Sequential Electro-Anatomical Mapping Methodology and Preliminary Results for Reentry Vulnerability Index Estimation

TY - CHAP

T1 - Sequential Electro-Anatomical Mapping Methodology and Preliminary Results for Reentry Vulnerability Index Estimation

AU - Orini, Michele

AU - Hanson, Ben

AU - Taggart, Peter

AU - Campos, Fernando

AU - Rinaldi, Aldo

AU - Gill, Jaswinder

AU - Bishop, Martin

AU - Lambiase, Pier D.

PY - 2018/9/1

Y1 - 2018/9/1

N2 - Ventricular tachycardia (VT) recurrence after catheter ablation remains frequent and improved ablation strategies are needed. The re-entry vulnerability index (RVI) is an activation-repolarization marker to localize critical sites for VT initiation. Its use is limited since current electro-anatomical mapping systems (EAMS) cannot provide global measurement of activation and repolarization times within a single beat. We carried out a simulation study to assess a simple method to measure RVI using data collected by sequential EAMS and we investigated the effect of background noise, RT variability (σ RT) and ectopics on RVI estimation. The mean correlation coefficient between single ECG beats and a representative template is used as inclusion/exclusion criterion. Localization of the vulnerable region associated with 5% bottom RVI was accurate (sensitivity 80±8%, specificity> 99± 1%) for moderate to large repolarization variability (5 ≤ σRT ≤ 20 ms) and moderate level of noise (S N R ≥ 10 dB) but it deteriorated for σRT ≥ 25 ms and S N R < 5 dB. Sensitivity remained high even when RVI estimates were only moderately accurate (cc > 0.67 ± 0.05, MAE < 25 ± 1 ms). The number of ectopic beats did not affect the results. In the in-vivo case analyzed, the sites of low RVI and VT exit was close (5.1 mm).

AB - Ventricular tachycardia (VT) recurrence after catheter ablation remains frequent and improved ablation strategies are needed. The re-entry vulnerability index (RVI) is an activation-repolarization marker to localize critical sites for VT initiation. Its use is limited since current electro-anatomical mapping systems (EAMS) cannot provide global measurement of activation and repolarization times within a single beat. We carried out a simulation study to assess a simple method to measure RVI using data collected by sequential EAMS and we investigated the effect of background noise, RT variability (σ RT) and ectopics on RVI estimation. The mean correlation coefficient between single ECG beats and a representative template is used as inclusion/exclusion criterion. Localization of the vulnerable region associated with 5% bottom RVI was accurate (sensitivity 80±8%, specificity> 99± 1%) for moderate to large repolarization variability (5 ≤ σRT ≤ 20 ms) and moderate level of noise (S N R ≥ 10 dB) but it deteriorated for σRT ≥ 25 ms and S N R < 5 dB. Sensitivity remained high even when RVI estimates were only moderately accurate (cc > 0.67 ± 0.05, MAE < 25 ± 1 ms). The number of ectopic beats did not affect the results. In the in-vivo case analyzed, the sites of low RVI and VT exit was close (5.1 mm).

UR - http://www.scopus.com/inward/record.url?scp=85068795193&partnerID=8YFLogxK

U2 - 10.22489/CinC.2018.286

DO - 10.22489/CinC.2018.286

M3 - Conference paper

AN - SCOPUS:85068795193

VL - 2018-September

BT - Computing in Cardiology Conference, CinC 2018

PB - IEEE Computer Society

T2 - 45th Computing in Cardiology Conference, CinC 2018

Y2 - 23 September 2018 through 26 September 2018

ER -