Right ventricular substrate mapping using the Ensite Navx system

Accuracy of high-density voltage map obtained by automatic point acquisition during geometry reconstruction

Michela Casella, Francesco Perna, Antonio Dello Russo, Gemma Pelargonio, Stefano Bartoletti, Annalisa Ricco, Tommaso Sanna, Maurizio Pieroni, Giovanni Forleo, Augusto Pappalardo, Luigi Di Biase, Luigi Natale, Fulvio Bellocci, Paolo Zecchi, Andrea Natale, Claudio Tondo

Research output: Contribution to journalArticle

10 Citations (Scopus)

Abstract

Background: Contact point-to-point electroanatomic mapping (Pt-Map) is a validated tool to evaluate right ventricular (RV) substrate. When using the EnSite NavX system (St. Jude Medical, St Paul, Minnesota), geometry reconstruction by dragging the mapping catheter (Geo-Map) allows for quicker acquisition of a large number of points and better definition of anatomy, but it is not validated for substrate mapping. Objective: This study evaluates the feasibility and accuracy of Geo-Map. Methods: Thirteen patients (mean age 38 ± 12 years) with RV arrhythmias and an apparently normal heart underwent cardiac magnetic resonance imaging (MRI), Pt-Map, and Geo-Map. The 2 maps were compared in terms of mapping procedural time, radiation time, and total number of points acquired. We finally compared the number and characteristics of low-potential areas on each patient's Pt-Map, Geo-Map, and cardiac MRI. Results: Geo-Map required significantly shorter mapping and radiation times in comparison to Pt-Map (12.4 ± 4.6 vs. 31.9 ± 10.1 and 5.8 ± 2.1 vs. 12.1 ± 3.9, P <.001). Furthermore, Geo-Map was based on a significantly higher density of points in comparison to Pt-Map (802 ± 205 vs. 194 ± 38, P <.001). Taking into consideration the total number of RV regions analyzed, the Pt-Map and Geo-Map disagreed in 2 of 65 (3%) regions (P = NS), which only Geo-Map identified as low-potential areas and indeed corresponded to wall motion abnormalities on MRI. Conclusion: Voltage maps obtained through RV geometry acquisition have accuracy comparable to that of conventional point-by-point mapping in detecting low-voltage areas, have a good correlation with MRI wall motion abnormalities, and allow a significant reduction in procedural time and x-ray exposure.

Original languageEnglish (US)
Pages (from-to)1598-1605
Number of pages8
JournalHeart Rhythm
Volume6
Issue number11
DOIs
StatePublished - Nov 2009
Externally publishedYes

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Magnetic Resonance Imaging
Radiation
Feasibility Studies
Cardiac Arrhythmias
Anatomy
Catheters
X-Rays

Keywords

  • Arrhythmogenic right ventricular dysplasia
  • Cardiac magnetic resonance imaging
  • Electroanatomic mapping

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Physiology (medical)

Cite this

Right ventricular substrate mapping using the Ensite Navx system : Accuracy of high-density voltage map obtained by automatic point acquisition during geometry reconstruction. / Casella, Michela; Perna, Francesco; Dello Russo, Antonio; Pelargonio, Gemma; Bartoletti, Stefano; Ricco, Annalisa; Sanna, Tommaso; Pieroni, Maurizio; Forleo, Giovanni; Pappalardo, Augusto; Di Biase, Luigi; Natale, Luigi; Bellocci, Fulvio; Zecchi, Paolo; Natale, Andrea; Tondo, Claudio.

In: Heart Rhythm, Vol. 6, No. 11, 11.2009, p. 1598-1605.

Research output: Contribution to journalArticle

Casella, M, Perna, F, Dello Russo, A, Pelargonio, G, Bartoletti, S, Ricco, A, Sanna, T, Pieroni, M, Forleo, G, Pappalardo, A, Di Biase, L, Natale, L, Bellocci, F, Zecchi, P, Natale, A & Tondo, C 2009, 'Right ventricular substrate mapping using the Ensite Navx system: Accuracy of high-density voltage map obtained by automatic point acquisition during geometry reconstruction', Heart Rhythm, vol. 6, no. 11, pp. 1598-1605. https://doi.org/10.1016/j.hrthm.2009.07.040
Casella, Michela ; Perna, Francesco ; Dello Russo, Antonio ; Pelargonio, Gemma ; Bartoletti, Stefano ; Ricco, Annalisa ; Sanna, Tommaso ; Pieroni, Maurizio ; Forleo, Giovanni ; Pappalardo, Augusto ; Di Biase, Luigi ; Natale, Luigi ; Bellocci, Fulvio ; Zecchi, Paolo ; Natale, Andrea ; Tondo, Claudio. / Right ventricular substrate mapping using the Ensite Navx system : Accuracy of high-density voltage map obtained by automatic point acquisition during geometry reconstruction. In: Heart Rhythm. 2009 ; Vol. 6, No. 11. pp. 1598-1605.
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abstract = "Background: Contact point-to-point electroanatomic mapping (Pt-Map) is a validated tool to evaluate right ventricular (RV) substrate. When using the EnSite NavX system (St. Jude Medical, St Paul, Minnesota), geometry reconstruction by dragging the mapping catheter (Geo-Map) allows for quicker acquisition of a large number of points and better definition of anatomy, but it is not validated for substrate mapping. Objective: This study evaluates the feasibility and accuracy of Geo-Map. Methods: Thirteen patients (mean age 38 ± 12 years) with RV arrhythmias and an apparently normal heart underwent cardiac magnetic resonance imaging (MRI), Pt-Map, and Geo-Map. The 2 maps were compared in terms of mapping procedural time, radiation time, and total number of points acquired. We finally compared the number and characteristics of low-potential areas on each patient's Pt-Map, Geo-Map, and cardiac MRI. Results: Geo-Map required significantly shorter mapping and radiation times in comparison to Pt-Map (12.4 ± 4.6 vs. 31.9 ± 10.1 and 5.8 ± 2.1 vs. 12.1 ± 3.9, P <.001). Furthermore, Geo-Map was based on a significantly higher density of points in comparison to Pt-Map (802 ± 205 vs. 194 ± 38, P <.001). Taking into consideration the total number of RV regions analyzed, the Pt-Map and Geo-Map disagreed in 2 of 65 (3{\%}) regions (P = NS), which only Geo-Map identified as low-potential areas and indeed corresponded to wall motion abnormalities on MRI. Conclusion: Voltage maps obtained through RV geometry acquisition have accuracy comparable to that of conventional point-by-point mapping in detecting low-voltage areas, have a good correlation with MRI wall motion abnormalities, and allow a significant reduction in procedural time and x-ray exposure.",
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T1 - Right ventricular substrate mapping using the Ensite Navx system

T2 - Accuracy of high-density voltage map obtained by automatic point acquisition during geometry reconstruction

AU - Casella, Michela

AU - Perna, Francesco

AU - Dello Russo, Antonio

AU - Pelargonio, Gemma

AU - Bartoletti, Stefano

AU - Ricco, Annalisa

AU - Sanna, Tommaso

AU - Pieroni, Maurizio

AU - Forleo, Giovanni

AU - Pappalardo, Augusto

AU - Di Biase, Luigi

AU - Natale, Luigi

AU - Bellocci, Fulvio

AU - Zecchi, Paolo

AU - Natale, Andrea

AU - Tondo, Claudio

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N2 - Background: Contact point-to-point electroanatomic mapping (Pt-Map) is a validated tool to evaluate right ventricular (RV) substrate. When using the EnSite NavX system (St. Jude Medical, St Paul, Minnesota), geometry reconstruction by dragging the mapping catheter (Geo-Map) allows for quicker acquisition of a large number of points and better definition of anatomy, but it is not validated for substrate mapping. Objective: This study evaluates the feasibility and accuracy of Geo-Map. Methods: Thirteen patients (mean age 38 ± 12 years) with RV arrhythmias and an apparently normal heart underwent cardiac magnetic resonance imaging (MRI), Pt-Map, and Geo-Map. The 2 maps were compared in terms of mapping procedural time, radiation time, and total number of points acquired. We finally compared the number and characteristics of low-potential areas on each patient's Pt-Map, Geo-Map, and cardiac MRI. Results: Geo-Map required significantly shorter mapping and radiation times in comparison to Pt-Map (12.4 ± 4.6 vs. 31.9 ± 10.1 and 5.8 ± 2.1 vs. 12.1 ± 3.9, P <.001). Furthermore, Geo-Map was based on a significantly higher density of points in comparison to Pt-Map (802 ± 205 vs. 194 ± 38, P <.001). Taking into consideration the total number of RV regions analyzed, the Pt-Map and Geo-Map disagreed in 2 of 65 (3%) regions (P = NS), which only Geo-Map identified as low-potential areas and indeed corresponded to wall motion abnormalities on MRI. Conclusion: Voltage maps obtained through RV geometry acquisition have accuracy comparable to that of conventional point-by-point mapping in detecting low-voltage areas, have a good correlation with MRI wall motion abnormalities, and allow a significant reduction in procedural time and x-ray exposure.

AB - Background: Contact point-to-point electroanatomic mapping (Pt-Map) is a validated tool to evaluate right ventricular (RV) substrate. When using the EnSite NavX system (St. Jude Medical, St Paul, Minnesota), geometry reconstruction by dragging the mapping catheter (Geo-Map) allows for quicker acquisition of a large number of points and better definition of anatomy, but it is not validated for substrate mapping. Objective: This study evaluates the feasibility and accuracy of Geo-Map. Methods: Thirteen patients (mean age 38 ± 12 years) with RV arrhythmias and an apparently normal heart underwent cardiac magnetic resonance imaging (MRI), Pt-Map, and Geo-Map. The 2 maps were compared in terms of mapping procedural time, radiation time, and total number of points acquired. We finally compared the number and characteristics of low-potential areas on each patient's Pt-Map, Geo-Map, and cardiac MRI. Results: Geo-Map required significantly shorter mapping and radiation times in comparison to Pt-Map (12.4 ± 4.6 vs. 31.9 ± 10.1 and 5.8 ± 2.1 vs. 12.1 ± 3.9, P <.001). Furthermore, Geo-Map was based on a significantly higher density of points in comparison to Pt-Map (802 ± 205 vs. 194 ± 38, P <.001). Taking into consideration the total number of RV regions analyzed, the Pt-Map and Geo-Map disagreed in 2 of 65 (3%) regions (P = NS), which only Geo-Map identified as low-potential areas and indeed corresponded to wall motion abnormalities on MRI. Conclusion: Voltage maps obtained through RV geometry acquisition have accuracy comparable to that of conventional point-by-point mapping in detecting low-voltage areas, have a good correlation with MRI wall motion abnormalities, and allow a significant reduction in procedural time and x-ray exposure.

KW - Arrhythmogenic right ventricular dysplasia

KW - Cardiac magnetic resonance imaging

KW - Electroanatomic mapping

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