Quantitative analyses of the distal bipolar electrogram for focal premature ventricular contraction ablation

Figures

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  FIGURE 1. Representative successful and unsuccessful ablation, and anatomical distribution of focal PVCs and ablation outcomes. (A) Successful RVOT case with single ablation lesion (red dot). (B) An unsuccessful RVOT case with multiple ablations. (C) PVC locations and ablation outcomes. For the definition of focal PVC location, see text.

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  FIGURE 2. Sharpness of the initial deflection of the distal bi‐EGM defined by half time of activation T ½, slope factor S and linear slope dV/dt and the ablation outcome. (A) Representative measurements of the half time of activation T ½ (ms) of the initial deflection of the distal bi‐EGM for a successful and an unsuccessful ablation case. (B) Representative regression fittings of the Boltzmann equation for the slope factor S (ms) of the initial deflection of the distal bi‐EGM for a successful and unsuccessful ablation case. Dots are data points and the smooth curves are the non‐linear regression fit of Boltzmann equation for slope factor. (C) Representative calculations of the linear slope dV/dt (mV/ms) of the initial deflection of the distal bi‐EGM for a successful and unsuccessful ablation case. (D) Box plots of the half time of activation T ½ (ms) between successful and unsuccessful group. (E) Box plots of the slope factor S (ms) between successful and unsuccessful group. (F) Box plots of the linear slope dV/dt (mV/ms) between successful and unsuccessful group. Each box plot depicts the median with the lower hinge representing 25th percentile and the upper hinge representing 75th…

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  FIGURE 3. Earliness of the distal bi‐EGM defined by the time of distal bi‐EGM to surface QRS and ablation outcome. (A) Representative measurements of the time from the onset of the distal bi‐EGM to the surface QRS T s for a successful and an unsuccessful ablation case. (B) Box plots of the time from bi‐EGM to surface EKG (T s). Definitions of the box plot are the same as Figure 2F.

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  FIGURE 4. Degree of fractionation of distal bi‐EGM and the ablation outcome. (A) Representative reconstructions of the distal bi‐EGM from the ASCII files depicting the number of deflections of a successful and unsuccessful ablation case. A defection is defined as a complete reversal of the polarity of b‐EGM from positive to negative or verse versa from the baseline. (B) Box plot of the number of deflections (De#) between successful and unsuccessful group. Definitions of the box plot are the same as Figure 2F.

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  FIGURE 5. Internal validation with ROC for each parameter. (A) ROC curve for t ½. (B) ROC curve for S. (C) ROC curve for T s. (D) ROC curve for dV/dt. (E) ROC curve for De#. t ½, S, and T s show discrimination power with AUC of 0.85, 0.88, and 0.87 respectively.