Performance and limitations of noninvasive cardiac activation mapping

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Presentation transcript:

Performance and limitations of noninvasive cardiac activation mapping Josselin Duchateau, MD, MSc, Frédéric Sacher, MD, PhD, Thomas Pambrun, MD, Nicolas Derval, MD, Judit Chamorro-Servent, PhD, Arnaud Denis, MD, Sylvain Ploux, MD, PhD, Mélèze Hocini, MD, Pierre Jaïs, MD, PhD, Olivier Bernus, PhD, Michel Haïssaguerre, MD, Rémi Dubois, PhD Heart Rhythm Volume 16, Issue 3, Pages 435-442 (March 2019) DOI: 10.1016/j.hrthm.2018.10.010 Copyright © 2018 The Authors Terms and Conditions

Figure 1 Comparative activation maps in representative patients with paced rhythms. Invasive maps (left) show progressive delay from the breakthrough point (asterisk) near the pacing site to the latest activated regions (left ventricular [LV] base for patient A; right ventricular outflow tract for patient B). Noninvasive maps (right) image overall activation correctly. Small conduction block visible in the LV lateral wall in patient A is not imaged. Instead, artificial lines of block perpendicular to the wavefront propagation (black lines and arrows) are reconstructed. For patient B, the lateral LV pacing site is not visible. Ao = aorta; LAD = left anterior descending. Heart Rhythm 2019 16, 435-442DOI: (10.1016/j.hrthm.2018.10.010) Copyright © 2018 The Authors Terms and Conditions

Figure 2 Comparative activation maps of patients with idiopathic ventricular fibrillation with normal baseline QRS complex A. and B. Two patients with normal QRS at baseline. Contact maps (left) show 3 breakthroughs (asterisks) on the right ventricular (RV) free wall, the anterior left ventricle (LV), and the inferior LV. RV outflow tract and basal segments are activated late. Noninvasive maps (left) show 1–2 breakthroughs, all located in the RV. RV outflow tract and RV lateral base are depicted as early activated. Vertical lines on examplary signals indicate local activation time. Ao = aorta; LAD = left anterior descending. Heart Rhythm 2019 16, 435-442DOI: (10.1016/j.hrthm.2018.10.010) Copyright © 2018 The Authors Terms and Conditions

Figure 3 Comparative epicardial breakthrough positions in patients with normal QRS. The size of the asterisks represents the number of breakthroughs in each location. Blue asterisks are for right ventricular (RV) breakthroughs and red asterisks for left ventricular (LV) breakthroughs. All 23 patients had a primary breakthrough on the RV anterior wall as imaged by contact mapping (left). Most patients then had an inferior and anterior LV breakthrough. Noninvasive maps (right) showed a smaller number of breakthroughs, with a less systematic distribution. These were often located in the RV outflow tract or RV lateral base. Heart Rhythm 2019 16, 435-442DOI: (10.1016/j.hrthm.2018.10.010) Copyright © 2018 The Authors Terms and Conditions

Figure 4 Comparative activation maps in representative patients with intraventricular conduction disorders. A: Patient with right bundle branch block, along with contact (left) and noncontact (right) electrograms. B: Patient with left bundle branch block. Overall activation pattern is similar in both modalities, but lines of conduction block (black lines and arrows) appear in noninvasive maps (right), perpendicular to wavefront propagation. Breakthrough sites are represented by asterisks. Vertical lines on examplary signals indicate local activation time. Ao = aorta; LAD = left anterior descending. Heart Rhythm 2019 16, 435-442DOI: (10.1016/j.hrthm.2018.10.010) Copyright © 2018 The Authors Terms and Conditions

Figure 5 Comparative activation maps in representative patients with abnormal contact maps. A: Patient with Brugada syndrome. Contact mapping (left) demonstrates heterogeneous activation with multiple small islands of delayed activation predominant in the right ventricular (RV) outflow tract. Signals in these regions confirm double potentials. Reconstructed signals in the same area are morphologically different and exhibit no fragmentation. B: Patient with arrhythmogenic right ventricular cardiomyopathy. A small area of delayed activation is present at the RV inferolateral base. Noninvasive maps (right) do not show the abnormal conduction present in these 3 patients. Lines of block are represented by black arrows, and breakthrough sites are represented by asterisks. Vertical lines on examplary signals indicate local activation time. Ao = aorta; LAD = left anterior descending. Heart Rhythm 2019 16, 435-442DOI: (10.1016/j.hrthm.2018.10.010) Copyright © 2018 The Authors Terms and Conditions