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Zhou S, AbdelWahab A, Sapp JL, Sung E, Aronis KN, Warren JW, MacInnis PJ, Shah R, Horáček BM, Berger R, Tandri H, Trayanova NA, Chrispin J. Assessment of an ECG-Based System for Localizing Ventricular Arrhythmias in Patients With Structural Heart Disease. J Am Heart Assoc 2021; 10:e022217. [PMID: 34612085 PMCID: PMC8751877 DOI: 10.1161/jaha.121.022217] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Background We have previously developed an intraprocedural automatic arrhythmia‐origin localization (AAOL) system to identify idiopathic ventricular arrhythmia origins in real time using a 3‐lead ECG. The objective was to assess the localization accuracy of ventricular tachycardia (VT) exit and premature ventricular contraction (PVC) origin sites in patients with structural heart disease using the AAOL system. Methods and Results In retrospective and prospective case series studies, a total of 42 patients who underwent VT/PVC ablation in the setting of structural heart disease were recruited at 2 different centers. The AAOL system combines 120‐ms QRS integrals of 3 leads (III, V2, V6) with pace mapping to predict VT exit/PVC origin site and projects that site onto the patient‐specific electroanatomic mapping surface. VT exit/PVC origin sites were clinically identified by activation mapping and/or pace mapping. The localization error of the VT exit/PVC origin site was assessed by the distance between the clinically identified site and the estimated site. In the retrospective study of 19 patients with structural heart disease, the AAOL system achieved a mean localization accuracy of 6.5±2.6 mm for 25 induced VTs. In the prospective study with 23 patients, mean localization accuracy was 5.9±2.6 mm for 26 VT exit and PVC origin sites. There was no difference in mean localization error in epicardial sites compared with endocardial sites using the AAOL system (6.0 versus 5.8 mm, P=0.895). Conclusions The AAOL system achieved accurate localization of VT exit/PVC origin sites in patients with structural heart disease; its performance is superior to current systems, and thus, it promises to have potential clinical utility.
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Affiliation(s)
- Shijie Zhou
- Alliance for Cardiovascular Diagnostic and Treatment Innovation Johns Hopkins University Baltimore MD
| | - Amir AbdelWahab
- Department of Medicine Queen Elizabeth II Health Sciences Centre Halifax NS Canada
| | - John L Sapp
- Department of Medicine Queen Elizabeth II Health Sciences Centre Halifax NS Canada.,Department of Physiology and Biophysics Dalhousie University Halifax NS Canada
| | - Eric Sung
- Alliance for Cardiovascular Diagnostic and Treatment Innovation Johns Hopkins University Baltimore MD.,Department of Biomedical Engineering Johns Hopkins University Baltimore MD
| | - Konstantinos N Aronis
- Division of Cardiology Department of Medicine Section of Cardiac Electrophysiology Johns Hopkins Hospital Baltimore MD.,Department of Biomedical Engineering Johns Hopkins University Baltimore MD
| | - James W Warren
- Department of Physiology and Biophysics Dalhousie University Halifax NS Canada
| | - Paul J MacInnis
- Department of Physiology and Biophysics Dalhousie University Halifax NS Canada
| | - Rushil Shah
- Division of Cardiology Department of Medicine Section of Cardiac Electrophysiology Johns Hopkins Hospital Baltimore MD
| | - B Milan Horáček
- School of Biomedical Engineering Dalhousie University Halifax NS Canada
| | - Ronald Berger
- Alliance for Cardiovascular Diagnostic and Treatment Innovation Johns Hopkins University Baltimore MD.,Division of Cardiology Department of Medicine Section of Cardiac Electrophysiology Johns Hopkins Hospital Baltimore MD
| | - Harikrishna Tandri
- Alliance for Cardiovascular Diagnostic and Treatment Innovation Johns Hopkins University Baltimore MD.,Division of Cardiology Department of Medicine Section of Cardiac Electrophysiology Johns Hopkins Hospital Baltimore MD
| | - Natalia A Trayanova
- Alliance for Cardiovascular Diagnostic and Treatment Innovation Johns Hopkins University Baltimore MD.,Department of Biomedical Engineering Johns Hopkins University Baltimore MD
| | - Jonathan Chrispin
- Alliance for Cardiovascular Diagnostic and Treatment Innovation Johns Hopkins University Baltimore MD.,Division of Cardiology Department of Medicine Section of Cardiac Electrophysiology Johns Hopkins Hospital Baltimore MD
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Wang L, Gharbia OA, Nazarian S, Horácek BM, Sapp JL. Non-invasive epicardial and endocardial electrocardiographic imaging for scar-related ventricular tachycardia. Europace 2019; 20:f263-f272. [PMID: 29684187 DOI: 10.1093/europace/euy082] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2018] [Accepted: 03/22/2018] [Indexed: 11/13/2022] Open
Abstract
Aims Contact mapping is currently used to guide catheter ablation of scar-related ventricular tachycardia (VT) but usually provides incomplete assessment of 3D re-entry circuits and their arrhythmogenic substrates. This study investigates the feasibility of non-invasive electrocardiographic imaging (ECGi) in mapping scar substrates and re-entry circuits throughout the epicardium and endocardium. Methods and results Four patients undergoing endocardial and epicardial mapping and ablation of scar-related VT had computed tomography scans and a 120-lead electrocardiograms, which were used to compute patient-specific ventricular epicardial and endocardial unipolar electrograms (CEGMs). Native-rhythm CEGMs were used to identify sites of myocardial scar and signal fractionation. Computed electrograms of induced VT were used to localize re-entrant circuits and exit sites. Results were compared to in vivo contact mapping data and epicardium-based ECGi solutions. During native rhythm, an average of 493 ± 18 CEGMs were analysed on each patient. Identified regions of scar and fractionation comprised, respectively, 25 ± 4% and 2 ± 1% of the ventricular surface area. Using a linear mixed-effects model grouped at the level of an individual patient, CEGM voltage and duration were significantly associated with contact bipolar voltage. During induced VT, the inclusion of endocardial layer in ECGi made it possible to identify two epicardial vs. three endocardial VT exit sites among five reconstructed re-entry circuits. Conclusion Electrocardiographic imaging may be used to reveal sites of signal fractionation and to map short-lived VT circuits. Its capacity to map throughout epicardial and endocardial layers may improve the delineation of 3D re-entry circuits and their arrhythmogenic substrates.
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Affiliation(s)
- Linwei Wang
- College of Computing and Information Sciences, Rochester Institute of Technology, Room 74-1075, 102 Lomb Memorial Drive, Rochester, NY, USA
| | - Omar A Gharbia
- College of Computing and Information Sciences, Rochester Institute of Technology, Room 74-1075, 102 Lomb Memorial Drive, Rochester, NY, USA
| | - Saman Nazarian
- School of Medicine, The University of Pennsylvania, Philadelphia, PA, USA
| | - B Milan Horácek
- School of Biomedical Engineering, Dalhousie University, Halifax, NS, Canada
| | - John L Sapp
- School of Biomedical Engineering, Dalhousie University, Halifax, NS, Canada
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Rapid 12-lead automated localization method: Comparison to electrocardiographic imaging (ECGI) in patient-specific geometry. J Electrocardiol 2018; 51:S92-S97. [PMID: 30177365 DOI: 10.1016/j.jelectrocard.2018.07.022] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2018] [Revised: 07/13/2018] [Accepted: 07/27/2018] [Indexed: 11/23/2022]
Abstract
BACKGROUND Rapid accurate localization of the site of ventricular activation origin during catheter ablation for ventricular arrhythmias could facilitate the procedure. Electrocardiographic imaging (ECGI) using large lead sets can localize the origin of ventricular activation. We have developed an automated method to identify sites of early ventricular activation in real time using the 12-lead ECG. We aim to compare the localization accuracy of ECGI and the automated method, identifying pacing sites/VT exit based on a patient-specific model. METHODS A patient undergoing ablation of VT on the left-ventricular endocardium and epicardium had 120-lead body-surface potential mapping (BSPM) recorded during the procedure. (1) ECGI methodology: The L1-norm regularization was employed to reconstruct epicardial potentials based on patient-specific geometry for localizing endocardial ventricular activation origin. We used the BSPM data corresponding to known endocardial pacing sites and a VT exit site identified by 3D contact mapping to analyze them offline. (2) The automatedmethod: location coordinates of pacing sites together with the time integral of the first 120 ms of the QRS complex of 3 ECG predictors (leads III, V2 and V6) were used to calculate patient-specific regression coefficients to predict the location of unknown sites of ventricular activation origin ("target" sites). Localization error was quantified over all pacing sites in millimeters by comparing the calculated location and the known reference location. RESULTS Localization was tested for 14 endocardial pacing sites and 1 epicardial VT exit site. For 14 endocardial pacing sites the mean localization error of the automated method was significantly lower than that of the ECGI (8.9 vs. 24.9 mm, p < 0.01), when 10 training pacing sites are used. Emulation of a clinical procedure demonstrated that the automated method achieved localization error of <5 mm for the VT-exit site; while the ECGI approach approximately correlates with the site of VT exit from the scar within a distance of 18.4 mm. CONCLUSIONS The automated method using only 3 ECGs shows promise to localize the origin of ventricular activation as tested by pacing, and the VT-exit site and compares favourably to inverse solution calculation, avoiding cumbersome lead sets. As 12-lead ECG data is acquired by current 3D mapping systems, it is conceivable that the algorithm could be directly incorporated into a mapping system. Further validation in a prospective cohort study is needed to confirm and extend observations reported in this study.
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Zhou S, Sapp JL, AbdelWahab A, Šťovíček P, Horáček BM. Localization of ventricular activation origin using patient-specific geometry: Preliminary results. J Cardiovasc Electrophysiol 2018; 29:979-986. [PMID: 29702740 DOI: 10.1111/jce.13622] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2017] [Revised: 04/13/2017] [Accepted: 04/17/2017] [Indexed: 11/29/2022]
Abstract
BACKGROUND AND OBJECTIVES Catheter ablation of ventricular tachycardia (VT) may include induction of VT and localization of VT-exit site. Our aim was to assess localization performance of a novel statistical pace-mapping method and compare it with performance of an electrocardiographic inverse solution. METHODS Seven patients undergoing ablation of VT (4 with epicardial, 3 with endocardial exit) aided by electroanatomic mapping underwent intraprocedural 120-lead body-surface potential mapping (BSPM). Two approaches to localization of activation origin were tested: (1) A statistical method, based on multiple linear regression (MLR), which required only the conventional 12-lead ECG for a sufficient number of pacing sites with known origin together with patient-specific geometry of the endocardial/epicardial surface obtained by electroanatomic mapping; and (2) a classical deterministic inverse solution for recovering heart-surface potentials, which required BSPM and patient-specific geometry of the heart and torso obtained via computed tomography (CT). RESULTS For the MLR method, at least 10-15 pacing sites with known coordinates, together with their corresponding 12-lead ECGs, were required to derive reliable patient-specific regression equations, which then enabled accurate localization of ventricular activation with unknown origin. For 4 patients who underwent epicardial mapping, the median of localization error for the MLR was significantly lower than that for the inverse solution (10.6 vs. 27.3 mm, P = 0.034); a similar result held for 3 patients who underwent endocardial mapping (7.7 vs. 17.1 mm, P = 0.017). The pooled localization error for all epicardial and endocardial sites was also significantly smaller for the MLR compared with the inverse solution (P = 0.005). CONCLUSIONS The novel pace-mapping approach to localizing the origin of ventricular activation offers an easily implementable supplement and/or alternative to the preprocedure inverse solution; its simplicity makes it suitable for real-time applications during clinical catheter-ablation procedures.
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Affiliation(s)
- Shijie Zhou
- School of Biomedical Engineering, Dalhousie University, Halifax, Nova Scotia, Canada
| | - John L Sapp
- Department of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Amir AbdelWahab
- Department of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Petr Šťovíček
- General University Hospital, Charles University, Prague, Czech Republic
| | - B Milan Horáček
- School of Biomedical Engineering, Dalhousie University, Halifax, Nova Scotia, Canada
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Wang L, Gharbia OA, Horáček BM, Sapp JL. Noninvasive epicardial and endocardial electrocardiographic imaging of scar-related ventricular tachycardia. J Electrocardiol 2016; 49:887-893. [PMID: 27968777 DOI: 10.1016/j.jelectrocard.2016.07.026] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2016] [Indexed: 12/11/2022]
Abstract
BACKGROUND The majority of life-threatening ventricular tachycardias (VTs) are sustained by heterogeneous scar substrates with narrow strands of surviving tissue. An effective treatment for scar-related VT is to modify the underlying scar substrate by catheter ablation. If activation sequence and entrainment mapping can be performed during sustained VT, the exit and isthmus of the circuit can often be identified. However, with invasive catheter mapping, only monomorphic VT that is hemodynamically stable can be mapped in this manner. For the majority of patients with poorly tolerated VTs or multiple VTs, a close inspection of the re-entry circuit is not possible. A noninvasive approach to fast mapping of unstable VTs can potentially allow an improved identification of critical ablation sites. METHODS For patients who underwent catheter ablation of scar-related VT, CT scan was obtained prior to the ablation procedure and 120-lead body-surface electrocardiograms (ECGs) were acquired during induced VTs. These data were used for noninvasive ECG imaging to computationally reconstruct electrical potentials on the epicardium and on the endocardium of both ventricles. Activation time and phase maps of the VT circuit were extracted from the reconstructed electrograms. They were analyzed with respect to scar substrate obtained from catheter mapping, as well as VT exits confirmed through ablation sites that successfully terminated the VT. RESULTS The reconstructed re-entry circuits correctly revealed both epicardial and endocardial origins of activation, consistent with locations of exit sites confirmed from the ablation procedure. The temporal dynamics of the re-entry circuits, particularly the slowing of conduction as indicated by the crowding and zig-zag conducting of the activation isochrones, collocated well with scar substrate obtained by catheter voltage maps. Furthermore, the results indicated that some re-entry circuits involve both the epicardial and endocardial layers, and can only be properly interpreted by mapping both layers simultaneously. CONCLUSIONS This study investigated the potential of ECG-imaging for beat-to-beat mapping of unstable reentrant circuits. It shows that simultaneous epicardial and endocardial mapping may improve the delineation of the 3D spatial construct of a re-entry circuit and its exit. It also shows that the use of phase mapping can reveal regions of slow conduction that collocate well with suspected heterogeneous regions within and around the scar.
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Affiliation(s)
- Linwei Wang
- Rochester Institute of Technology, Rochester, NY, USA.
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Novel percutaneous left atrial appendage closure. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2014; 14:164-7. [PMID: 23773498 DOI: 10.1016/j.carrev.2013.04.001] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2013] [Accepted: 04/04/2013] [Indexed: 11/22/2022]
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Sapp JL, Dawoud F, Clements JC, Horácek BM. Inverse solution mapping of epicardial potentials: quantitative comparison with epicardial contact mapping. Circ Arrhythm Electrophysiol 2012; 5:1001-9. [PMID: 22923272 DOI: 10.1161/circep.111.970160] [Citation(s) in RCA: 64] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Catheter ablation of ventricular tachycardia (VT) is still one of the most challenging procedures in cardiac electrophysiology, limited, in part, by unmappable arrhythmias that are nonsustained or poorly tolerated. Calculation of the inverse solution from body surface potential mapping (sometimes known as ECG imaging) has shown tremendous promise and can rapidly map these arrhythmias, but we lack quantitative assessment of its accuracy in humans. We compared inverse solution mapping with computed tomography-registered electroanatomic epicardial contact catheter mapping to study the resolution of this technique, the influence of myocardial scar, and the ability to map VT. METHODS AND RESULTS For 4 patients undergoing epicardial catheter mapping and ablation of VT, 120-lead body surface potential mappings were obtained during implantable defibrillator pacing, catheter pacing from 79 epicardial sites, and induced VT. Inverse epicardial electrograms computed using individualized torso/epicardial surface geometries extracted from computed tomography images were compared with registered electroanatomic contact maps. The distance between estimated and actual epicardial pacing sites was 13 ± 9 mm over normal myocardium with no stimulus-QRS delay but increased significantly over scar (P=0.013) or was close to scar (P=0.014). Contact maps during right ventricular pacing correlated closely to inverse solution isochrones. Maps of inverse epicardial potentials during 6 different induced VTs indicated areas of earliest activation, which correlated closely with clinically identified VT exit sites for 2 epicardial VTs. CONCLUSIONS Inverse solution maps can identify sites of epicardial pacing with good accuracy, which diminishes over myocardial scar or over slowly conducting tissue. This approach can also identify epicardial VT exit sites and ventricular activation sequences.
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Affiliation(s)
- John L Sapp
- Department of Medicine, Dalhousie University, Halifax, NS, Canada.
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Abstract
Cardiovascular disease remains a leading cause of hospitalization and mortality worldwide. Conventional heart failure treatment is making steady and substantial progress to reduce the burden of disease. Nevertheless novel therapies and especially cardiac gene therapy have been emerging in the past and successfully made their way into first clinical trials. Gene therapy was initially a visionary treatment strategy for inherited, monogenetic diseases but has now developed to have potential for polygenic diseases as atherosclerosis, arrhythmias and heart failure. These novel therapeutic strategies require testing in clinically relevant animal models to transition from 'bench to bedside'. One of the major hurdles for effective cardiovascular gene therapy is the delivery of the viral vectors to the heart. In this review we present the currently available vector-mediated cardiac gene delivery methods in vivo considering the specific merits and deficiencies.
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Gyurjyan HV, Tucker-Schwartz JM, Gillies GT, Mahapatra S. Anthropomorphic simulator for minimally invasive epicardial access procedures. J Med Eng Technol 2009; 34:134-40. [PMID: 19929238 DOI: 10.3109/03091900903428340] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
We have developed a prototype, in vitro anthropomorphic model for simulating pressure-guided, subxiphoid access procedures done to enable minimally invasive epicardial cardiac procedures including treatments for ventricular tachycardia. Life-size replicas of the heart and lungs were modelled using anatomically accurate surrogates. The dynamic pressure-frequency profiles of simulated pericardial fluid surrounding the water-pumped replica heart were measured and validated against previously acquired human intrapericardial pressure observations (Pearson's r = 0.88, p < 0.001). In replicating access procedures for approaching and entering the pericardial space, the system produced physiologically appropriate pressure measurements at each intermediate point along the needle's insertion pathway. Details of construction and performance are presented and discussed.
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Affiliation(s)
- H V Gyurjyan
- University of Virginia, Department of Biomedical Engineering, PO Box 800759, Charlottesville, VA 22908, USA
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Tucker-Schwartz JM, Gillies GT, Scanavacca M, Sosa E, Mahapatra S. Pressure–Frequency Sensing Subxiphoid Access System for Use in Percutaneous Cardiac Electrophysiology: Prototype Design and Pilot Study Results. IEEE Trans Biomed Eng 2009; 56:1160-8. [DOI: 10.1109/tbme.2008.2009527] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Bartoli CR, Akiyama I, Godleski JJ, Verrier RL. Long-term pericardial catheterization is associated with minimum foreign-body response. Catheter Cardiovasc Interv 2007; 70:221-7. [PMID: 17632787 DOI: 10.1002/ccd.21167] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
OBJECTIVES The goals of this study were to assess the feasibility and to characterize the foreign-body response of a long-term catheter in the pericardium. BACKGROUND Long-term access to the normal pericardial space provides opportunities for diagnostic sampling and therapeutic intervention. METHODS After thoracotomy, in 7 anesthetized canines, the pericardium was opened and a 5 French silicone vascular access catheter was advanced 10 cm into the pericardial sac toward the apex of the heart. A hydraulic coronary balloon occluder was implanted (N=6). Pericardium was sealed with Prolene suture. Catheters were tunneled to the nape of the neck, attached to a subcutaneous vascular access port, and buried in the fascia. Animals underwent multiple experimental coronary artery occlusions across months. At sacrifice, we assessed the histopathological response of pericardium and epicardium to chronically indwelling silicone catheters. RESULTS Post-mortem examinations were performed at 213 days post-operatively (mean, range=96-413, N=6), with one animal maintained for longer-term study. At sacrifice, all catheters were bidirectionally patent and completely mobile in the pericardium without evidence of tissue overgrowth around the intrapericardial segment. Adhesion tissue was found only at the site of catheter entry through the pericardium. Microscopic histopathological examination at catheter entry site, surrounding pericardium, and myocardium revealed minimum chronic inflammation. CONCLUSIONS This subcutaneous system provides dependable, chronic access to the normal pericardial space for drug delivery and sampling. The presence of a chronic silicone catheter in the pericardium does not precipitate clinically significant pathologic changes even after repeated ischemic events.
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Affiliation(s)
- Carlo R Bartoli
- Molecular and Integrative Physiological Sciences Program, Department of Environmental Health, Harvard School of Public Health, Boston, Massachusetts, and Department of Pathology, Brigham and Women's Hospital 02115, USA
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Horowitz BN, Vaseghi M, Mahajan A, Cesario DA, Buch E, Valderrábano M, Boyle NG, Ellenbogen KA, Shivkumar K. Percutaneous intrapericardial echocardiography during catheter ablation: a feasibility study. Heart Rhythm 2006; 3:1275-82. [PMID: 17074631 DOI: 10.1016/j.hrthm.2006.07.025] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2006] [Accepted: 07/21/2006] [Indexed: 10/24/2022]
Abstract
BACKGROUND Percutaneous pericardial access, epicardial mapping, and ablation have been used successfully for catheter ablation procedures. OBJECTIVES The purpose of this study was to evaluate the safety and feasibility of closed-chest direct epicardial ultrasound imaging for aiding cardiac catheter ablation procedures. METHODS An intracardiac ultrasound catheter was used for closed-chest epicardial imaging of the heart in 10 patients undergoing percutaneous epicardial access for catheter ablation. All patients underwent concomitant intracardiac echocardiography and preprocedural transesophageal echocardiography. Using a double-wire technique, two sheaths were placed in the pericardium, and a phased-array ultrasound catheter was manipulated within the pericardial sinuses for imaging. RESULTS Multiple images from varying angles were obtained for catheter navigation. Notably, image stability was excellent, and structures such as the left atrial appendage were seen in great detail. No complications resulting from use of the ultrasound catheter in the pericardium occurred, and no restriction of movement due to the presence of the additional catheter in the pericardial space was observed. Wall motion was correlated to voltage maps in five patients and showed that areas of scars correlated with wall-motion abnormalities. Normal wall-motion score correlated to sensed signals of 4.2 +/- 0.3 mV (normal myocardium >1.5 mV), and scores >1 correlated to areas with signals <0.5 mV in that territory). CONCLUSION Intrapericardial imaging using an ultrasound catheter is feasible and safe and has the potential to provide additional valuable information for complex ablation procedures.
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Affiliation(s)
- Barbara Natterson Horowitz
- UCLA Cardiac Arrhythmia Center, Division of Cardiology, Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, California 90095, USA
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