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Non-invasive electroanatomic mapping to reduce mapping time during catheter ablation of outflow tract ventricular premature depolarizations

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Abstract

Purpose

Ventricular premature depolarizations (VPD) commonly arise from the septal anterior right ventricular outflow tract (sRVOT), the left coronary cusp (LCC), and the distal great cardiac vein (dGCV), and share common ECG characteristics. To assess the diagnostic accuracy of non-invasive electroanatomic mapping (NIEAM) in differentiating VPD origin between sRVOT, LCC and dGCV and quantify its clinical utility in eliminating unnecessary mapping and ablation.

Methods

ECGs and NIEAMs (CardioInsight, Medtronic) from 32 patients (56.3 ± 15.2 years) undergoing ablation for VPDs originating from sRVOT, LCC, or dGCV were blindly reviewed for their diagnostic accuracy in predicting the SOO. A 2-step algorithm using NIEAM-based activation timing of the superior basal septum of < 22.5 ms and lateral mitral annulus of > 60.5 ms was compared with subjective ECG evaluation, the maximum deflection index (MDI), and the V2 transitional ratio in predicting SOO. We calculated the mapping and ablation time that could have been avoided had the operators relied on activation timing by NIEAM in designing their mapping and ablation strategy.

Results

NIEAM was superior to subjective ECG evaluation, MDI, and V2 transition ratio in predicting the SOO yielding a sensitivity and specificity of 96.9% and 98.4% respectively. Using NIEAM in determining the SOO would have obviated 22 ± 4.5 min of mapping in the wrong chamber and prevented unnecessary ablation of 4.5 ± 1.8 min.

Conclusion

NIEAM has high diagnostic accuracy in differentiating between sRVOT, LCC, and dGCV VPDs, and can significantly reduce mapping time, obviating the need for unnecessary access and ablation.

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Abbreviations

ECG:

Electrocardiogram

EPS:

Electrophysiology study

GCV:

Great cardiac vein

LCC:

Left coronary cusp

LVS:

Left ventricular summit

MDI:

Maximum deflection index

NIEAM:

Non-invasive electroanatomic mapping

RVOT:

Right ventricular outflow tract

SoV:

Sinuses of Valsalva

SOO:

Site of origin

VPD:

Ventricular premature depolarization

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Funding

This study was financially supported by Medtronic External Funding (Minneapolis, MN).

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Authors and Affiliations

  1. Department of Cardiac Electrophysiology, Northwell Health-Lenox Hill Heart and Lung, 100 East 77th Street, New York, NY, 10075, USA

    Stavros E. Mountantonakis, Kristie M. Coleman, Aditi S. Vaishnav, Jamie Shein, Parth Makker, Moussa Saleh, Kabir Bhasin, Neil E. Bernstein & Nicholas T. Skipitaris

Authors
  1. Stavros E. Mountantonakis
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  2. Kristie M. Coleman
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  3. Aditi S. Vaishnav
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  4. Jamie Shein
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  5. Parth Makker
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  6. Moussa Saleh
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  7. Kabir Bhasin
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  8. Neil E. Bernstein
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  9. Nicholas T. Skipitaris
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Corresponding author

Correspondence to Stavros E. Mountantonakis.

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Conflict of interest

Dr. Mountantonakis Speakers Honoraria. Dr. Skipitaris, Medtronic Advisory Board. The remaining authors have nothing to disclose.

Ethical approval

This study was approved by our institutional review board.

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Mountantonakis, S.E., Coleman, K.M., Vaishnav, A.S. et al. Non-invasive electroanatomic mapping to reduce mapping time during catheter ablation of outflow tract ventricular premature depolarizations. J Interv Card Electrophysiol 60, 295–302 (2021). https://doi.org/10.1007/s10840-020-00731-z

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  • DOI: https://doi.org/10.1007/s10840-020-00731-z

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