Key result
Noninvasive 3D ECG mapping correctly diagnoses atrial tachycardia mechanisms in 92% of cases versus invasive mapping.
Why the study?
Conventional 12-lead electrocardiography has diagnostic limitations in facilitating the diagnosis of atrial tachycardias.
Observational (n=52)
Single-blind
Yes
Answers are grounded in this paper and cite their sources.
Captured external expert commentary on this paper, strongest first. Original sources are linked where available.
“As outlined by Ashok et al., the results are nothing short of spectacular. For example, the system correctly diagnosed 85% of the re-entrant arrhythmias, and 100% of the centrifugal tachycardias.”
Prospective multicenter study demonstrates high diagnostic accuracy for noninvasive 3D mapping in atrial tachycardia, highlighting its utility before catheter ablation.
This study prospectively evaluated the role of a novel 3-dimensional, noninvasive, beat-by-beat mapping system, Electrocardiographic Mapping (ECM), in facilitating the diagnosis of atrial tachycardias (AT). Conventional 12-lead electrocardiogram, a widely used noninvasive tool in clinical arrhythmia practice, has diagnostic limitations. Various AT (de novo and post-atrial fibrillation ablation) were mapped using ECM followed by standard-of-care electrophysiological mapping and ablation in 52 patients. The ECM consisted of recording body surface electrograms from a 252-electrode-vest placed on the torso combined with computed tomography-scan-based biatrial anatomy (CardioInsight Inc., Cleveland, Ohio). We evaluated the feasibility of this system in defining the mechanism of AT-macro-re-entrant (perimitral, cavotricuspid isthmus-dependent, and roof-dependent circuits) versus centrifugal (focal-source) activation-and the location of arrhythmia in centrifugal AT. The accuracy of the noninvasive diagnosis and detection of ablation targets was evaluated vis-à-vis subsequent invasive mapping and successful ablation. Comparison between ECM and electrophysiological diagnosis could be accomplished in 48 patients (48 AT) but was not possible in 4 patients where the AT mechanism changed to another AT (n = 1), atrial fibrillation (n = 1), or sinus rhythm (n = 2) during the electrophysiological procedure. ECM correctly diagnosed AT mechanisms in 44 of 48 (92%) AT: macro-re-entry in 23 of 27; and focal-onset with centrifugal activation in 21 of 21. The region of interest for focal AT perfectly matched in 21 of 21 (100%) AT. The 2:1 ventricular conduction and low-amplitude P waves challenged the diagnosis of 4 of 27 macro-re-entrant (perimitral) AT that can be overcome by injecting atrioventricular node blockers and signal averaging, respectively. This prospective multicenter series shows a high success rate of ECM in accurately diagnosing the mechanism of AT and the location of focal arrhythmia. Intraprocedural use of the system and its application to atrial fibrillation mapping is under way.
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Shah et al. (2013) conducted an observational in Atrial tachycardias (n=52). Electrocardiographic Mapping (ECM) vs. Invasive electrophysiological mapping was evaluated on Accuracy of noninvasive diagnosis of atrial tachycardia mechanism. Noninvasive 3-dimensional electrocardiographic mapping correctly diagnosed the mechanism of atrial tachycardia in 92% (44 of 48) of evaluable cases compared to invasive electrophysiological mapping.
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