Transmural activation mapping of ventricular arrhythmias with high–frame rate echocardiography and validation against contact mapping
File(s)
Published version
Author(s)
Type
Journal Article
Abstract
Background
The restriction of activation mapping to the ventricular surface of contemporary mapping systems often leads to failure to correctly identify the true sites of origin (SoOs) of intramural and/or subepicardial ventricular arrhythmias (VAs), reducing procedural success.
Objectives
The aim of this study was to evaluate if noninvasive electromechanical wave imaging (EWI) can locate the SoOs of VAs along the endo-epicardial axis in patients with and without structural heart disease.
Methods
Patients with VAs requiring ablation underwent preprocedural transthoracic EWI to identify the SoOs and validate using contact mapping. Local electromechanical activation was defined as time point of the downward zero crossing on the incremental axial strain curve. The site of earliest activation on contact mapping and/or successful ablation was employed as ground truth for VA SoO.
Results
Twenty-eight patients underwent EWI, and 25 proceeded to contact mapping (56% men, mean age 53 ± 16 years, mean left ventricular ejection fraction 47% ± 28%, 52% with late gadolinium enhancement (LGE) on magnetic resonance imaging). Five patients were excluded (insufficient or different ventricular tachycardia or ventricular ectopic activity at the time of EWI vs contact mapping). EWI mapping correctly localized the VA SoOs in 17 of 20 (85%) of the cases and mapped them to the adjacent segments in the remaining ones. In the presence of scar, EWI localized 81.8% of the VA SoOs (n = 9 of 11) correctly compared with 88.9% (n = 8 of 9) in patients without (P = NS). The transmural SoOs (endocardial, midmyocardial, or epicardial) were successfully identified in 18 of 20 cases (90%; P = NS for LGE-positive vs LGE-negative patients).
Conclusions
EWI correctly identified the transmural SoOs of focal VAs, including in the presence of scar, in the majority of cases using contact mapping as the gold standard and thus could support preprocedural planning, including requirement for epicardial access and/or ablation techniques. The absence of a true gold standard for clinical transmural mapping remains an important challenge for the validation of novel mapping technologies.
The restriction of activation mapping to the ventricular surface of contemporary mapping systems often leads to failure to correctly identify the true sites of origin (SoOs) of intramural and/or subepicardial ventricular arrhythmias (VAs), reducing procedural success.
Objectives
The aim of this study was to evaluate if noninvasive electromechanical wave imaging (EWI) can locate the SoOs of VAs along the endo-epicardial axis in patients with and without structural heart disease.
Methods
Patients with VAs requiring ablation underwent preprocedural transthoracic EWI to identify the SoOs and validate using contact mapping. Local electromechanical activation was defined as time point of the downward zero crossing on the incremental axial strain curve. The site of earliest activation on contact mapping and/or successful ablation was employed as ground truth for VA SoO.
Results
Twenty-eight patients underwent EWI, and 25 proceeded to contact mapping (56% men, mean age 53 ± 16 years, mean left ventricular ejection fraction 47% ± 28%, 52% with late gadolinium enhancement (LGE) on magnetic resonance imaging). Five patients were excluded (insufficient or different ventricular tachycardia or ventricular ectopic activity at the time of EWI vs contact mapping). EWI mapping correctly localized the VA SoOs in 17 of 20 (85%) of the cases and mapped them to the adjacent segments in the remaining ones. In the presence of scar, EWI localized 81.8% of the VA SoOs (n = 9 of 11) correctly compared with 88.9% (n = 8 of 9) in patients without (P = NS). The transmural SoOs (endocardial, midmyocardial, or epicardial) were successfully identified in 18 of 20 cases (90%; P = NS for LGE-positive vs LGE-negative patients).
Conclusions
EWI correctly identified the transmural SoOs of focal VAs, including in the presence of scar, in the majority of cases using contact mapping as the gold standard and thus could support preprocedural planning, including requirement for epicardial access and/or ablation techniques. The absence of a true gold standard for clinical transmural mapping remains an important challenge for the validation of novel mapping technologies.
Date Issued
2025-04-01
Date Acceptance
2024-11-25
Citation
JACC: Clinical Electrophysiology, 2025, 11 (4), pp.667-681
ISSN
2405-500X
Publisher
Elsevier BV
Start Page
667
End Page
681
Journal / Book Title
JACC: Clinical Electrophysiology
Volume
11
Issue
4
Copyright Statement
© 2025 The Authors. Published by Elsevier on behalf of the American College of Cardiology Foundation. This is an open access article under the CC BY license ( http://creativecommons.org/licenses/by/4.0/ ) .
License URL
Identifier
https://www.ncbi.nlm.nih.gov/pubmed/40146088
PII: S2405-500X(24)01026-0
Subjects
electromechanical wave imaging
radiofrequency ablation
transmural mapping
ventricular arrhythmias
Humans
Male
Middle Aged
Female
Adult
Echocardiography
Tachycardia, Ventricular
Aged
Electrophysiologic Techniques, Cardiac
Catheter Ablation
Heart Ventricles
Arrhythmias, Cardiac
Publication Status
Published
Coverage Spatial
United States
Date Publish Online
2025-03-26