Abstract 18141: Outcomes of Prospective Computational 12-Lead ECG Mapping to Guide Ablation of Unstable Ventricular Tachycardia
Gordon Ho, Kevin Sung, Frederick Han, Jonathan Hsu, Kurt Hoffmayer, farshad raissi, Gregory K Feld, David E Krummen- Physiology (medical)
- Cardiology and Cardiovascular Medicine
Background: Unstable ventricular tachycardia is difficult to map and ablate, with high recurrence rates. We developed a 12-lead ECG mapping algorithm based on computational models to localize VT to help guide ablation of unstable VT.
Hypothesis: We hypothesized that prospective ECG-mapping can facilitate invasive activation mapping and improve the success of unstable VT ablation.
Aims: To compare the time to ICD shock + death in patients undergoing ECG-mapping guided ablation of unstable VT compared to standard ablation controls.
Methods: Consecutive patients from 2 centers with unstable VT undergoing ECG-mapping guided VT ablation were prospectively enrolled. Using the ECG, computational mapping localized the VT onto a 3D model. A multielectrode catheter was placed at the predicted site and activation mapping was performed during VT reinduction. Ablation was performed per standard protocol. Time to ICD shock or death was compared using Cox regression (adjusting for age, EF and ICM) between ECG-mapping guided ablation vs standard VT ablation controls with a minimum 3 month f/u. Accuracy of ECG mapping was compared with activation mapping.
Results: Out of 32 consecutive patients who underwent ECG-mapping guided VT ablation, 26 had unstable VT (age 66±10 yr, EF 34±17%). All 26 (100%) patients with unstable VT (median VT CL: 326±81ms) underwent successful activation mapping, Fig 1A. Using Cox regression adjusting for covariates, ECG-mapping guided VT ablation had a significant reduction in ICD shock or death compared to standard ablation controls (p=0.01, HR=0.23 [CI 0.07-0.70], Fig 1B). There was a 99% reduction in total ICD shocks during mean 7.5 month f/u. For all 32 patients, the mean accuracy of ECG mapping was 1.3±0.7cm when compared to invasive activation±entrainment mapping.
Conclusions: Use of computational 12-lead ECG mapping to guide ablation of unstable VT significantly improved freedom from ICD shocks and death resulting in excellent accuracy.