ECGI pace-map is a unique tool that can identify the origin of infrequent VAs in an outpatient clinical setting in order to screen out patients not feasible for CA. Low burden PVCs maybe attempted to be ablated when the source is clearly associated of certain anatomical structures.

scholarly journals Personalized Evaluation of Atrial Complexity of Patients Undergoing Atrial Fibrillation Ablation: A Clinical Computational Study

Biology ◽  
2021 ◽  
Vol 10 (9) ◽  
pp. 838
Author(s):  
Ana María Sánchez de la Nava ◽  
Ana González Mansilla ◽  
Esteban González-Torrecilla ◽  
Pablo Ávila ◽  
Tomás Datino ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Computational Study ◽  
P Value ◽  
Electrocardiographic Imaging ◽  
Non Invasive ◽  
Electrical Modelling ◽  
One Year ◽  
Improve Patient ◽  
Af Recurrence

Current clinical guidelines establish Pulmonary Vein (PV) isolation as the indicated treatment for Atrial Fibrillation (AF). However, AF can also be triggered or sustained due to atrial drivers located elsewhere in the atria. We designed a new simulation workflow based on personalized computer simulations to characterize AF complexity of patients undergoing PV ablation, validated with non-invasive electrocardiographic imaging and evaluated at one year after ablation. We included 30 patients using atrial anatomies segmented from MRI and simulated an automata model for the electrical modelling, consisting of three states (resting, excited and refractory). In total, 100 different scenarios were simulated per anatomy varying rotor number and location. The 3 states were calibrated with Koivumaki action potential, entropy maps were obtained from the electrograms and compared with ECGi for each patient to analyze PV isolation outcome. The completion of the workflow indicated that successful AF ablation occurred in patients with rotors mainly located at the PV antrum, while unsuccessful procedures presented greater number of driving sites outside the PV area. The number of rotors attached to the PV was significantly higher in patients with favorable long-term ablation outcome (1-year freedom from AF: 1.61 ± 0.21 vs. AF recurrence: 1.40 ± 0.20; p-value = 0.018). The presented workflow could improve patient stratification for PV ablation by screening the complexity of the atria.

scholarly journals NON-INVASIVE ELECTROCARDIOGRAPHIC IMAGING IN DIFFERENTIAL AND TOPICAL DIAGNOSIS OF VENTRICULAR TACHYCARDIA WITH VENTRICULOATRIAL RETROGRADE CONDUCTION

2020 ◽  
Vol 26 (3) ◽  
pp. 65-70
Author(s):  
M. P. Chmelevsky ◽  
S. V. Zubarev ◽  
M. A. Budanova ◽  
T. V. Treshkur ◽  
D. S. Lebedev
Keyword(s):  
Ventricular Tachycardia ◽  
Conflicts Of Interest ◽  
Right Ventricular Outflow Tract ◽  
Ventricular Outflow Tract ◽  
Electrocardiographic Imaging ◽  
Clinical Specialist ◽  
Non Invasive ◽  
Topical Diagnosis ◽  
Endocardial Surface ◽  
Retrograde Conduction

A case report of differential and topical diagnosis of ventricular tachycardia from right ventricular outflow tract endocardial surface with ventriculoatrial retrograde conduction using non-invasive electrocardiographic imaging is presented.Conflicts of Interest: M.Chmelevsky - clinical specialist EP Solutions SA, S.Zubarev and M.Budanova - consultants EP Solutions SA.

scholarly journals Non-Invasive Assessment of Complexity of Atrial Fibrillation: Correlation with Contact Mapping and Impact of Ablation

2020 ◽  
Author(s):  
Miguel Rodrigo ◽  
Andreu M. Climent ◽  
Ismael Hernández-Romero ◽  
Alejandro Liberos ◽  
Tina Baykaner ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Body Surface ◽  
Response To Therapy ◽  
The Body ◽  
Surface Mapping ◽  
Electrocardiographic Imaging ◽  
Phase Singularity ◽  
Contact Mapping ◽  
Clinical Endpoints ◽  
Non Invasive

Background - It is difficult to non-invasively phenotype atrial fibrillation (AF) in a way that reflects clinical endpoints such as response to therapy. We set out to map electrical patterns of disorganization and regions of reentrant activity in AF from the body surface using electrocardiographic imaging (ECGI), calibrated to panoramic intracardiac recordings and referenced to AF termination by ablation. Methods - Bi-atrial intracardiac electrograms of 47 AF patients at ablation (30 persistent, 29 male, 63±9 years) were recorded with 64-pole basket catheters and simultaneous 57-lead body surface ECGs. Atrial epicardial electrical activity was reconstructed and organized sites were invasively and non-invasively tracked in 3D using phase singularity (PS). In a subset of 17 patients, sites of AF organization were targeted for ablation. Results - Body surface mapping showed greater AF organization near intracardially-detected drivers than elsewhere, both in PS density (2.3±2.1 vs 1.9±1.6, p=0.02) and number of drivers (3.2±2.3 vs 2.7±1.7, p=0.02). Complexity, defined as the number of stable AF reentrant sites, was concordant between non-invasive and invasive methods (r 2 =0.5, CC=0.71). In the subset receiving targeted ablation, AF complexity showed lower values in those in whom AF terminated than those in whom AF did not terminate (p<0.01). Conclusions - AF complexity tracked non-invasively correlates well with organized and disorganized regions detected by panoramic intracardiac mapping, and correlates with the acute outcome by ablation. This approach may assist in bedside monitoring of therapy or in improving the efficacy of ongoing ablation procedures.

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