Abstract 18650: Activation Mapping of Ventricular Ectopy: Characterization of a Threshold Value Predicting Successful Catheter Ablation

Circulation ◽  
2015 ◽  
Vol 132 (suppl_3) ◽  
Author(s):  
Will Camnitz ◽  
Kenneth Bilchick ◽  
John Dimarco ◽  
Kevin Driver ◽  
John Ferguson ◽  
...  
Keyword(s):  
Catheter Ablation ◽  
Threshold Value ◽  
Accurate Method ◽  
Ventricular Ectopy ◽  
Activation Time ◽  
Local Activation ◽  
Successful Ablation ◽  
Activation Times ◽  
Local Activation Time ◽  
Activation Mapping

Background: Catheter ablation of ventricular ectopy is performed with increasing frequency. Activation mapping to determine the site with the earliest presystolic electrogram (EGM) is the most accurate method to locate the optimal ablation site. Despite this, activation mapping of ventricular ectopy has not been systematically reviewed in a large series, and the optimal activation time predicting successful ablation has not previously been determined. The goal of this study is to determine the local presystolic activation time most predictive of successful ablation. Methods and Results: We retrospectively reviewed 100 consecutive successful endocardial PVC ablations and analyzed the local activation time at each successful and unsuccessful ablation site. A total of 561 ablation lesions were reviewed. Activation time was calculated as the difference between the peak of the local bipolar EGM and the onset of the reference surface QRS complex. Acute success was defined as complete elimination of the target PVC during the procedure with no recurrence at 30 days by ECG and follow-up Holter. A local activation time 27 msec presystolic best predicted success with a sensitivity of 88%, specificity 85%, and an area under the ROC curve of 0.936 (95% CI 0.91 - 0.95; figure 1). The 27 msec presystolic activation time remained most predictive of success after sub-stratifying activation times by location (RVOT v LVOT, outflow v intracavitary). The odds ratio for success with each 1 msec increase in activation time (becomes more negative by 1 msec) is 1.24 (95% CI 1.19 - 1.29). Conclusion: In our experience, a local presystolic activation time of 27 msec is the threshold value most predictive of successful PVC ablation. Our review is the first to systematically characterize an activation time predicting success with PVC ablation in a large cohort. Figure 1

scholarly journals 1224A hybrid local activation time mapping model as for the ablation of premature ventricular contractions

EP Europace ◽  
2017 ◽  
Vol 19 (suppl_3) ◽  
pp. iii254-iii255
Author(s):  
T J R De Potter ◽  
E. Silva Garcia ◽  
T. Strisciuglio ◽  
T. Bar-On ◽  
S. Chatzikyriakou ◽  
...  
Keyword(s):  
Activation Time ◽  
Premature Ventricular Contractions ◽  
Mapping Model ◽  
Local Activation ◽  
Local Activation Time

scholarly journals High-Resolution Measurement of Local Activation Time Differences From Bipolar Electrogram Amplitude

2021 ◽  
Vol 12 ◽  
Author(s):  
Stephen Gaeta ◽  
Tristram D. Bahnson ◽  
Craig Henriquez
Keyword(s):  
High Resolution ◽  
Spatial Scales ◽  
Delta Method ◽  
Peak Amplitude ◽  
Clinical Electrophysiology ◽  
Activation Time ◽  
Local Activation ◽  
High Resolution Measurement ◽  
Resolution Measurement ◽  
Local Activation Time

Localized changes in myocardial conduction velocity (CV) are pro-arrhythmic, but high-resolution mapping of local CV is not yet possible during clinical electrophysiology procedures. This is in part because measurement of local CV at small spatial scales (1 mm) requires accurate annotation of local activation time (LAT) differences with very high temporal resolution (≤1 ms), beyond that of standard clinical methods. We sought to develop a method for high-resolution measurement of LAT differences and validate against existing techniques. First, we use a simplified theoretical model to identify a quantitative relationship between the LAT difference of a pair of electrodes and the peak amplitude of the bipolar EGM measured between them. This allows LAT differences to be calculated from bipolar EGM peak amplitude, by a novel “Determination of EGM Latencies by Transformation of Amplitude” (DELTA) method. Next, we use simulated EGMs from a computational model to validate this method. With 1 kHz sampling, LAT differences less than 4 ms were more accurately measured with DELTA than by standard LAT annotation (mean error 3.8% vs. 22.9%). In a 1-dimensional and a 2-dimension model, CV calculations were more accurate using LAT differences found by the DELTA method than by standard LAT annotation (by unipolar dV/dt timing). DELTA-derived LAT differences were more accurate than standard LAT annotation in simulated complex fractionated EGMs from a model incorporating fibrosis. Finally, we validated the DELTA method in vivo using 18,740 bipolar EGMs recorded from the left atrium of 10 atrial fibrillation patients undergoing catheter ablation. Using clinical EGMs, there was agreement in LAT differences found by DELTA, standard LAT annotation, and unipolar waveform cross-correlation. These results demonstrate an underlying relationship between a bipolar EGM’s peak amplitude and the activation time difference between its two electrodes. Our computational modeling and clinical results suggest this relationship can be leveraged clinically to improve measurement accuracy for small LAT differences, which may improve CV measurement at small spatial scales.

scholarly journals การสร้างภาพสามมิติ (3D Mapping) ในกลุ่มผู้ป่วยภาวะหัวใจเต้นผิดจังหวะชนิดเร็วที่ได้รับการรักษาโดยการจี้ด้วยกระแสไฟฟ้า (Ablation)

2021 ◽  
Vol 14 (3) ◽  
pp. 53-60
Author(s):  
Chatyapa Sriprom ◽  
Supaluck Kanjanauthai ◽  
Anon Jantanukul
Keyword(s):  
3D Mapping ◽  
Rf Ablation ◽  
Activation Time ◽  
Hybrid Technology ◽  
Local Activation ◽  
Bipolar Voltage ◽  
Voltage Mapping ◽  
Atrial Electrogram ◽  
Local Activation Time ◽  
Complex Fractionated Atrial Electrogram

ในปัจจุบันการสร้างภาพสามมิติ (3D Mapping) ในกลุ่มผู้ป่วยภาวะหัวใจเต้นผิดจังหวะชนิดเร็วที่ได้รับการรักษาโดยการจี้ด้วยกระแสไฟฟ้า (RF Ablation) ได้รับความนิยมอย่างแพร่หลายมากขึ้น เนื่องจากการสร้างภาพสามมิติ มีการนำเทคโนโลยีสมัยใหม่เข้ามาช่วยในการสร้างภาพได้แก่ Magnetic Technology, Current-based technology, Hybrid technology ทำให้สามารถสร้างภาพสามมิติออกมาได้หลายรูปแบบอย่างเช่น Anatomical mapping, Local Activation Time mapping (LAT), Bipolar Voltage mapping, Complex Fractionated Atrial Electrogram (CFAEs) Map,  Pace map, Merge หรือ Fusion, Reentrant map เป็นต้นโดยภาพที่ได้นอกจากจะแสดงเป็นภาพนิ่งแล้วยังสามารถแสดงเป็น Video Animation ได้อีกด้วยอย่างเช่น  Propagation Map, Ripple Map เป็นต้น ทำให้มีความแม่นยำในการรักษา ผู้ป่วยได้รับปริมาณรังสีที่น้อยลง มีความปลอดภัย และลดภาวะแทรกซ้อน ซึ่งก่อให้เกิดประโยชน์สูงสุดแก่ผู้ป่วย คำสำคัญ: การสร้างภาพสามมิติ, การจี้ด้วยกระแสไฟฟ้า

scholarly journals Effects of local activation times on the tension development of human cardiomyocytes in a computational model

2018 ◽  
Vol 4 (1) ◽  
pp. 247-250
Author(s):  
Armin Müller ◽  
Ekaterina Kovacheva ◽  
Steffen Schuler ◽  
Olaf Dössel ◽  
Lukas Baron
Keyword(s):  
Human Heart ◽  
Maximum Pressure ◽  
Simulation Framework ◽  
Activation Time ◽  
Tension Development ◽  
Human Cardiomyocytes ◽  
Local Activation ◽  
Activation Times ◽  
The Right ◽  
Simulation Time

AbstractThe human heart is an organ of high complexity and hence, very challenging to simulate. To calculate the force developed by the human heart and therefore the tension of the muscle fibers, accurate models are necessary. The force generated by the cardiac muscle has physiologically imposed limits and depends on various characteristics such as the length, strain and the contraction velocity of the cardiomyocytes. Another characteristic is the activation time of each cardiomyocyte, which is a wave and not a static value for all cardiomyocytes. To simulate a physiologically correct excitation, the functionality of the cardiac simulation framework CardioMechanics was extended to incorporate inhomogeneous activation times. The functionality was then used to evaluate the effects of local activation times with two different tension models. The active stress generated by the cardiomyocytes was calculated by (i) an explicit function and (ii) an ode-based model. The results of the simulations showed that the maximum pressure in the left ventricle dropped by 2.3% for the DoubleHill model and by 5.3% for the Lumens model. In the right ventricle the simulations showed similar results. The maximum pressure in both the left and the right atrium increased using both models. Given that the simulation of the inhomogeneously activated cardiomyocytes increases the simulation time when used with the more precise Lumens model, the small drop in maximum pressure seems to be negligible in favor of a simpler simulation model

scholarly journals Clinical validation of automatic local activation time annotation during focal premature ventricular complex ablation procedures

EP Europace ◽  
2017 ◽  
Vol 20 (FI2) ◽  
pp. f171-f178 ◽  
Author(s):  
Juan Acosta ◽  
David Soto-Iglesias ◽  
Juan Fernández-Armenta ◽  
Manuel Frutos-López ◽  
Beatriz Jáuregui ◽  
...  
Keyword(s):  
Premature Ventricular Complex ◽  
Clinical Validation ◽  
Activation Time ◽  
Local Activation ◽  
Local Activation Time

scholarly journals Differentiation of the right versus left outflow tract ventricular arrhythmias using local activation time at the His bundle electrogram

2020 ◽  
Vol 21 (1) ◽  
Author(s):  
Won-Seok Choe ◽  
So-Ryoung Lee ◽  
Myung-Jin Cha ◽  
Eue-Keun Choi ◽  
Seil Oh
Keyword(s):  
Diagnostic Accuracy ◽  
Outflow Tract ◽  
Activation Time ◽  
Characteristic Analysis ◽  
Predictive Values ◽  
Cutoff Value ◽  
Local Activation ◽  
His Bundle ◽  
Sensitivity Specificity ◽  
Local Activation Time

Abstract Background Although multiple algorithms based on surface electrocardiographic criteria have been introduced to localize idiopathic ventricular arrhythmia (VA) origins from the outflow tract (OT), their diagnostic accuracy and clinical usefulness remain limited. We evaluated whether local activation time of the His bundle region could differentiate left and right ventricular OT VA origins in the early stage of electrophysiology study. Methods We studied 30 patients who underwent catheter ablation for OT VAs with a left bundle branch block pattern and inferior axis QRS morphology. The interval between the local V signal on the mapping catheter placed in the RVOT and His bundle region (V(RVOT)-V(HB) interval) and the interval from QRS complex onset to the local V signal on the His bundle region (QRS-V(HB) interval) were measured during VAs. Results The V(RVOT)-V(HB) and QRS-V(HB) intervals were significantly shorter in patients with LVOT VAs. The area under the curve (AUC) for the V(RVOT)-V(HB) interval by receiver operating characteristic analysis was 0.865. A cutoff value of ≤ 50 ms predicted an LVOT origin of VA with sensitivity, specificity, and positive and negative predictive values of 100%, 62.5%, 40%, and 100%, respectively. The QRS-V(HB) interval showed similar diagnostic accuracy (AUC, 0.840), and a cutoff value of ≤ 15 ms predicted an LVOT origin of VA with a sensitivity, specificity, and positive and negative predictive values of 100%, 70.8%, 45.2%, and 100%, respectively. Conclusion The V(RVOT)-V(HB) and QRS-V(HB) intervals could differentiate left from right OT origins of VA with high sensitivity and negative predictive values.

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