Precise Noninvasive ECG Mapping Derived Localization of the Origin of an Epicardial Ventricular Tachycardia
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Invasive electrophysiological study with subsequent radiofrequency ablation is the most common therapeutic approach for the management of idiopathic ventricular tachycardias (VTs). Different algorithms based on the standard 12-lead ECG have been described for localizing the origin of ventricular arrhythmias. The standard surface ECG has limitations of spatial resolution, whereas an electrophysiological study, requiring invasive access, does not provide global activation patterns and cannot easily track changing arrhythmia patterns. Invasive mapping remains, however, the gold standard of spatial localization.
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A novel approach for diagnosing the source of ventricular arrhythmias was demonstrated in recent years. This method, noninvasive electrocardiographic imaging, is based on the numeric reconstruction of epicardial electrograms (based on epicardial potentials) derived from computed tomography (CT) or magnetic resonance imaging–based thoracic imaging and multichannel body surface EGG recording. This case study demonstrates the feasibility of a novel noninvasive epicardial and endocardial electrophysiology system (NEEES) for the diagnosis of an epicardially originating idiopathic VT.
We present here the case of a 61-year-old female patient who was referred to our center for the investigation of symptomatic sustained VT. The 12-lead surface ECG showed a monomorphic VT with a QRS duration of 120 ms, a left superior axis, a right bundle branch morphology, and an early septal transition in the precordial leads suggesting a posteroseptal origin (Figure 1). No detectable anomalies were found on transthoracic echocardiographic examination.
Noninvasive Electrocardiographic Imaging Findings
She then underwent a noninvasive electrocardiographic imaging study (NEEES system Amycard 01C electrophysiology [EP] laboratory; EP Solutions SA, Yverdon-les-Bains, Switzerland) followed by an invasive electrophysiological and ablation procedure. Two-hundred twenty-four body surface mapping electrodes were applied on the patient’s torso and connected to a multichannel ECG amplifier (EP Solutions SA). ECG recording was performed during 30 minutes, and 10 to 15 …