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Noninvasive Electrocardiographic Mapping vs. Conventional ECG Analysis in Predicting Ventricular Tachycardia Origin
Session:
SESSÃO DE POSTERS 44 - ARRITMIAS VENTRICULARES
Speaker:
Catarina Gregório
Congress:
CPC 2025
Topic:
C. Arrhythmias and Device Therapy
Theme:
08. Ventricular Arrhythmias and Sudden Cardiac Death (SCD)
Subtheme:
08.4 Ventricular Arrhythmias and SCD - Treatment
Session Type:
Cartazes
FP Number:
---
Authors:
Catarina Gregório; Afonso Nunes-Ferreira; Ana Abrantes; Tiago Rodrigues; Ana Rita Francisco; Pedro Silva; Irina Neves; Joana Brito; Gustavo Lima da Silva; Nuno Cortez-Dias; Fausto J. Pinto; João de Sousa
Abstract
<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"><strong>Introduction: </strong></span></span></span><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000">Pre-procedural planning is crucial for the success of ventricular tachycardia (VT) ablation. VT origin can be predicted through systematic analysis of VT electrocardiograms (ECG). Non-invasive ECG mapping (ECGi) offers potentially more precise predictions of VT location, but its value in structural heart disease (SHD) remains uncertain.</span></span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"><strong>Purpose:</strong></span></span></span><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"> To evaluate the usefulness of ECGi in guiding SHD VT ablation planning by comparing its accuracy in predicting VT mapping areas with that of ECG analysis by electrophysiologists (EPs) and general cardiologists (GCs).</span></span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"><strong>Methods:</strong></span></span></span><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"> This single-center prospective study included patients with SHD referred for left ventricular VT ablation from 2022 to October 2024, who underwent ECGi, and their clinical VT was fully mapped during the electrophysiological procedure. Pre-procedural planning included ECGi using a 252-electrode noninvasive 3D mapping system (CardioInsight™), mapping VTs induced by noninvasive programmed stimulation. The ECGi area of interest was defined as the earliest activation region (initial 20±5ms from the first dV/dT). Three EPs and three GCs analyzed the VT ECG in a blinded manner, applying the 16-segment Burruezo’s prediction algorithm. VT origin predictions were considered appropriate if they matched the VT exit site or isthmus, allowing a 1-segment margin of error. Paired T-tests were used for statistical analysis.</span></span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"><strong>Results:</strong></span></span></span><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"> We included 17 patients (88% male, 71±13 years; 53% with ischemic SHD). Physicians correctly predicted the VT origin though the ECG analysis in 48% of cases, with EPs performing slightly better than GCs (p<0.001). Inter-operator concordance was higher among EPs (76.5%) compared to GCs (66.7%), with an overall concordance of 71.6%. In cases where ECG analysis was inaccurate but adjacent to the true site, predictions were more apical in 15.6% of cases, more basal in 2%, and in unrelated segments in the remaining cases. ECGi predicted the VT origin in 88% of cases, significantly outperforming both EPs and GCs (p=0.003). Furthermore, ECGi exactly predicted the VT exit site or isthmus segment in 82.4% of patients, compared to 5.8% for physicians (p<0.001).</span></span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"><strong>Conclusion:</strong></span></span></span><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"> Analysis of the VT ECG, even by skilled EPs using systematic algorithms, has significant limitations in predicting the area of interest for VT mapping. ECGi demonstrated superior accuracy in predicting VT origin, enhancing pre-procedural planning in patients with SHD.</span></span></span></p>
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