SPC365

Accuracy of noninvasive electrocardiographic imaging using isopotential versus isochronal map for identifying the site of origin of ventricular arrhythmias.

Session: Comunicações Orais (Sessão 22) - Arritmias 4 - Vários Tópicos
Speaker: Leonor Parreira

Congress: CPC 2022
Topic: C. Arrhythmias and Device Therapy
Theme: 08. Ventricular Arrhythmias and Sudden Cardiac Death (SCD)
Subtheme: 08.3 Ventricular Arrhythmias and SCD - Diagnostic Methods
Session Type: Comunicações Orais
FP Number: ---
Authors: Leonor Parreira; Rita Marinheiro; Pedro Carmo; Dinis Mesquita; Sofia Mancelos; Silvia Nunes; Alexandra Goncalves; Pedro Amador; Antonio Ferreira; Pedro Goncalves; Hugo Marques; Pedro Adragao

<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><strong><span style="font-size:10.0pt">Background and aim</span></strong><strong><span style="font-size:10.0pt">:</span></strong> <span style="font-size:10.0pt"><span style="color:black">Previous studies</span></span><span style="font-size:10.0pt"><span style="color:black"> reporting the results of noninvasive electrocardiographic imaging (ECGI) used both isopotential map and isochronal map to assess the site of origin (SOO) of premature ventricular contractions (PVCs). The aim of this study was to evaluate the accuracy of both methods globally, and according to the location of the arrhythmia: from the right ventricular outflow tract (RVOT) or other locations (non-RVOT). &nbsp;</span></span></span></span></p>

<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><strong><span style="font-size:10.0pt">Methods:</span></strong><span style="font-size:10.0pt"> We </span><span style="font-size:10.0pt">studied with ECGI 30 </span><span style="font-size:10.0pt">consecutive patients</span><span style="font-size:10.0pt"> with frequent </span><span style="font-size:10.0pt">(&gt;10.000/24 h) </span><span style="font-size:10.0pt">PVCs. &nbsp;Patients were excluded if the ablation was not performed (3 patients) or was unsuccessful (7 patients). The study group consisted of 20 patients, 11 </span><span style="font-size:10.0pt">male, <span style="color:black">median age of </span></span><span style="font-size:10.0pt"><span style="color:black">58</span></span><span style="font-size:10.0pt"><span style="color:black"> (</span></span><span style="font-size:10.0pt"><span style="color:black">47</span></span><span style="font-size:10.0pt"><span style="color:black">-</span></span><span style="font-size:10.0pt"><span style="color:black">71</span></span><span style="font-size:10.0pt"><span style="color:black">) </span></span><span style="font-size:10.0pt">years</span><span style="font-size:10.0pt">. The ECGI was performed with the epi-endocardial system Amycard. Two noninvasive maps were obtained per patient: isopotential map using the first negative deflection method (FND) and the isochronal map obtained using the activation direction method (ADM) (Figure). The invasive activation map was obtained with the Carto or the Ensite system and radiofrequency was applied at the earliest activation site with QS morphology on the unipolar electrogram and a pace match of at least 11/12. &nbsp;The SOO of the PVCs was considered the site where the PVCs were abolished. &nbsp;We assessed the accuracy of the ECGI to identify the SOO of the PVCs using both methods. A perfect match was defined as a predicted location by the ECGI within the same anatomic segment of the actual SOO of the PVCs and a near match as a predicted location within the same segment or a contiguous one. Values are presented as median (Q<sub>1</sub>-Q<sub>3</sub>) </span></span></span></p>

<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><strong><span style="font-size:10.0pt">Results:</span></strong><span style="font-size:10.0pt"> PVCs originated in the RVOT in 10 (50%) patients. The percentage of near matches was not significantly different between FND and ADM methods (95% vs 85%, p=0.50), however the percentage of perfect matches was significantly higher with the FND than with the ADM technique (95% vs 65 %, p=0.031). We found no significant differences in accuracy according to the location of the PVCs: in the RVOT or outside (Table).</span></span></span></p>

<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><strong><span style="font-size:10.0pt">Conclusions: </span></strong><span style="font-size:10.0pt">We found a good agreement between ECGI and invasive maps, however the FND technique showed a better accuracy regardless the site of the PVCs. </span></span></span></p>