Electrocardiographic imaging (ECGi) guiding idiopathic ventricular tachycardia ablation

Introduction Precise localization of arrhythmogenic foci is critical for the success of radiofrequency catheter ablation (RCA) in patients with premature ventricular contractions (PVCs) or idiopathic ventricular tachyarrhythmias (IVT). Reliable preprocedural tools that aid localization are therefore of significant clinical interest. Aim To evaluate the diagnostic accuracy of electrocardiographic imaging (ECGi) compared with conventional 12-lead ECG in identifying the site of origin of IVTs. Methods In this retrospective, single centre study, consecutive patients undergoing RCA for PVCs or ITVs were included. All patients underwent 12-lead ECG, and 32% also underwent ECGi with a 252-electrode vest and thoracic CT scan (CardioInsight®). ECG locations from 12 lead recordings were interpreted by both arrhythmologists and nonarrhythmologists. For ECGi, the earliest activated site was considered the arrhythmia origin. Electrophysiology (EP) study with successful ablation defined the reference standard. Results Thirty-seven patients were analyzed (mean age 53 ± 14.6 years, 45.9% male). Compared with 12-lead ECG, ECGi demonstrated superior sensitivity (90.9% vs. 56.9%), specificity (99.4% vs. 97.1%), and overall diagnostic accuracy (98.9% vs. 94.6%; all p=0.025). Furthermore, ECGi use was associated with significantly shorter EP procedure times (92.1 ± 23.3 vs. 157.9 ± 62.5 minutes; p < 0.05). Conclusion ECGi provided more accurate localization of arrhythmia origins than conventional 12-lead ECG and was associated with shorter procedure times. Incorporating ECGi into pre-procedural planning may improve efficiency and outcomes in RCA.