A novel algorithm for 3-D visualization of electrogram duration for substrate-mapping in patients with ischemic heart disease and ventricular tachycardia

PLoS ONE, vol. 16, pp. e0254683

Abstract

BACKGROUND: Myocardial slow conduction is a cornerstone of ventricular tachycardia (VT). Prolonged electrogram (EGM) duration is a useful surrogate parameter and manual annotation of EGM characteristics are widely used during catheter-based ablation of the arrhythmogenic substrate. However, this remains time-consuming and prone to inter-operator variability. We aimed to develop an algorithm for 3-D visualization of EGM duration relative to the 17-segment American Heart Association model. METHODS: To calculate and visualize EGM duration, in sinus rhythm acquired high-density maps of patients with ischemic cardiomyopathy undergoing substrate-based VT ablation using a 64-mini polar basket-catheter with low noise of 0.01 mV were analyzed. Using a custom developed algorithm based on standard deviation and threshold, the relationship between EGM duration, endocardial voltage and ablation areas was studied by creating 17-segment 3-D models and 2-D polar plots. RESULTS: 140,508 EGMs from 272 segments (n = 16 patients, 94% male, age: 66±2.4, ejection fraction: 31±2%) were studied and 3-D visualization of EGM duration was performed. Analysis of signal processing parameters revealed that a 40 ms sliding SD-window, 15% SD-threshold and >70 ms EGM duration cutoff was chosen based on diagnostic odds ratio of 12.77 to visualize rapidly prolonged EGM durations. EGMs > 70 ms matched to 99% of areas within dense scar (<0.2 mV), in 95% of zones within scar border zone (0.2-1.0 mV) and detected ablated areas having resulted in non-inducibility at the end of the procedure. Ablation targets were identified with a sensitivity of 65.6% and a specificity of 94.6% avoiding false positive labeling of prolonged EGMs in segments with healthy myocardium. CONCLUSION: The novel algorithm allows rapid visualization of prolonged EGM durations. This may facilitate more objective characterization of arrhythmogenic substrate in patients with ischemic cardiomyopathy.

Authors 9

1. Mustafa Masjedi

   Evangelisches Krankenhaus Düsseldorf · Heinrich Heine University Düsseldorf

   Affiliation as printed

   Department of Cardiology, Angiology and Intensive Care, EVK Düsseldorf, cNEP, cardiac Neuro- and Electrophysiology Research Consortium, Düsseldorf, Germany

   Institute of Neural and Sensory Physiology, cNEP, cardiac Neuro- and Electrophysiology Research Consortium, Heinrich Heine University Düsseldorf, Düsseldorf, Germany

2. Christiane Jungen Aachen Department of Cardiology, Leiden University Medical Center

   Leiden University Medical Center · University Medical Center Hamburg-Eppendorf · German Centre for Cardiovascular Research

   Affiliation as printed

   DZHK (German Centre for Cardiovascular Research), Partner Site Hamburg/Kiel/Lübeck, Germany

   Department of Cardiology, Leiden University Medical Center, Leiden, Netherlands

   Department of Cardiology, University Heart & Vascular Centre, University Hospital Hamburg-Eppendorf, Hamburg, Germany

3. Paweł Kuklik

   Asklepios Klinik St. Georg · Asklepios

   Affiliation as printed

   Department of Cardiology, Asklepios Hospital St. Georg, Hamburg, Germany

4. Fares‐Alexander Alken

   Evangelisches Krankenhaus Düsseldorf · Heinrich Heine University Düsseldorf

   Affiliation as printed

   Department of Cardiology, Angiology and Intensive Care, EVK Düsseldorf, cNEP, cardiac Neuro- and Electrophysiology Research Consortium, Düsseldorf, Germany

   Institute of Neural and Sensory Physiology, cNEP, cardiac Neuro- and Electrophysiology Research Consortium, Heinrich Heine University Düsseldorf, Düsseldorf, Germany

5. Ann‐Kathrin Kahle

   Evangelisches Krankenhaus Düsseldorf · German Centre for Cardiovascular Research · Heinrich Heine University Düsseldorf

   Affiliation as printed

   DZHK (German Centre for Cardiovascular Research), Partner Site Hamburg/Kiel/Lübeck, Germany

   Department of Cardiology, Angiology and Intensive Care, EVK Düsseldorf, cNEP, cardiac Neuro- and Electrophysiology Research Consortium, Düsseldorf, Germany

   Institute of Neural and Sensory Physiology, cNEP, cardiac Neuro- and Electrophysiology Research Consortium, Heinrich Heine University Düsseldorf, Düsseldorf, Germany

6. Niklas Klatt

   Schön Klinik Neustadt

   Affiliation as printed

   Department of Cardiology, Schoen Hospital Neustadt, Neustadt in Holstein, Germany

7. Katharina Scherschel

   Evangelisches Krankenhaus Düsseldorf · German Centre for Cardiovascular Research · Heinrich Heine University Düsseldorf

   Affiliation as printed

   DZHK (German Centre for Cardiovascular Research), Partner Site Hamburg/Kiel/Lübeck, Germany

   Department of Cardiology, Angiology and Intensive Care, EVK Düsseldorf, cNEP, cardiac Neuro- and Electrophysiology Research Consortium, Düsseldorf, Germany

   Institute of Neural and Sensory Physiology, cNEP, cardiac Neuro- and Electrophysiology Research Consortium, Heinrich Heine University Düsseldorf, Düsseldorf, Germany

8. Jürgen Lorenz

   HAW Hamburg

   Affiliation as printed

   Faculty of Life Sciences, Department of Biomedical Engineering, Applied Science University Hamburg, Hamburg, Germany

9. Christian G. Meyer corresponding

   Evangelisches Krankenhaus Düsseldorf · German Centre for Cardiovascular Research · Heinrich Heine University Düsseldorf

   Affiliation as printed

   DZHK (German Centre for Cardiovascular Research), Partner Site Hamburg/Kiel/Lübeck, Germany

   Department of Cardiology, Angiology and Intensive Care, EVK Düsseldorf, cNEP, cardiac Neuro- and Electrophysiology Research Consortium, Düsseldorf, Germany

   Institute of Neural and Sensory Physiology, cNEP, cardiac Neuro- and Electrophysiology Research Consortium, Heinrich Heine University Düsseldorf, Düsseldorf, Germany