Single- and dual-site pace mapping of idiopathic septal intramural ventricular arrhythmias.
Pace mapping (PM) is used to identify the origin of ventricular arrhythmias (VAs). For intramural VAs, the site of origin often cannot be reached and therefore PM is less accurate.



The purpose of this study was to assess the value of single- and dual-site pace maps to differentiate intramural from nonintramural VAs.



In 18 consecutive patients with idiopathic intramural VAs, pace mapping was performed at 2 breakthrough sites in adjacent anatomic structures. Twelve-lead electrocardiograms of the 2 pace maps were averaged in MATLAB and compared (correlation coefficient [CC]) with the targeted VA. Dual-site pace mapping was performed in a control group of 18 patients with nonintramural VAs at the sites of earliest electrical activation and a breakthrough site in an adjacent anatomic location.



Dual-site pace maps had a higher CC than did best single-site pace maps (0.87 ± 0.1 vs 0.81 ± 0.16; P = .02) in patients with intramural VAs. At the site of origin, single-site pace maps had a higher CC than did dual-site pace maps obtained from adjacent anatomic locations (0.93 ± 0.04 vs 0.89 ± 0.05; P = .0004) in patients with nonintramural VAs. Sensitivity, specificity, positive predictive value, and negative predictive value of dual-site pace maps for identifying an intramural VA were 89%, 82%, 84%, 88%, and 86%, respectively. Furthermore, the receiver operating characteristic curve analysis revealed that a CC cutoff value of ≤0.86 for a single-site pace map best differentiated intramural from nonintramural VAs.



A higher CC value for a dual-site pace map obtained from the earliest breakthrough site as well as a CC cutoff value of ≤0.86 for a single-site pace map obtained from the site of earliest electrical activation can best differentiate intramural from nonintramural VAs.
Division of Cardiovascular Medicine.
Miki
M
Yokokawa
Department of Electrical Engineering and Computer Science, University of Michigan, Ann Arbor, Michigan.
Dae Yon
DY
Jung
Department of Electrical Engineering and Computer Science, University of Michigan, Ann Arbor, Michigan.
Alfred O
AO
Hero
Division of Cardiovascular Medicine.
Kazim
K
Baser
Division of Cardiovascular Medicine.
Fred
F
Morady
Division of Cardiovascular Medicine. Electronic address: fbogun@med.umich.edu.
Frank
F
Bogun
D000368:Aged; D018780:Body Surface Potential Mapping / Q000379:methods*; D017115:Catheter Ablation / Q000379:methods*; D003937:Diagnosis, Differential; D022062:Electrophysiologic Techniques, Cardiac / Q000379:methods; D005260:Female; D006352:Heart Ventricles / Q000473:pathology / Q000503:physiopathology; D006801:Humans; D008297:Male; D008875:Middle Aged; D012372:ROC Curve; D015203:Reproducibility of Results; D017180:Tachycardia, Ventricular / Q000175:diagnosis / Q000473:pathology / Q000601:surgery; D016896:Treatment Outcome
Ablation; Intramural ventricular arrhythmias; Pace mapping; Site of origin; Ventricular arrhythmia