Arrhythmias & electrophysiology
Transmural Activation Mapping of Ventricular Arrhythmias With High–Frame Rate Echocardiography and Validation Against Contact Mapping
Authors' conclusion
EWI correctly identified the transmural SoOs of focal VAs, including in the presence of scar, in the majority of cases using contact mapping as the gold standard and thus could support preprocedural planning, including requirement for epicardial access and/or ablation techniques. The absence of a true gold standard for clinical transmural mapping remains an important challenge for the validation of novel mapping technologies.
Study context
- Population
- Patients with ventricular arrhythmias (VAs) requiring ablation, with and without structural heart diseaseunderwent electromechanical wave imaging (EWI), 25 proceeded to contact mapping, 5 excluded, 20 analysed
- Participants
- 28 patients
- Comparison
- EWI localization of VA SoOs against the site of earliest activation on contact mapping and/or successful ablation as ground truth
- Late gadolinium enhancement (LGE)-positive (scar)n = 11
- LGE-negative (no scar)n = 9
- Outcome
- Correct localization of VA SoOs by EWI
Methodological detailspreprocedural transthoracic EWI
- Preprocedural transthoracic EWI
Performance
As reported in the abstract
Correctly localized
17 of 20
85%
Further findings
Correct localization of VA SoOs by scar status
P = NS
- Transmural SoOs (endocardial, midmyocardial, or epicardial) identified — Successfully identified
- 18 of 20 cases (90%) · P = NS
Patient characteristics (contact-mapping cohort)
- Men
- 56%
- Mean age
- 53 ± 16 years
- Mean left ventricular ejection fraction
- 47% ± 28%
- LGE on magnetic resonance imaging
- 52%
Exclusions
- Patients excluded (insufficient or different ventricular tachycardia or ventricular ectopic activity at the time of EWI vs contact mapping)
- Five
Original publication
Transmural Activation Mapping of Ventricular Arrhythmias With High–Frame Rate Echocardiography and Validation Against Contact Mapping. JACC Clin Electrophysiol. Published 26 March 2025. doi:10.
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