Abstract 19734: Advantages of the Cardiac Isochrone Positioning System for Localization of PVCs to the Endocardium, Epicardium, and Mid-myocardium from a 12 lead ECG
Introduction: PVC localization from a 12 lead ECG is an imperfect deduction prone to inaccuracy. The cardiac isochrone positioning system (CIPS) is a non-invasive cardiac imaging method to localize the PVC origin quantitatively to the ventricles using a 12 lead ECG coupled with anatomical imaging data from MRI/CT. The purpose of this study is to: 1) Demonstrate and clarify the limitations of using only the 12 lead ECG to localize a PVC, and 2) Show the advantages of CIPS to localize a PVC, including to the mid-myocardium.
Methods: 9 subjects had successful PVC ablation in the endo- , epi, or mid-myocardium. To demonstrate the limitations of localizing PVCs using only a 12 lead ECG, 8 blinded physicians were asked both to localize the PVC origin to a specific myocardial area using polar map representations of the LV and RV and to specify the PVC as endo- or epicardial in origin. CIPS was used to localize the same PVCs using the MRI derived models and the same 12 lead ECG.
Results: All 8 blinded reviewers located the PVCs to the correct location with an accuracy of 27%. A qualification of the PVC to an endo- or epicardial surface could not be reliably determined. In contrast, CIPS located the PVCs with an accuracy of 86%. CIPS also successfully localized all 9 PVCs to endo-, epi-, or mid-myocardium.
Conclusions: Our results confirm the limited capability of using only a 12 lead ECG to localize a PVC origin. Currently, there are no criteria to differentiate the location of the PVC specifically to the mid-myocardium. Coupling the 12 lead ECG and anatomical data, CIPS is able to reliably determine PVC origin. As demonstrated here, it also has the ability to successfully localize PVCs to an epi-, endo-, or mid-myocardial site. CIPS is a promising new technology that could be used to quickly and accurately ascertain an exact PVC location, translating into a direct clinical benefit for patients undergoing ablation.
Author Disclosures: J.P. Gordon: None. M. Laks: None. N.G. Boyle: None. P.M. van Dam: Ownership Interest; Significant; Peacs.
- © 2014 by American Heart Association, Inc.