Single- and dual-site pace mapping of idiopathic septal intramural ventricular arrhythmias

• Published in: Heart rhythm Vol. 13; no. 1; pp. 72 - 77
• Main Authors: Yokokawa, Miki, MD, Jung, Dae Yon, PhD, Hero III, Alfred O., PHD, Baser, Kazim, MD, Morady, Fred, MD, FACC, Bogun, Frank, MD, FACC
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 2016
• Subjects: Ablation; Aged; Body Surface Potential Mapping - methods; Cardiovascular; Catheter Ablation - methods; Diagnosis, Differential; Electrophysiologic Techniques, Cardiac - methods; Female; Heart Ventricles - pathology; Heart Ventricles - physiopathology; Humans; Intramural ventricular arrhythmias; Male; Middle Aged; Pace mapping; Reproducibility of Results; ROC Curve; Site of origin; Tachycardia, Ventricular - diagnosis; Tachycardia, Ventricular - pathology; Tachycardia, Ventricular - surgery; Treatment Outcome; Ventricular arrhythmia; CC; ventricular arrhythmia; Pace mapping; site of origin; Intramural ventricular arrhythmias; ECG; root mean square; VA; Ablation; SOO; RMS; PVC; premature ventricular complex; correlation coefficient; electrocardiogram/electrocardiographic; Ventricular arrhythmia; Site of origin
• ISSN: 1547-5271; 1556-3871
• DOI: 10.1016/j.hrthm.2015.08.032

Background Pace mapping (PM) is used to identify the origin of ventricular arrhythmias (VAs). For intramural VAs, the site of origin often cannot be reached and therefore PM is less accurate. Objective The purpose of this study was to assess the value of single- and dual-site pace maps to differentiate intramural from nonintramural VAs. Methods In 18 consecutive patients with idiopathic intramural VAs, pace mapping was performed at 2 breakthrough sites in adjacent anatomic structures. Twelve-lead electrocardiograms of the 2 pace maps were averaged in MATLAB and compared (correlation coefficient [CC]) with the targeted VA. Dual-site pace mapping was performed in a control group of 18 patients with nonintramural VAs at the sites of earliest electrical activation and a breakthrough site in an adjacent anatomic location. Results Dual-site pace maps had a higher CC than did best single-site pace maps (0.87 ± 0.1 vs 0.81 ± 0.16; P = .02) in patients with intramural VAs. At the site of origin, single-site pace maps had a higher CC than did dual-site pace maps obtained from adjacent anatomic locations (0.93 ± 0.04 vs 0.89 ± 0.05; P = .0004) in patients with nonintramural VAs. Sensitivity, specificity, positive predictive value, and negative predictive value of dual-site pace maps for identifying an intramural VA were 89%, 82%, 84%, 88%, and 86%, respectively. Furthermore, the receiver operating characteristic curve analysis revealed that a CC cutoff value of ≤0.86 for a single-site pace map best differentiated intramural from nonintramural VAs. Conclusion A higher CC value for a dual-site pace map obtained from the earliest breakthrough site as well as a CC cutoff value of ≤0.86 for a single-site pace map obtained from the site of earliest electrical activation can best differentiate intramural from nonintramural VAs.