Barts Heart Centre, Barts Health NHS Trust, London, United Kingdom (A.J.G., M.O., G.D., H.D., N.T.S., C.M., J.L., J.S.M., A.C., J.G., F.P., O.S., S.A., M.L., M.F., M.J.E., A.C., S.S., M.D., R.J.H., R.J.S., P.D.L.).
Institute of Cardiovascular Science, University College London, United Kingdom (M.O., P.D.L.).
Circ Arrhythm Electrophysiol. 2020 Feb;13(2):e007377. doi: 10.1161/CIRCEP.119.007377. Epub 2020 Jan 14.
ECG imaging (ECGI) has been used to guide treatment of ventricular ectopy and arrhythmias. However, the accuracy of ECGI in localizing the origin of arrhythmias during catheter ablation of ventricular tachycardia (VT) in structurally abnormal hearts remains to be fully validated.
During catheter ablation of VT, simultaneous mapping was performed using electroanatomical mapping (CARTO, Biosense-Webster) and ECGI (CardioInsight, Medtronic) in 18 patients. Sites of entrainment, pace-mapping, and termination during ablation were used to define the VT site of origin (SoO). Distance between SoO and the site of earliest activation on ECGI were measured using co-registered geometries from both systems. The accuracy of ECGI versus a 12-lead surface ECG algorithm was compared.
A total of 29 VTs were available for comparison. Distance between SoO and sites of earliest activation in ECGI was 22.6, 13.9 to 36.2 mm (median, first to third quartile). ECGI mapped VT sites of origin onto the correct AHA segment with higher accuracy than a validated 12-lead ECG algorithm (83.3% versus 38.9%; =0.015).
This simultaneous assessment demonstrates that CardioInsight localizes VT circuits with sufficient accuracy to provide a region of interest for targeting mapping for ablation. Resolution is not sufficient to guide discrete radiofrequency lesion delivery via catheter ablation without concomitant use of an electroanatomical mapping system but may be sufficient for segmental ablation with radiotherapy.
心电图成像（ECGI）已被用于指导室性心律失常和心律失常的治疗。然而，在结构性异常心脏的心室内折返性心动过速（VT）导管消融中，ECGI 定位心律失常起源的准确性仍有待充分验证。
在 VT 的导管消融过程中，18 例患者同时使用电解剖标测（CARTO，Biosense-Webster）和 ECGI（CardioInsight，Medtronic）进行同步标测。消融过程中诱发性、起搏性和终止性部位用于定义 VT 起源部位（SoO）。使用两个系统的共配准几何图形测量 SoO 与 ECGI 上最早激活部位之间的距离。比较了 ECGI 与 12 导联体表心电图算法的准确性。
共有 29 个 VT 可用于比较。SoO 与 ECGI 上最早激活部位之间的距离为 22.6、13.9 至 36.2mm（中位数，第一至第三四分位数）。ECGI 以比经过验证的 12 导联 ECG 算法更高的准确性将 VT 起源部位映射到正确的 AHA 节段（83.3%对 38.9%；=0.015）。
这项同步评估表明，CardioInsight 可以准确地定位 VT 环，为消融的标测提供感兴趣区域。分辨率不足以在不联合使用电解剖标测系统的情况下指导通过导管消融进行离散射频消融，但对于放射治疗的节段性消融可能足够。
