title: Clinical impact of a novel three-dimensional electrocardiographic imaging for non-invasive mapping of ventricular arrhythmias-a prospective randomized trial.
abstract: OBJECTIVE
  ECVUE™ technology, a novel, three-dimensional, non-invasive mapping system, offers a unique arrhythmia characterization and localization. We sought to evaluate the clinical impact of this system in routine clinical mapping and ablation of ventricular arrhythmias (VAs).
  
  
  RESULTS
  Patients with monomorphic premature ventricular contractions with or without monomorphic ventricular tachycardia were enrolled prospectively and randomized into two groups: ventricular ectopy localization using either 12-lead electrocardiogram (ECG) algorithms or with ECVUE™, followed by conventional guided ablation. Forty-two patients were enrolled in the study. The ECVUE™ system accurately identified both the chamber and sub-localized the VA origin in 20 of 21 (95.2%) patients. In contrast, using 12-lead ECG algorithms, the chamber was accurately diagnosed in 16 of 21 (76.2%) patients, while the arrhythmia origin in only 8 of 21 (38.1%), (P = 0.001 vs. ECVUE™). Acute success in ablation was achieved in all patients. Regarding the number of radiofrequency-energy applications (in total 2 vs. 4, P = 0.005) in the ECVUE™ arm, ablation was more precise than the ECG group which used standard of care activation and pace mapping-guided ablation. Three months success in ablation was 95.2% for the ECVUE™ and 100% for the ECG group (P = ns). Time to ablation was 35.3 min in the conventional arm and 24.4 min in ECVUE Group, (P = 0.035). The X-ray radiation exposure was 3.21 vs. 0.39 mSv, P = 0.001 for the ECVUE™ group and ECG group.
  
  
  CONCLUSIONS
  ECVUE™ technology offers a clinically useful tool to map VAs with high accuracy and more targeted ablations superior to the body surface ECG but had significantly higher radiation exposure due to computed tomography scan.
authors.affiliation: Department of Cardiology, Kerckhoff Heart and Thorax Center, Benekestr. 2-8, 61231 Bad Nauheim, Germany Department of Cardiology, Justus-Liebig University of Giessen, Giessen, Germany.
authors.forename: Damir
authors.initials: D
authors.lastname: Erkapic
authors.affiliation: Department of Cardiology, Kerckhoff Heart and Thorax Center, Benekestr. 2-8, 61231 Bad Nauheim, Germany.
authors.forename: Harald
authors.initials: H
authors.lastname: Greiss
authors.affiliation: Department of Cardiology, Kerckhoff Heart and Thorax Center, Benekestr. 2-8, 61231 Bad Nauheim, Germany.
authors.forename: Dmitri
authors.initials: D
authors.lastname: Pajitnev
authors.affiliation: Department of Cardiology, Kerckhoff Heart and Thorax Center, Benekestr. 2-8, 61231 Bad Nauheim, Germany.
authors.forename: Sergey
authors.initials: S
authors.lastname: Zaltsberg
authors.affiliation: Department of Cardiology, Kerckhoff Heart and Thorax Center, Benekestr. 2-8, 61231 Bad Nauheim, Germany.
authors.forename: Nicolas
authors.initials: N
authors.lastname: Deubner
authors.affiliation: Department of Cardiology, Kerckhoff Heart and Thorax Center, Benekestr. 2-8, 61231 Bad Nauheim, Germany.
authors.forename: Alexander
authors.initials: A
authors.lastname: Berkowitsch
authors.affiliation: Department of Cardiology, Kerckhoff Heart and Thorax Center, Benekestr. 2-8, 61231 Bad Nauheim, Germany.
authors.forename: Susanne
authors.initials: S
authors.lastname: Möllman
authors.affiliation: Department of Cardiology, Kerckhoff Heart and Thorax Center, Benekestr. 2-8, 61231 Bad Nauheim, Germany.
authors.forename: Johannes
authors.initials: J
authors.lastname: Sperzel
authors.affiliation: Department of Cardiology, Kerckhoff Heart and Thorax Center, Benekestr. 2-8, 61231 Bad Nauheim, Germany.
authors.forename: Andreas
authors.initials: A
authors.lastname: Rolf
authors.affiliation: Department of Cardiology, Kerckhoff Heart and Thorax Center, Benekestr. 2-8, 61231 Bad Nauheim, Germany Department of Cardiology, Justus-Liebig University of Giessen, Giessen, Germany.
authors.forename: Jörn
authors.initials: J
authors.lastname: Schmitt
authors.affiliation: Department of Cardiology, Kerckhoff Heart and Thorax Center, Benekestr. 2-8, 61231 Bad Nauheim, Germany Department of Cardiology, Justus-Liebig University of Giessen, Giessen, Germany.
authors.forename: Christian W
authors.initials: CW
authors.lastname: Hamm
authors.affiliation: Department of Cardiology, Kerckhoff Heart and Thorax Center, Benekestr. 2-8, 61231 Bad Nauheim, Germany.
authors.forename: Malte
authors.initials: M
authors.lastname: Kuniss
authors.affiliation: Department of Cardiology, Kerckhoff Heart and Thorax Center, Benekestr. 2-8, 61231 Bad Nauheim, Germany t.neumann@kerckhoff-klinik.de.
authors.forename: Thomas
authors.initials: T
authors.lastname: Neumann
mesh_terms: D000328:Adult; D000465:Algorithms; D018780:Body Surface Potential Mapping / Q000379:methods*; D003936:Diagnosis, Computer-Assisted / Q000379:methods*; D004562:Electrocardiography / Q000379:methods*; D005260:Female; D006801:Humans; D021621:Imaging, Three-Dimensional / Q000379:methods*; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D017180:Tachycardia, Ventricular / Q000175:diagnosis*; D018879:Ventricular Premature Complexes / Q000175:diagnosis*
keywords: Ablation; Electrocardiographic mapping; Non-invasive 3-D mapping; Premature ventricular contraction; Ventricular arrhythmia