Imageless electrocardiographic imaging for the location of premature ventricular contractions

Abstract Background Precise, non-invasive localization of Premature Ventricular Contractions (PVCs) is challenging with current 12-lead ECG methods, which often lack accuracy. Catheter ablation, while effective, requires lengthy procedures to identify ectopic origins, raising costs and patient risk. Imageless Electrocardiographic Imaging (ECGI) could overcome these issues, offering faster, safer, real-time localization without CT scans. Objective To validate the Imageless ECGI technique as a tool for localizing the origin of ectopic ventricular beats and supporting the pre-procedural therapeutic decision making, by comparing with electroanatomical mapping (EAM) systems. Methods ECGI was performed in 38 patients (55.2 ± 15.1 years old; 52.8% male) submitted for PVC ablation guided through EAM during the procedure. In contrast to current methods requiring patient-specific torso-heart geometries from CT/MRI scans, the employed Imageless ECGI system computes a personalized cardiac anatomical model from a 3D-camera torso reconstruction. The outflow tract of the ventricles was divided in 8 clinically relevant regions and the ECGI earliest local activation time (LAT) maps were compared with the origin established by the EAM. The classification on these regions by the electrophysiologist based only on the 12-lead ECG was also compared with the EAM gold-standard. Results The region of PVC origin identified by non-invasive ECGI mapping was consistent with the region determined by EAM in 90% of cases when considering both the same region and neighbouring areas. For cases where the ectopic beat origin was identified in the regions Right Ventricle Outflow Tract (RVOT) septal, RVOT Free Wall and Left Ventricle Outflow Tract (LVOT), perfect agreement was found with the Gold Standard EAM in 100% of the cases, with 7, 8 and 7 patients, respectively. By contrast, when the origin was located outside the ventricular outflow tract, concordance with EAM was less consistent. These scenarios are less common clinically and, in the present database, represent less than 10% of cases. Additionally, the comparison of the origins identified by ECGI and ECG showed that the novel technique has a 30% greater agreement with EAM than the 12-lead ECG analysis alone. Conclusions ECGI activation maps are consistent with the gold-standard for PVC localization without prior medical imaging. It is a technique that adds value to 12-lead ECG diagnosis.EAM Vs imageless ECGI - PVC localization