Accuracy of non-invasive electrocardiographic imaging in scar-dependent ventricular tachycardia: Relationship to arrhythmogenic substrate and imaging defined scar.
Al-Sheikhli, Jaffar Wang, Xuezhe Mayer, Joseph Mohamed, Mohamed Anwar Ali, Syed Rizwan Siang, Rafaella Thant, May Patchett, Ian Ammar, Ahmed Silberbauer, John
Al-Sheikhli, Jaffar
Wang, Xuezhe
Mayer, Joseph
Mohamed, Mohamed Anwar
Ali, Syed Rizwan
Siang, Rafaella
Thant, May
Patchett, Ian
Ammar, Ahmed
Silberbauer, John
Abstract
BACKGROUND AND AIMS: Accuracy data for non-invasive electrocardiographic imaging (ECGi) in defining the arrhythmogenic substrate for scar-dependant ventricular tachycardia (VT) is lacking. This study evaluated the accuracy of ECGi mapping to localise the arrhythmogenic substrate and assessed the relationship to myocardial scar, isthmus, exit and successful ablation sites.
METHODS: A total of 48 VTs in 31 patients were mapped with both ECGi (View into Ventricular Onset, VIVO) and electro-anatomical maps (EAM) to define the arrhythmogenic substrate. Myocardial segments were assigned for the VT-exit site region (VT-ESR), isthmus region, successful ablation sites and cardiac cross-sectional imaging defined scar using the ventricular AHA segment model and underwent blinded analysis.
RESULTS: VT-ESR complete match (defined as exact AHA segment concordance between ECGi and EAM) was seen in 67% and partial match (defined as adjacent segments) in 21% of VTs. ECGi VT-ESR was located within or adjacent to cross-sectional imaging defined scar in 85% of VTs. The VT isthmus was within or adjacent to the ECGi VT-ESR in 77% of VTs. Successful ablation sites were within or adjacent to the ECGi VT-ESR in 82% of VTs. VIVO ECGi accuracy was not affected by cardiomyopathy type or VT cycle length. In identifying epicardial VT-ESR for ischaemic cardiomyopathy, VIVO ECGi had a sensitivity and specificity of 71.4% and 92.9%; for non-ischaemic cardiomyopathy 66.7% and 100%, respectively.
CONCLUSION: ECGi mapping with VIVO can accurately predict the arrhythmogenic substrate for scar-dependent VT. Incorporation of ECGi mapping to conventional VT ablation workflows may improve procedural efficiency.
Affiliations
Heart Rhythm Research Group, Division of Biomedical Sciences, Warwick Medical School, Clinical Sciences Research Laboratory, Coventry, UK; Institute for Cardio-Metabolic Medicine, University Hospital Coventry and Warwickshire NHS Trust, Coventry, UK; Institute of Cardiovascular Science, University College London, UK; Royal Stoke University Hospital, Stoke-on-Trent, UK; Sussex Cardiac Centre, Royal Sussex County Hospital, Brighton, UK; Department of Computer Science, University of Warwick, Coventry CV4 7AL
Date
2026-04-09
Type
Article
Citation
EP Europace, 2026 Apr 9: euag076