title: Validation of novel 3-dimensional electrocardiographic mapping of atrial tachycardias by invasive mapping and ablation: a multicenter study.
abstract: OBJECTIVE
  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.
authors.affiliation: Department of Rhythmologie, Hôpital Cardiologique du Haut-Lévêque and the Université Bordeaux II, Bordeaux, France. drashahep@gmail.com
authors.forename: Ashok J
authors.initials: AJ
authors.lastname: Shah
authors.forename: Meleze
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authors.lastname: Xhaet
authors.forename: Patrizio
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authors.lastname: Pascale
authors.forename: Laurent
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authors.lastname: Roten
authors.forename: Stephen B
authors.initials: SB
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authors.forename: Nick
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authors.lastname: Linton
authors.forename: Daniel
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authors.lastname: Scherr
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authors.forename: Amir S
authors.initials: AS
authors.lastname: Jadidi
authors.forename: Xingpeng
authors.initials: X
authors.lastname: Liu
authors.forename: Andrei
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authors.lastname: Forclaz
authors.forename: Isabelle
authors.initials: I
authors.lastname: Nault
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authors.initials: L
authors.lastname: Rivard
authors.forename: Michala E F
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authors.lastname: Pedersen
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authors.lastname: Derval
authors.forename: Frederic
authors.initials: F
authors.lastname: Sacher
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authors.lastname: Knecht
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authors.forename: Sandra
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authors.lastname: Eliautou
authors.forename: Ryan
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authors.lastname: Bokan
authors.forename: Maria
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authors.lastname: Strom
authors.forename: Charu
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authors.lastname: Ramanathan
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authors.lastname: Cakulev
authors.forename: Jayakumar
authors.initials: J
authors.lastname: Sahadevan
authors.forename: Bruce
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authors.lastname: Lindsay
authors.forename: Albert L
authors.initials: AL
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mesh_terms: D000368:Aged; D018780:Body Surface Potential Mapping / Q000379:methods*; D017115:Catheter Ablation / Q000379:methods*; D004562:Electrocardiography / Q000379:methods*; D005260:Female; D005602:France; D006325:Heart Atria / Q000503:physiopathology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D013617:Tachycardia, Supraventricular / Q000175:diagnosis* / Q000503:physiopathology; D014481:United States
keywords: 3-dimensional; 3D; AF; AT; CT; ECG; ECM; EP; Electrocardiographic Mapping; ablation; atrial fibrillation; atrial tachycardia; atrial tachycardia(s); computerized tomography; electrocardiography; electrocardiomapping; electrophysiological; noninvasive mapping