Prospective Assessment of an Automated Intraprocedural 12-Lead ECG-Based System for Localization of Early Left Ventricular Activation.
Action Potentials
Adult
Aged
Aged, 80 and over
Automation
Catheter Ablation
Electrocardiography
Electrophysiologic Techniques, Cardiac
Female
Heart Conduction System
/ physiopathology
Heart Rate
Humans
Male
Middle Aged
Predictive Value of Tests
Prospective Studies
Reproducibility of Results
Signal Processing, Computer-Assisted
Tachycardia, Ventricular
/ diagnosis
Time Factors
arrhythmias
catheter ablation
electrocardiography
electrophysiology
human
ventricular tachycardia
Journal
Circulation. Arrhythmia and electrophysiology
ISSN: 1941-3084
Titre abrégé: Circ Arrhythm Electrophysiol
Pays: United States
ID NLM: 101474365
Informations de publication
Date de publication:
07 2020
07 2020
Historique:
pubmed:
17
6
2020
medline:
11
11
2020
entrez:
16
6
2020
Statut:
ppublish
Résumé
To facilitate ablation of ventricular tachycardia (VT), an automated localization system to identify the site of origin of left ventricular activation in real time using the 12-lead ECG was developed. The objective of this study was to prospectively assess its accuracy. The automated site of origin localization system consists of 3 steps: (1) localization of ventricular segment based on population templates, (2) population-based localization within a segment, and (3) patient-specific site localization. Localization error was assessed by the distance between the known reference site and the estimated site. In 19 patients undergoing 21 catheter ablation procedures of scar-related VT, site of origin localization accuracy was estimated using 552 left ventricular endocardial pacing sites pooled together and 25 VT-exit sites identified by contact mapping. For the 25 VT-exit sites, localization error of the population-based localization steps was within 10 mm. Patient-specific site localization achieved accuracy of within 3.5 mm after including up to 11 pacing (training) sites. Using 3 remotes (67.8±17.0 mm from the reference VT-exit site), and then 5 close pacing sites, resulted in localization error of 7.2±4.1 mm for the 25 identified VT-exit sites. In 2 emulated clinical procedure with 2 induced VTs, the site of origin localization system achieved accuracy within 4 mm. In this prospective validation study, the automated localization system achieved estimated accuracy within 10 mm and could thus provide clinical utility.
Sections du résumé
BACKGROUND
To facilitate ablation of ventricular tachycardia (VT), an automated localization system to identify the site of origin of left ventricular activation in real time using the 12-lead ECG was developed. The objective of this study was to prospectively assess its accuracy.
METHODS
The automated site of origin localization system consists of 3 steps: (1) localization of ventricular segment based on population templates, (2) population-based localization within a segment, and (3) patient-specific site localization. Localization error was assessed by the distance between the known reference site and the estimated site.
RESULTS
In 19 patients undergoing 21 catheter ablation procedures of scar-related VT, site of origin localization accuracy was estimated using 552 left ventricular endocardial pacing sites pooled together and 25 VT-exit sites identified by contact mapping. For the 25 VT-exit sites, localization error of the population-based localization steps was within 10 mm. Patient-specific site localization achieved accuracy of within 3.5 mm after including up to 11 pacing (training) sites. Using 3 remotes (67.8±17.0 mm from the reference VT-exit site), and then 5 close pacing sites, resulted in localization error of 7.2±4.1 mm for the 25 identified VT-exit sites. In 2 emulated clinical procedure with 2 induced VTs, the site of origin localization system achieved accuracy within 4 mm.
CONCLUSIONS
In this prospective validation study, the automated localization system achieved estimated accuracy within 10 mm and could thus provide clinical utility.
Identifiants
pubmed: 32538133
doi: 10.1161/CIRCEP.119.008262
pmc: PMC7375941
mid: NIHMS1604783
doi:
Types de publication
Journal Article
Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
e008262Subventions
Organisme : NHLBI NIH HHS
ID : R01 HL126802
Pays : United States
Organisme : NHLBI NIH HHS
ID : R01 HL142496
Pays : United States
Organisme : NHLBI NIH HHS
ID : U01 HL141074
Pays : United States
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