In patients with ventricular arrhythmias like ventricular tachycardia, catheter ablation often fails due to multifocal origin. Ventricular tachycardia and premature ventricular complexes (PVCs) at an anatomically difficult location and absence or non-inducibility may also be responsible for failure of CA. To determine an effective treatment strategy for these patients a novel, non-invasive electrocardiographic imaging (ECGI) diagnostic tool may prove helpful.
The patients with infrequent ventricular arrhythmias referred for CA were intended to be assessed in the study for their outpatient ECGI using view into ventricular onset (VIVO) to develop a tailored treatment for them.
This pilot study included 13 VA patients enrolled in an outpatient setting. VIVO ECGI mapping, a novel technique, was performed on all the patients for pre-procedural diagnosis. In this technique, the heart and thorax of the patient are reconstructed using cardiac computed tomography imaging (CT) or cardiac magnetic resonance imaging (MRI) accompanied by a 12-lead ECG. Both these contribute to detect the origin of VAs. Based on the VIVO mapping of the cohort, the suitability for ablation was determined.
The group comprising 10 females and 3 males, was reported with a mean age of 39 ±15 years. The VIVO technique was used to analyze 16 PVC or VT morphologies.
A low PVC burden was found in 10 (8%) of the patients. 4 patients underwent CT imaging, and 10 had cardiac MRI. Non-ischemic cardiomyopathy was observed in 6 patients, and the remaining 7 had normal heart structure.
Two groups were formed based on the results of the VIVO mapping. Ablation was considered suitable in 7 patients who were grouped in Group A. Out of these 7, about 3 PVC patients underwent VIVO-based anatomy CA, of which 2 were successful. CA was not offered to the 6 group B patients due to an unacceptable chance for treatment success.
Patients not suitable for CA can be screened by detecting the origin of infrequent VAs using the non-invasive ECGI pace-map. Ablation can be performed in anatomical structure led low burden PVCs.