Focal Arrhythmia Ablation Determined by High-Resolution Noninvasive Maps: Multicenter Feasibility Study.
BACKGROUND
A noninvasive 3D mapping technique (ECVUE™, CardioInsight Inc., Cleveland) maps the origin and mechanisms of various arrhythmias without catheterizing the heart.


METHODS
Thirty-three patients (3 centers, mean 45.0 ± 14.6 years,) with symptomatic premature ventricular complexes (24 PVCs), focal atrial tachycardias (2 ATs), and manifest accessory pathways (7 WPW syndromes) were prospectively explored using 3D, noninvasive bedside electrocardiomapping. The location of origin of the focal arrhythmia was first determined using noninvasive mapping. Subsequently, a stimulus artifact was delivered at this site to confirm and evaluate the precise location of the mapped focal origin. The procedural parameters and clinical efficacy were studied.


RESULTS
Ablation was successful in 32/33 (97%) patients (PVCs: 13 right, 10 left, 1 septal; WPW: 3 left, 3 right; ATs: 2 left) without complications. The time from catheterization to permanent arrhythmia elimination/termination, RF duration, skin-to-skin procedural duration, and fluoroscopic exposure were median 16, 3.98, 71, and 11.9 minutes (for n = 29), respectively. At mean 24.7 ± 3.7 months of follow-up, 31 patients remain arrhythmia-free after a single procedure. One patient (right WPW syndrome) required repeat ablation 1 month later. One patient had recurrence of PVCs and is now deceased. The cumulative radiation (CT scan and fluoroscopy) exposure was median 7.57 mSv.


CONCLUSIONS
ECVUE(TM) is a noninvasive tool allowing rapid preprocedural localization of focal arrhythmia and enables the electrophysiologist with highly specific information to direct RF delivery at the source of the arrhythmia with minimal intracardiac mapping.
LIRYC Institute (Electrophysiology and Heart Modeling Institute), Hôpital Cardiologique du Haut Lévêque and Université Victor Segalen of Bordeaux II, Bordeaux, France.
Mélèze
M
Hocini
LIRYC Institute (Electrophysiology and Heart Modeling Institute), Hôpital Cardiologique du Haut Lévêque and Université Victor Segalen of Bordeaux II, Bordeaux, France.
Ashok J
AJ
Shah
Kerckhoff Heart Center, Bad Nauheim, Germany.
Thomas
T
Neumann
Kerckhoff Heart Center, Bad Nauheim, Germany.
Malte
M
Kuniss
Kerckhoff Heart Center, Bad Nauheim, Germany.
Damir
D
Erkapic
LIRYC Institute (Electrophysiology and Heart Modeling Institute), Hôpital Cardiologique du Haut Lévêque and Université Victor Segalen of Bordeaux II, Bordeaux, France.
Arnaud
A
Chaumeil
St. Mary's Hospital, London, England.
Shahnaz-Jamil
SJ
Copley
St. Mary's Hospital, London, England.
Phang Boon
PB
Lim
St. Mary's Hospital, London, England.
Prapa
P
Kanagaratnam
LIRYC Institute (Electrophysiology and Heart Modeling Institute), Hôpital Cardiologique du Haut Lévêque and Université Victor Segalen of Bordeaux II, Bordeaux, France.
Arnaud
A
Denis
LIRYC Institute (Electrophysiology and Heart Modeling Institute), Hôpital Cardiologique du Haut Lévêque and Université Victor Segalen of Bordeaux II, Bordeaux, France.
Nicolas
N
Derval
LIRYC Institute (Electrophysiology and Heart Modeling Institute), Hôpital Cardiologique du Haut Lévêque and Université Victor Segalen of Bordeaux II, Bordeaux, France.
Rémi
R
Dubois
LIRYC Institute (Electrophysiology and Heart Modeling Institute), Hôpital Cardiologique du Haut Lévêque and Université Victor Segalen of Bordeaux II, Bordeaux, France.
Hubert
H
Cochet
LIRYC Institute (Electrophysiology and Heart Modeling Institute), Hôpital Cardiologique du Haut Lévêque and Université Victor Segalen of Bordeaux II, Bordeaux, France.
Pierre
P
Jais
LIRYC Institute (Electrophysiology and Heart Modeling Institute), Hôpital Cardiologique du Haut Lévêque and Université Victor Segalen of Bordeaux II, Bordeaux, France.
Michel
M
Haissaguerre
D058606:Accessory Atrioventricular Bundle / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery*; D000200:Action Potentials; D000328:Adult; D017115:Catheter Ablation / Q000009:adverse effects / Q000379:methods*; D004562:Electrocardiography; D022062:Electrophysiologic Techniques, Cardiac; D005060:Europe; D005240:Feasibility Studies; D005260:Female; D006329:Heart Conduction System / Q000503:physiopathology / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D061646:Operative Time; D000067716:Point-of-Care Testing; D011237:Predictive Value of Tests; D011446:Prospective Studies; D011829:Radiation Dosage; D015641:Radiography, Interventional; D012008:Recurrence; D013617:Tachycardia, Supraventricular / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery*; D013997:Time Factors; D016896:Treatment Outcome; D018879:Ventricular Premature Complexes / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery*
fast mapping; focal arrhythmia; noninvasive; preprocedural; rapid mapping