From St Mary's Hospital and Imperial College School of Medicine,
London, UK.
Correspondence to D. Wyn Davies, MD, Waller Department of Cardiology, St Mary's Hospital, Praed St, London W2 1NY, United Kingdom.
Background—Catheter ablation of
ventricular tachycardia is limited in part by
difficulty in identifying suitable sites for ablation. A noncontact
multielectrode array (MEA) has been developed that allows
reconstruction of 3360 electrograms, using inverse-solution
mathematics, that are superimposed onto a computer-simulated model of
the endocardium. This study assesses the accuracy of timing and
morphology of reconstructed unipolar electrograms compared with contact
unipolar electrograms from the same endocardial site.
Methods and Results—The MEA was deployed in the left ventricles
of 13 patients (end-diastolic diameters, 61.7±8.4 mm
[mean±SD]). We recorded contact electrograms at 76 points
equatorial and 32 points nonequatorial to the MEA during sinus rhythm
using a catheter-locator signal to record direction and distance
from the MEA. Morphology (cross-correlation) and timing of maximum
-dV/dt of contact and reconstructed electrograms were compared
at different distances from the MEA center to endocardium (M-E) and
from the MEA equatorial plane. For equatorial data, the M-E was
32.12±12.12 mm. The timing of reconstructed with respect to
contact electrograms was -1.94±7.12 ms for M-E <34 mm and
-14.16±19.29 ms at M-E >34 mm (P<0.001).
Cross-correlation of electrograms was 0.87±0.12 (95% CI, 0.84 to
0.91) and 0.76±0.18 (95% CI, 0.69 to 0.83) for M-E <34 mm and
>34 mm, respectively. Nonequatorial points were 32.33±10.81
mm (range, 16.9 to 55.6 mm) from the MEA equatorial plane;
electrogram timing difference was -8.97±15.75 ms and was unrelated to
this distance from the equator.
Conclusions—This noncontact mapping system accurately
reconstructs endocardial unipolar electrograms from the human left
ventricle. At M-E distances >34 mm, timing accuracy of
reconstruction decreases.
© 1998 American Heart Association, Inc.
Clinical Investigation and Reports
Simultaneous Endocardial Mapping in the Human Left Ventricle Using a Noncontact Catheter
Comparison of Contact and Reconstructed Electrograms During Sinus Rhythm
Key Words: mapping • tachyarrhythmia • electrophysiology
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