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Early Results on the Utilisation of ECG-Imaging during Catheter Ablation Procedures for Prediction of Sites of Earliest Activation during Re-entrant Ventricular Tachycardia

Orini, M; Graham, A; Dhinoja, M; Hunter, R; Schilling, RJ; Chow, AW; Taggart, P; (2018) Early Results on the Utilisation of ECG-Imaging during Catheter Ablation Procedures for Prediction of Sites of Earliest Activation during Re-entrant Ventricular Tachycardia. In: Computing in Cardiology 2018. IEEE: Maastricht, Netherlands. Green open access

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Abstract

Success rate of ventricular tachycardia (VT) ablation remains sub-optimal. Current technology does not allow fast and accurate delineation of the ablation target. Noninvasive panoramic ECG-imaging (ECGI) offers the possibility of studying the interaction between arrhythmogenic substrate and earliest sites of activation during VT to improve ablation strategies. ECGI mapping (CardioInsight, Medtronic) was performed in 5 patients undergoing VT ablation. Ventricular pacing was delivered from the RV and three indices were measured at each ventricular site to map susceptibility to arrhythmia initiation: Re-entry vulnerability index (RVI), local dispersion of AT (∆AT) and local dispersion of repolarization (∆ARI). Regions of high susceptibility were defined as those corresponding to the bottom 5% of RV I and the upper 5% of ∆AT and ∆ARI. Morphologically distinct VTs were analyzed to measure the AT sequence and localize the region of earliest epicardial activation (AT < 5 ms). In total, 20 VTs were analyzed (4.0 ± 1.2 per patient). The minimum distance between the region of high vulnerability and the region of earliest AT during VT was 5.6 ± 8.6 mm for RV I, 6.1 ± 10.8 mm for ∆AT and 12.8 ± 22.4 mm for ∆ARI (P > 0.13 for all pair-wise comparison). The vulnerable region presented at least partial overlap with the region of earliest activation during VT in 50%, 55% and 50% of all VTs for RV I, ∆AT and ∆ARI, respectively. These early data confirm the mechanistic link between markers of arrhythmogenic risk and VT initiation and suggest that ECGI could be potentially used for targeting ablation in non-inducible or hemodynamically non-tolerated VTs.

Type: Proceedings paper
Title: Early Results on the Utilisation of ECG-Imaging during Catheter Ablation Procedures for Prediction of Sites of Earliest Activation during Re-entrant Ventricular Tachycardia
Event: Computing in Cardiology 2018
Location: Maastricht, The Netherlands.
Dates: September 23-26, 2018
ISBN-13: 9781728109589
Open access status: An open access version is available from UCL Discovery
DOI: 10.22489/CinC.2018.283
Publisher version: https://doi.org/10.22489/CinC.2018.283
Language: English
Additional information: This is an open-access publication, in which copyright in each article is held by its authors, who grant permission to copy and redistribute their work with attribution, under the terms of the Creative Commons Attribution License https://creativecommons.org/licenses/by/2.5/
UCL classification: UCL
UCL > Provost and Vice Provost Offices
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Population Health Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Population Health Sciences > Institute of Cardiovascular Science
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Population Health Sciences > Institute of Cardiovascular Science > Clinical Science
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Population Health Sciences > Institute of Cardiovascular Science > Population Science and Experimental Medicine
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Population Health Sciences > Institute of Cardiovascular Science > Population Science and Experimental Medicine > MRC Unit for Lifelong Hlth and Ageing
URI: https://discovery.ucl.ac.uk/id/eprint/10079581
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