Key result
The combined cardiac signal comparison method achieved an end-point accuracy of 0.76 mm in guiding an ablation catheter to an arrhythmogenic site in a realistic torso model, compared to 16.9 mm with the original algorithm.
Why the study?
Does a new method compensating for dipole orientation improve the accuracy of guiding ablation catheters to arrhythmogenic sites in computer simulations?
Does a new method compensating for dipole orientation improve the accuracy of guiding ablation catheters to arrhythmogenic sites in computer simulations?
A novel computational method compensating for dipole orientation can guide ablation catheters to within 1.5 mm of arrhythmogenic sites in simulations, potentially facilitating RF ablation for hemodynamically unstable arrhythmias.
Enhances simulated catheter guidance precision; hypothesis-generating and should not yet change clinical ablation practice.
Treatment of hemodynamically unstable ventricular arrhythmias requires rapid and accurate localization of the reentrant circuit. We have previously described an algorithm that uses the single-equivalent moving dipole model to rapidly identify both the location of cardiac sources from body surface electrocardiographic signals and the location of the ablation catheter tip from current pulses delivered at the tip. However, during catheter ablation, in the presence of sources of systematic error, even if the exit site and catheter tip dipole are superposed in real space, their calculated positions may be separated by as much as 5 mm if their orientations are not exactly matched. In this study, we present a method to compensate for the effect of dipole orientation and examine the method's ability to guide a dipole at a catheter tip to an arrhythmogenic dipole corresponding to the exit site. In computer simulations, we show that the new method enables the user to guide the catheter tip to within 1.5 mm of the arrhythmogenic dipole using a realistic number of movements of the ablation catheter. These results suggest that this method has the potential to greatly facilitate RF ablation procedures, especially in the significant patient population with hemodynamically unstable arrhythmias.
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Barley et al. (2008) studied Ventricular tachycardia. Combined Cardiac Signal Comparison (CSC) method vs. Original Inverse Solution Guidance Algorithm (ISGA) was evaluated on End-point accuracy in the left ventricle (mm). The combined cardiac signal comparison method achieved an end-point accuracy of 0.76 mm in guiding an ablation catheter to an arrhythmogenic site in a realistic torso model, compared to 16.9 mm with the original algorithm.
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