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.

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 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.

Evaluation of noninvasive electrophysiological imaging accuracy for focal atrial arrhythmias

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
M Budanova ◽  
M Chmelevsky ◽  
S Zubarev ◽  
T Treshkur ◽  
D Lebedev
Keyword(s):  
Ventricular Arrhythmias ◽  
High Accuracy ◽  
Atrial Pacing ◽  
Atrial Arrhythmias ◽  
Electrocardiographic Imaging ◽  
Epicardial Surface ◽  
Atrial Contraction ◽  
Premature Atrial Contraction ◽  
Endocardial Surface ◽  
The Right

Abstract Background High accuracy of noninvasive electrocardiographic imaging (ECGI) has recently been shown for topical diagnostics of ventricular arrhythmias. However, the precision of diagnostics of atrial focal arrhythmias requires clarification. To estimate the accuracy of ECGI for premature atrial contraction (PAC) we performed atrial pacing in patients with CRT system and compared early activation zone (EAZ) with pacemaker's tip location. Purpose To determine the accuracy of ECGI for focal atrial arrhythmias using atrial pacing. Methods Twenty-six patients (m/f – 18/9), age (min–max) 52 (26–78) with CRT system and pacemaker's tip location in the right atrium (RA) appendage underwent ECGI (“Amycard 01C”) in combination with CT or MR imaging. Thirty-four atrial pacing (mono- and bipolar) was performed in all patients using standard amplitude 1.5–3.8 mV. Epi-/endocardial polygonal heart models were created and isopotential maps were calculated. The distance between EAZ and the pacemaker's tip were measured for ECG recordings without using the isoline filter on endocardial surface (Fig. 1) as well as for epicardial surface. The time between epicardial and endocardial EAZ breakthrough was calculated also. Results On endocardial surface the EAZ was located in RA appendage, the base of superior cava vena or superior lateral RA wall. The distance (mm) (Me (min; max)) between EAZ and the pacemacer's tip was 28 (6; 68). For epicardial surface in most cases the EAZ was also located in RA appendage, the base of superior cava vena or superior lateral RA wall. In two cases the EAZ was located in inferior septal RA wall, in one case - in superior septal RA wall and in five cases the EAZ was undetectable. The distance between EAZ and the pacemacer's tip was 22 (6; 48). The time (ms) (Mean; Me (min; max)) between EAZ of the endocardial and epicardial surfaces was 16; 7 (0; 68). Conclusion ECGI allows to assess the location of focal atrial arrhythmias on endocardial surface and sometimes on epicardial surface also within the three segments. The results of this study revealed that accuracy of ECGI for atrial arrhythmias is worse than for ventricular arrhythmias. However, it is better on epicardial surface of atrium when EAZ can be determined. Funding Acknowledgement Type of funding source: None

scholarly journals RESULTS OF NON-INVASIVE ACTIVATION MAPPING OF THE HEART IN “IDIOPATHIC” VENTRICULAR ARRHYTHMIAS IN COMPARISON WITH STRUCTURAL CHARACTERISTICS OF MYOCARDIUM BY MAGNETIC RESONANCE IMAGING

2018 ◽  
pp. 32-40
Author(s):  
N. A. Mironova ◽  
L. H. Yeghiazaryan ◽  
О. P. Aparina ◽  
T. A. Malkina ◽  
O. V. Stukalova ◽  
...  
Keyword(s):  
Ventricular Tachycardia ◽  
Magnetic Resonance ◽  
Ventricular Arrhythmias ◽  
Structural Characteristics ◽  
Magnetic Resonance Tomography ◽  
Late Enhancement ◽  
Morphological Type ◽  
Sustained Ventricular Tachycardia ◽  
Ventricular Ectopic Activity ◽  
Non Invasive

Aim.To compare the results of non-invasive activational mapping in patients with “idiopathic” ventricular arrhythmias (IVA) with the data on myocardial structure obtained by late enhancement magnetic resonance tomography (MRI).Material and methods.Twenty eight IVA patients, mean age 37 y. o. [26; 45], with ventricular arrhythmias of the heart (VA) of 2nd or higher grade by Lown, and 5 healthy volunteers (HV), mean age 29 [29; 30], underwent surface epiand endocardial non-invasive mapping (SEENIM) of the heart with the system for noninvasive electrophysiological investigation of the heart “Amicard 01C” with the analysis of duration of the activation-recovery interval (ARI) of the ventricles, and high resolution MRI (voxel 1,25x1,25x2,5mm) with delayed contrasting.Results.The number of VA in IVA group was 20196 [11479; 29834] for 24 hours. In 11 patients there were episodes of non-sustained ventricular tachycardia (VT). By SEENIM, predominating morphological type of ventricular ectopic activity in 22 patients sourced from the right ventricle myocardium (RV), of those in 20 from outflow tract of the LV (OTLV). There was significantly prolonged ARI in OTLV patients with IVA comparing to HV (p<0,05). In IVA and non-sustained ventricular tachycardia patients, by contrast MRI of the heart, in LV myocardium there were small foci of contrast retention found. There was no correlation of the areas of contrast retention and topography of VA sources.Conclusion.In most of IVA patients the source of VA was outflowing tract of the RV. The revealed prolongation of the ARI of this area in IVA patients can be an important factor of IVA onset. Small foci of LV fibrosis, found in late enhancement MRI of the heart and episodes of so called idiopathic VT, might be the earliest presentation of the “tachycardiopathy” at the step of pathology development when there are no signs of LV dilation.

scholarly journals B-PO05-120 A NOVEL NON-INVASIVE ELECTROCARDIOGRAPHIC IMAGING MAPPING IS A USEFUL TOOL TO PREDICT PREMATURE VENTRICULAR COMPLEXES LOCALIZATION BEFORE CATHETER ABLATION PROCEDURE

Heart Rhythm ◽  
2021 ◽  
Vol 18 (8) ◽  
pp. S420-S421
Author(s):  
Krista Lesina ◽  
Mark G. Hoogendijk ◽  
Bakhtawar Mahmoodi Emile Peters ◽  
André de Wit ◽  
Alexander Hirsch ◽  
...  
Keyword(s):  
Catheter Ablation ◽  
Ablation Procedure ◽  
Electrocardiographic Imaging ◽  
Premature Ventricular Complexes ◽  
Non Invasive

scholarly journals PFNA-II Internal Fixation Helps Hip Joint Recovery and Improves Quality of Life of Patients with Lateral-Wall Dangerous Type of Intertrochanteric Fracture

2021 ◽  
Vol 2021 ◽  
pp. 1-6
Author(s):  
Weilu Mu ◽  
Junlin Zhou
Keyword(s):  
Internal Fixation ◽  
Hip Joint ◽  
Intertrochanteric Fracture ◽  
Operation Time ◽  
Lateral Wall ◽  
Intraoperative Blood Loss ◽  
Function Score ◽  
Curative Effect ◽  
Hip Function

Objective. To analyze the effect of PFNA-II internal fixation on hip joint recovery and quality of life (QOL) in patients with lateral-wall dangerous type of intertrochanteric fracture. Methods. One hundred and twelve patients with lateral-wall dangerous type of intertrochanteric fracture who underwent surgical treatment in our hospital from May 2017 to May 2019 were selected as the participants of the study. Based on the treatment method, all the enrolled patients were divided into two groups: proximal femoral nail antirotation (PFNA group; n = 59 ) who received closed reduction and minimally invasive PFNA internal fixation and dynamic hip screw group (DHS; n = 53 ) who received internal fixation. The clinical indicators, curative effect, hip function score, pain degree, postoperative QOL score, and complications were compared between the two groups. Results. The operation time, intraoperative blood loss, postoperative drainage volume, and the incidence of postoperative complications in PFNA group were statistically lower than those in DHS group ( P < 0.05 ). The curative effect in PFNA group was notably better than that in DHS group. There were no significant differences in scores of hip function, visual analogue scale (VAS), and QOL between the two groups before operation ( P > 0.05 ). However, the hip function score and QOL score increased in both groups after surgery, and the increase was more significant in the PFNA group, while the VAS score decreased in both groups, and the decrease in PFNA group was more significant ( P < 0.05 ). Conclusion. PFNA internal fixation for the treatment of lateral-wall dangerous type of intertrochanteric fracture has the advantages of short operation time, less intraoperative blood loss, effective improvement of hip joint function, and fewer postoperative complications, which is worthy of clinical application.

scholarly journals Interesting Clinical Presentation of Myxoid Liposarcoma of Oropharynx

2013 ◽  
Vol 4 (1) ◽  
pp. 57-58
Author(s):  
Sagaya Raj ◽  
Shuaib Merchant ◽  
Azeem Mohiyuddin ◽  
P Arun
Keyword(s):  
Head And Neck ◽  
Clinical Presentation ◽  
Surgical Excision ◽  
Myxoid Liposarcoma ◽  
Lateral Wall ◽  
Posterior Wall ◽  
Low Grade ◽  
Present Case Report ◽  
Case Presentation ◽  
Histologic Pattern

ABSTRACT Aims To describe an unusual presentation of myxoid liposarcoma of oropharynx and a brief review of literature. Introduction Liposarcomas of head and neck are very rare. Its treatment and prognosis mainly depends on the site and the histologic pattern of the tumor. Case presentation The present case report describes a 65-year-old male with complaints of dysphagia, dyspnea, and a peculiar complaint of mass in the throat which turned out to be a low-grade myxoid liposarcoma arising from right lateral wall of oropharynx extending intraluminal in the esophagus, compressing posterior wall of trachea. The mass was successfully excised surgically and postoperative period was uneventful and patient was asymptomatic 4 months after surgery. Conclusion Myxoid liposarcoma is a rare tumor in head and neck and surgical excision with adequate margin is the treatment of choice. How to cite this article Mohiyuddin A, Raj S, Merchant S, Arun P. Interesting Clinical Presentation of Myxoid Liposarcoma of Oropharynx. Int J Head and Neck Surg 2013;4(1):57-58.

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