Non-invasive electrocardiographic imaging for the characterization of complex atrial tachyarrhythmias
| Autor: | J Reventos-Presmanes, E Invers-Rubio, E Ferro, R Borras, M Regany, M S Guillem, E Guasch, J M Tolosana, I Roca-Luque, A Porta-Sanchez, E Arbelo, T Althoff, A M Climent, L Mont, J B Guichard |
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| Rok vydání: | 2023 |
| Předmět: | |
| Zdroj: | Europace. 25 |
| ISSN: | 1532-2092 1099-5129 |
| Popis: | Funding Acknowledgements Type of funding sources: Public grant(s) – EU funding. Main funding source(s): This work was supported by the European Union NextGenerationEU/PRTR. Background – The non-invasive characterization of complex atrial tachyarrhythmias, including atrial flutter (AFL) and focal atrial tachycardia (AT) is challenging. Conventional 12-lead electrocardiogram (ECG) faces several limitations. Planning a precise and preprocedural strategy for complex tachyarrhythmias catheter ablation (CA) is not easy. Purpose To evaluate the diagnostic capacity of a novel electrocardiographic imaging (ECGI) system that does not require previous CT/MRI thoracic imaging. Methods – 42 patients (27 males, CHA2DS2-VASc score 2±1, LVEF 54.5 ± 11.0 % and LA area 31.3 ± 7.0 cm2) undergoing CA for focal AT or AFL were prospectively included in the study. A preprocedural ECGI was managed based on a 64-electrode vest, a torso reconstruction using a 3D real-time acquisition camera, and an artificial intelligence-based method to estimate the patient atrial geometry. The differential diagnostic capacities of non-invasive 12-lead ECG and ECGI were assessed compared with endocavity electroanatomical mapping (EAM) regarding three endpoints: 1) the identification of the involved atrial cavity, 2) the mechanism (focal/micro-reentry or macro-reentry), and (3) the ablation target site defined as the area where the earliest activation was located for focal/micro re-entrant arrhythmias, and the precise anatomical pathway for macro re-entrant tachyarrhythmias. Regarding the ECG, the three endpoints were assessed based on validated algorithms by 2 different observers blinded from the diagnosis. Results – 48 atrial tachyarrhythmias of which 59.5% occurred in the context of a history of CA were evaluated. The non-invasive characterization of complex atrial arrhythmias using this novel ECGI system was possible in 94% of the cases (Figure A): directly for 36 arrhythmias and after decreasing ventricular response using vagal maneuvers for 9. ECGI obtained global accuracy to identify the involved atrial cavity of 91.7%, the mechanism of 89.6%, and the ablation target of 83.3%. In challenging cases, such as in patients with history of CA for AF (n = 27) and in patients without a final diagnosis of counterclockwise typical AFL (n=38) the diagnosis capacity of ECGI is consistent compared to the whole study population. The ECGI diagnostic capacity significantly outclassed the ECG one regarding the identification of the involved cavity (p Conclusions (Figure B) – This novel non-invasive ECGI system that does not require CT/MRI thoracic imaging accurately characterizes complex atrial tachyarrhythmia and outclasses ECG, the current noninvasive diagnostic tool of reference. |
| Databáze: | OpenAIRE |
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