Automatic activation mapping and origin identification of idiopathic outflow tract ventricular arrhythmias
Purpose: Activation mapping is used to guide ablation of idiopathic outflow tract ventricular arrhythmias (OTVAs). Isochronal activation maps help to predict the site of origin (SOO): left vs right outflow tract (OT). We evaluate an algorithm for automatic activation mapping based on the onset of th...
| Authors: | , , , , , , , , , , , , |
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| Format: | article |
| Status: | Versión aceptada para publicación |
| Publication Date: | 2018 |
| Country: | España |
| Institution: | Varias* (Consorci de Biblioteques Universitáries de Catalunya, Centre de Serveis Científics i Acadèmics de Catalunya) |
| Repository: | Recercat. Dipósit de la Recerca de Catalunya |
| OAI Identifier: | oai:recercat.cat:10230/47885 |
| Online Access: | http://hdl.handle.net/10230/47885 http://dx.doi.org/10.1016/j.jelectrocard.2017.10.015 |
| Access Level: | Open access |
| Keyword: | Activation mapping Idiopathic ventricular arrhythmia Left ventricle outflow tract Right ventricle outflow tract Ventricular tachycardia ablation |
| Summary: | Purpose: Activation mapping is used to guide ablation of idiopathic outflow tract ventricular arrhythmias (OTVAs). Isochronal activation maps help to predict the site of origin (SOO): left vs right outflow tract (OT). We evaluate an algorithm for automatic activation mapping based on the onset of the bipolar electrogram (EGM) signal for predicting the SOO and the effective ablation site in OTVAs. Methods: Eighteen patients undergoing ablation due to idiopathic OTVAs were studied (12 with left ventricle OT origin). Right ventricle activation maps were obtained offline with an automatic algorithm and compared with manual annotation maps obtained during the intervention. Local activation time (LAT) accuracy was assessed, as well as the performance of the 10 ms earliest activation site (EAS) isochronal area in predicting the SOO. Results: High correlation was observed between manual and automatic LATs (Spearman's: 0.86 and Lin's: 0.85, both p < 0.01). The EAS isochronal area were closely located in both map modalities (5.55 ± 3.56 mm) and at a similar distance from the effective ablation site (0.15 ± 2.08 mm difference, p = 0.859). The 10 ms isochronal area longitudinal/perpendicular diameter ratio measured from automatic maps showed slightly superior SOO identification (67% sensitivity, 100% specificity) compared with manual maps (67% sensitivity, 83% specificity). Conclusions: Automatic activation mapping based on the bipolar EGM onset allows fast, accurate and observer-independent identification of the SOO and characterization of the spreading of the activation wavefront in OTVAs. |
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