Validation of Novel 3-Dimensional Electrocardiographic Mapping of Atrial Tachycardias by Invasive Mapping and Ablation
Open accessAbstract
Objectives This study prospectively evaluated the role of a novel 3-dimensional, noninvasive, beat-by-beat mapping system, Electrocardiographic Mapping (ECM), in facilitating the diagnosis of atrial tachycardias (AT).Background Conventional 12-lead electrocardiogram, a widely used noninvasive tool in clinical arrhythmia practice, has diagnostic limitations.Methods Various AT (de novo and post-atrial fibrillation ablation) were mapped using ECM followed by standard-of-care electrophysiological mapping and ablation in 52 patients. The ECM consisted of recording body surface electrograms from a 252-electrode-vest placed on the torso combined with computed tomography-scan-based biatrial anatomy (CardioInsight Inc., Cleveland, Ohio). We evaluated the feasibility of this system in defining the mechanism of AT-macro-re-entrant (perimitral, cavotricuspid isthmus-dependent, and roof-dependent circuits) versus centrifugal (focal-source) activation-and the location of arrhythmia in centrifugal AT. The accuracy of the noninvasive diagnosis and detection of ablation targets was evaluated vis-à-vis subsequent invasive mapping and successful ablation.Results Comparison between ECM and electrophysiological diagnosis could be accomplished in 48 patients (48 AT) but was not possible in 4 patients where the AT mechanism changed to another AT (n = 1), atrial fibrillation (n = 1), or sinus rhythm (n = 2) during the electrophysiological procedure. ECM correctly diagnosed AT mechanisms in 44 of 48 (92%) AT: macro-re-entry in 23 of 27; and focal-onset with centrifugal activation in 21 of 21. The region of interest for focal AT perfectly matched in 21 of 21 (100%) AT. The 2:1 ventricular conduction and low-amplitude P waves challenged the diagnosis of 4 of 27 macro-re-entrant (perimitral) AT that can be overcome by injecting atrioventricular node blockers and signal averaging, respectively.Conclusions This prospective multicenter series shows a high success rate of ECM in accurately diagnosing the mechanism of AT and the location of focal arrhythmia. Intraprocedural use of the system and its application to atrial fibrillation mapping is under way.
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Body surface mapping has been shown accurate in localizing focal ATs, particularly for rare or difficult to induce arrhythmia.
“Body surface mapping has been shown In localized reentry fractionation is present and accounts for a significant part of the cycle lengthy (CL), while in truly focal AT the electrogram at the earliest site is much narrower, with sometimes a preceding sharp activity.accurate in localizing focal ATs, and this is particularly interesting in case of rare or difficult to induce arrhythmia.104”
From European Heart Rhythm Association (EHRA) consensus document on the management of supraventricular arrhythmias, endorsed by Heart Rhythm Society (HRS), Asia-Pacific Heart Rhythm Society (APHRS), and Sociedad Latinoamericana de Estimulacion Cardiaca y Electrofisiologia (SOLAECE) (2017) · cites this paper as [104]
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- Authors
- Shah, A. J., Hocini, M., Xhaet, O., Pascale, P., Roten, L., Wilton, S. B., Linton, N., Scherr, D., Miyazaki, S., Jadidi, A. S., Liu, X., Forclaz, A., Nault, I., Rivard, L., Pedersen, M. E. F., Derval, N., Sacher, F., Knecht, S., Jais, P., Dubois, R., Eliautou, S., Bokan, R., Strom, M., Ramanathan, C., Cakulev, I., Sahadevan, J., Lindsay, B., Waldo, A. L., & Haissaguerre, M.
- Affiliations
- Université de Bordeaux (FR)
- Hôpital Cardiologique du Haut-Lévêque (FR)
- University Hospitals Cleveland Medical Center (US)
- Cleveland Clinic (US)
- Corresponding author
- Shah, Ashok J.
- ORCID
- Venue
- Journal of the American College of Cardiology
- Publisher
- Elsevier BV
- Published
- 2013-09
- Volume
- 62
- Issue
- 10
- Pages
- 889-897
- ISSN
- 0735-1097 (ISSN-L)
- OpenAlex
- W180111838
- Cited by
- 94
- References
- 17
- Citations by year
- 2026: 3 · 2025: 5 · 2024: 2 · 2023: 3 · 2022: 2 · 2021: 2 · 2020: 5 · 2019: 10 · 2018: 9 · 2017: 9 · 2016: 5 · 2015: 15 · 2014: 16 · 2013: 7 · 2012: 1
- FWCI
- 9.74
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Licence
- Locations
- Journal of the American College of Cardiology (publishedVersion)
- PubMed (publishedVersion)
- BORIS (University Library Bern) (submittedVersion)
- Digital Access to Libraries (submittedVersion, other-oa)
- Funders
- European Union Seventh Framework Programme (FP7/2007-2013, HEALTH-F2-2010-261057)
- Sorin
- Topics
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac Arrhythmias and Treatments
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac electrophysiology and arrhythmias
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › ECG Monitoring and Analysis
- Keywords
- atrial tachycardia, atrial fibrillation, signal averaging
- MeSH terms
- Aged, Electrocardiography, Female, France, Heart Atria, Humans, Male, Middle Aged, Prospective Studies, Tachycardia, Supraventricular, United States, Catheter Ablation, Body Surface Potential Mapping
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