Predictability of indicators in local activation time mapping of ablation success for premature ventricular contractions

Abstract

Introduction

Differences in predictability of ablation success for premature ventricular contractions (PVCs) between earliest isochronal map area (EIA), local activation time (LAT) differences on unipolar and bipolar electrograms (⊿LAT_Bi-Uni), LAT prematurity on bipolar electrograms (LAT_Bi), and unipolar morphology of QS or Q pattern remain unclear. We verified multiple statistical predictabilities of those indicators of ablation success on mapped cardiac surface.

Methods

Thirty-five patients with multiple PVCs underwent catheter ablation after LAT mapping using multipolar mapping catheters with unipolar-based annotation. Patients were divided into success and failure groups based on ablation success on mapped cardiac surfaces. Discrimination ability, reclassification table, calibration plots, and decision curve analysis of 10 ms EIA (EIA_10ms), ⊿LAT_Bi-Uni, and LAT_Bi were validated. Unipolar morphology was compared between success and failure groups.

Results

Right ventricular outflow tract, aortic cusp, and left ventricle were mapped in 17, 10, and 8 patients, respectively. In 14/35 (40%) patients, successful ablation was performed on mapped cardiac surfaces. Area under the curve of receiver-operating characteristic curve of EIA_10ms, ⊿LAT_Bi-Uni, and LAT_Bi were 0.874, 0.801, and 0.650, respectively (EIA_10ms vs. LAT_Bi, p =.014; ⊿LAT_Bi-Uni vs. LAT_Bi, p =.278; EIA_10ms vs. ⊿LAT_Bi-Uni, p =.464). EIA_10ms and ⊿LAT_Bi-Uni demonstrated better predictability, calibration, and clinical utility on reclassification table, calibration plots, and decision curve analysis than LAT_Bi. Unipolar morphology of QS or Q pattern did not correlate with ablation success (p =.518).

Conclusion

EIA_10ms and ⊿LAT_Bi-Uni more accurately predict ablation success for PVCs on mapped cardiac surfaces than LAT_Bi and unipolar morphology.