Forward-Solution Noninvasive Computational Arrhythmia Mapping: The VMAP Study

Autor: David E. Krummen, Christopher T. Villongco, Gordon Ho, Amir A. Schricker, Michael E. Field, Kevin Sung, Katherine A. Kacena, Melissa S. Martinson, Kurt S. Hoffmayer, Jonathan C. Hsu, Farshad Raissi, Gregory K. Feld, Andrew D. McCulloch, Frederick T. Han
Rok vydání: 2023
Předmět:
Zdroj: Circulation. Arrhythmia and electrophysiology. 15(9)
ISSN: 1941-3084
0455-9061
Popis: Background: The accuracy of noninvasive arrhythmia source localization using a forward-solution computational mapping system has not yet been evaluated in blinded, multicenter analysis. This study tested the hypothesis that a computational mapping system incorporating a comprehensive arrhythmia simulation library would provide accurate localization of the site-of-origin for atrial and ventricular arrhythmias and pacing using 12-lead ECG data when compared with the gold standard of invasive electrophysiology study and ablation. Methods: The VMAP study (Vectorcardiographic Mapping of Arrhythmogenic Probability) was a blinded, multicenter evaluation with final data analysis performed by an independent core laboratory. Eligible episodes included atrial and ventricular: tachycardia, fibrillation, pacing, premature atrial and ventricular complexes, and orthodromic atrioventricular reentrant tachycardia. Mapping system results were compared with the gold standard site of successful ablation or pacing during electrophysiology study and ablation. Mapping time was assessed from time-stamped logs. Prespecified performance goals were used for statistical comparisons. Results: A total of 255 episodes from 225 patients were enrolled from 4 centers. Regional accuracy for ventricular tachycardia and premature ventricular complexes in patients without significant structural heart disease (n=75, primary end point) was 98.7% (95% CI, 96.0%–100%; P 0 P 0 P 0 Conclusions: Computational ECG mapping using a forward-solution approach exceeded prespecified accuracy goals for arrhythmia and pacing localization. Spatial accuracy analysis demonstrated clinically actionable results. This rapid, noninvasive mapping technology may facilitate catheter-based and noninvasive targeted arrhythmia therapies. Registration: URL: https://www.clinicaltrials.gov ; Unique identifier: NCT04559061.
Databáze: OpenAIRE
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