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Assessment of wavefront activation duration across the right ventricular outflow tract in patients with idiopathic premature ventricular contractions using noninvasive electrocardiographic mapping: a validation study
Session:
Comunicações Orais (Sessão 1) - Arrítmias 1 - Taquicardia ventricular
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; Lia Marques; Catalin Marinescu; Silvia Nunes; Duarte Chambel; Antonio Ferreira; Pedro Amador; Pedro Goncalves; Hugo Marques; Pedro Adragao
Abstract
<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><strong><span style="font-size:10.0pt">Introduction</span></strong><strong><span style="font-size:10.0pt">:</span></strong><span style="font-size:10.0pt"> Previous studies have reported that </span><span style="font-size:10.0pt">wavefront propagation </span><span style="font-size:10.0pt">speed </span><span style="font-size:10.0pt">across</span><span style="font-size:10.0pt"> the right ventricular outflow tract (RVOT) can distinguish</span> <span style="font-size:10.0pt">premature ventricular contractions (PVCs) with a RVOT origin from PVCs with a left ventricular outflow tract (LVOT) origin</span><span style="font-size:10.0pt">.</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">Aim: </span></strong><span style="font-size:10.0pt"><span style="color:black">Validate the non-invasive electrocardiographic mapping (ECGI) for assessment of </span></span><span style="font-size:10.0pt"><span style="color:black">RVOT </span></span><span style="font-size:10.0pt"><span style="color:black">activation duration (AD) during PVCs and </span></span><span style="font-size:10.0pt"><span style="color:black">assess </span></span><span style="font-size:10.0pt"><span style="color:black">its value as a predictor of the origin of the PVCs. </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 studied </span><span style="font-size:10.0pt">17 </span><span style="font-size:10.0pt">consecutive patients,</span><span style="font-size:10.0pt"> 8</span><span style="font-size:10.0pt"> males, median age </span><span style="font-size:10.0pt">56</span><span style="font-size:10.0pt"> (</span><span style="font-size:10.0pt">40</span><span style="font-size:10.0pt">-</span><span style="font-size:10.0pt">64</span><span style="font-size:10.0pt">) years that underwent ablation of frequent (</span><span style="font-size:10.0pt">> </span><span style="font-size:10.0pt">10.000</span><span style="font-size:10.0pt"> per </span><span style="font-size:10.0pt">24 h) idiopathic PVCs with inferior axis and had an </span><span style="font-size:10.0pt">ECGI performed before ablation</span><span style="font-size:10.0pt">. </span><span style="font-size:10.0pt">The ECGI was performed with the Amycard system, and the invasive mapping was performed with Carto or Ensite system. Isochronal activation maps of the PVCs were obtained with the activation direction method (ADM) of the ECGI, and with the Carto and Ensite systems. T</span><span style="font-size:10.0pt">otal RVOT AD was measured as the time interval between the earliest and the latest activated region.</span><span style="font-size:10.0pt"> Agreement between the two methods was performed using linear regression and a B</span><span style="font-size:10.0pt">land-Altman </span><span style="font-size:10.0pt">p</span><span style="font-size:10.0pt">lot</span><span style="font-size:10.0pt">. The cutoff value of AD to predict PVC origin was calculated with ROC curve.</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 from the RVOT in 10 (50%) patients. The median (Q<sub>1</sub>-Q<sub>3</sub>) RVOT AD measured with ECGI was 50 (38-69) ms and with invasive map 54 (35-71) ms. The agreement between both methods was good with an R<sup>2</sup> of 0.750, p<0.0001. Figure displays the Bland-Altman plot (panel A) and an example of the same patient assessed with invasive mapping (panel B) and ECGI (panel C). The AD was significantly higher in PVCs from the RVOT vs LVOT, both with ECGI and invasive map, respectively 65 (56-76) vs 37 (31-37) ms, p<0.0001 and 69 (59-77) vs 35 (30-40) ms, p<0.0001. The cutoff value of 43 ms for AD measured with ECGI predicted the origin of the PVCs with a sensitivity and specificity of 100%.</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 good agreement between ECGI and invasive map. The AD obtained with ECGI was accurate to predict the origin of the PVCs.</span></span></span></p> <p style="text-align:justify"> </p>
Slides
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