Performance and Robustness Testing of a Non-Invasive Mapping System for Ventricular Arrhythmias

Figures

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  FIGURE 1. Two examples of predicted locations of a premature ventricular complex (PVC) by the VIVO system showing the analyzed PVC with the onset of the QRS complex marked by a red and the end by a blue line and triangulated heart model (left) and the electro-anatomical map with the local ventricular activation time (LAT) of the morphologically same PVC (right). The example at the top shows a good correlation with the ventricular activation measured from the great cardiac vein preceding the activation measured the left atrial appendage and ventricle. The PVC was successfully treated with radio-frequent energy applications from the left ventricle and great cardiac vein (patient 22). The example at the bottom shows the absence of a good correlation between the VIVO map (predicted location of origin being the right coronary cusp) and the electro-anatomical map with the ventricular activation recorded from the great cardiac vein preceding the activation measured from the right and left ventricle and coronary cusps. Ablation from great cardiac vein and left ventricle suppressed the PVCs but applications from the left coronary cusp were ineffective. After the procedure, the remaining PVCs…

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  FIGURE 2. Ventricular heart model with 28 segments with epicardial, basal, mid and apical view. 1) Left ventricle summit; 2) Aortomitral continuity; 3) Left coronary cups; 4) Right coronary cusp; 5) Left ventricle anterolateral wall; 6) Left ventricle posterolateral wall; 7) Right ventricle outflow tract free wall; 8) Right ventricle outflow tract posteroseptal wall; 9) Right ventricle anteroseptal wall; 10) Right ventricle free wall; 11) Right ventricle anteroseptal wall; 12) Right ventricle posteroseptal wall; 13) Left ventricle anteroseptal wall; 14) Left ventricle posteroseptal wall; 15) Left ventricle anterolateral wall; 16) Left ventricle posterolateral wall; 17) Right ventricle anterolateral free wall; 18) Right ventricle posterolateral free wall; 19) Right ventricle anteroseptal wall; 20) Right ventricle posteroseptal wall; 21) Left ventricle anteroseptal wall; 22) Left ventricle posteroseptal wall; 23) Left ventricle anterolateral wall; 24) Left ventricle posterolateral wall; 25) Anterolateral papillary muscle; 26) Posteromedial papillary muscle; 27) Right ventricle apex; 28) Left ventricle apex.

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  FIGURE 3. Shifts in the predicted origin of PVCs in relation to changes in time marker placement. Top left: ECG with time markers indicating onset (red), end of the QRS complex (blue) and an isoelectric point after the T wave (green). Top middle: Predicted activation map using standard timing placement. Top right: Predicted activation map using a delayed onset of the QRS complex (+10 ms) showing a clinically unimportant shift of one triangle side. Graphs below show the percentage of patients with clinically unchanged predictions of origin of the PVCs (defined as shifts ≤2 or ≤4 triangle sides and indicated as % of cases with an unchanged prediction) before and after altering the onset (left) and end marker (right) of the QRS-complex.