Ventricular ectopy ablation and electrical synchrony assessment as potential clinical applications of a novel vectorcardiography-based analysis software

MALDONADO KEVIN; CÁCERES MONIÉ CESAR; SPAGNUOLO DAMIAN; TELLO SANTA CRUZ IVÁN; CHARA OSVALDO; FERNÁNDEZ JUAN; PLUCHE NATALÍ; AVACA HORACIO

Congreso; 16th World Congress of Arrhythmias; 2019

Background: Ventricular ectopy ablation can be performed by comparing extrasystolic and paced beatelectrocardiogram (ECG) signals (pace-mapping). This technique depends on the operator?s expertiseand does not provide precise information about the localization of the arrhythmic focus.Electroanatomic mapping systems are hi-tech alternatives that notably improve the accuracy of themethod; however, they are expensive and difficult to implement. Indication criteria and strategies for the configuration of resynchronization therapy (RT) devices areunresolved topics. Moreover, it is now clear that QRS width is not a reliable indicator of RT requirementor response, and therefore alternative variables are necessary. Objective: To test the potential utility of a vectorcardiographyc-based method in two clinically relevantscenarios: catheter positioning during ventricular ectopy ablation and ventricular electrical synchronyassessment. Methods: Digital 12-lead surface ECGs were recorded before, during, and after ventricular arrhythmiaablation and RT device implantation. For two ablation procedures, ectopic activation vectorcardiogramswere calculated obtaining patient-specific arrhythmia templates. During pace-mapping, catheter-induced ventricular activation patterns were compared to the corresponding arrhythmia templates.Similarity, indexes and relative localization coordinates were obtained. For synchrony assessment, a novel synchrony index based on vectorcardiogram speed/voltage ratio wasdeveloped and tested on three patients with left bundle branch block (LBBB) and one RT patient beforeand after resynchronization. Results: In both cases of ectopic focus ablation, the same arrhythmic focus location was identified byour software and by physicians guided by electroanatomical mapping. Moreover, during pace-mapping,the software correctly suggested the catheter movement required to localize the focus and showed abetter correlation between signals as the target zone was reached. In patients with LBBB, the synchrony index was clearly different from control population values. In thepatient who underwent RT, the synchrony index was reset to a value similar to control individuals. Conclusions: Vectorcardiographyc analysis provided by our software could assist ventricular ectopic beatablation, RT indication and placement providing a low cost-low complexity tool complementary toexisting technology.