Noninvasive beat-to-beat epi-endocardial panoramic mapping in patients with polymorphic ventricular arrhythmias

Mikhail Chmelevsky1, Stepan Zubarev2, Margarita Budanova3, Danila Potyagaylo4, Tatjana Treshkur2, Dmitry Lebedev2
1Almazov National Medical Research Centre, 2Almazov National Medical Research Center, 3Federal Almazov National Medical Research Center, 4EP Solutions


Background: Noninvasive epi-endocardial panoramic mapping is a promising ECG Imaging technology alternative to catheter-based invasive methods. Some unstable ventricular arrhythmias arising from complex anatomic sites render mapping and ablation difficulties with conventional approach. Objective: To assess the use of a noninvasive panoramic mapping for diagnosis and localization of ventricular arrhythmias. Methods: 35 patients (20 male, median (25-75%) age - 35 (12-60) years) with polymorphic premature ventricular contractions (PVCs) and 3-5 different QRS morphologies (1500-19000 per day) or monomorphic ventricular tachycardia (VT) were enrolled in the study. Up to 224 body surface electrodes were connected to the noninvasive epi-endocardial electrophysiological system for multichannel ECG recording followed by computed tomography of the heart and torso. The body-surface ECG data were processed using inverse-problem solution software in combination with realistic 3D anatomical models of the heart and torso. The earliest site of activation were determined on isopotential maps for each QRS morphology. On the same day patients underwent catheter ablation of one or two dominant PVC morphologies using 3D electroanatomical mapping system. The site of successful catheter ablation served as final confirmation. Afterwards, electroanatomical maps were exported from Carto 3 system and compared with noninvasive maps using custom written Python-based software. Results: In total 47 similar PVC morphologies in 30 patients were mapped using noninvasive and invasive electroanatomical mapping systems, 34 (72%) PVCs were correctly diagnosed and 13 (28%) did not accurately correspond with sites of radiofrequency ablation. In 2 patients with four PVC morphologies an early activation zones were determined as a breakthrough from epi and endocardial surface using noninvasive activation maps. Conclusion: Non invasive epi-endocardial panoramic mapping technology is a novel diagnostic method which can be used as an additional pre-procedural tool for topical diagnosis of polymorphic PVCs.