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Our approach to minimize risk of epicardial access: standard techniques with the addition of electroanatomic mapping guidance.

ABSTRACT: Epicardial mapping and ablation is increasingly being performed for the treatment of complex arrhythmias. Right ventricular (RV) puncture remains the most common complication, with damage to surrounding non-cardiac structures also a concern. We describe the standard techniques used in our lab essential for safe epicardial access, as well as a novel technique incorporating electroanatomic mapping (EAM) guidance. In a series of 8 patients referred for ventricular tachycardia ablation, an RV endocardial voltage map was created using EAM systems. EAM images were fused with preprocedure CT scans when available. A 17G Tuohy needle was integrated with the EAM system by attaching the needle to sterile electrode clamps. EAM location points were used in conjunction with standard access techniques until epicardial access was obtained. Epicardial access was successfully obtained in 8/8 (100%) patients. Successful access without RV puncture was achieved in 7/8 (88%) cases. This proof of concept study demonstrates that EAM systems can be used as an adjunct to standard access techniques to visualize and facilitate pericardial access.

SUBMITTER: Bradfield JS

PROVIDER: S-EPMC3696725 | biostudies-literature | 2013 Jun

REPOSITORIES: biostudies-literature

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Our approach to minimize risk of epicardial access: standard techniques with the addition of electroanatomic mapping guidance.

Bradfield Jason S JS Tung Roderick R Boyle Noel G NG Buch Eric E Shivkumar Kalyanam K

Journal of cardiovascular electrophysiology 20121221 6

Epicardial mapping and ablation is increasingly being performed for the treatment of complex arrhythmias. Right ventricular (RV) puncture remains the most common complication, with damage to surrounding non-cardiac structures also a concern. We describe the standard techniques used in our lab essential for safe epicardial access, as well as a novel technique incorporating electroanatomic mapping (EAM) guidance. In a series of 8 patients referred for ventricular tachycardia ablation, an RV endoca ...[more]

PMID: 23279311

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Project description:BackgroundElectroanatomic mapping systems are used to support electrophysiology research. Data exported from these systems is stored in proprietary formats which are challenging to access and storage-space inefficient. No previous work has made available an open-source platform for parsing and interrogating this data in a standardized format. We therefore sought to develop a standardized, open-source data structure and associated computer code to store electroanatomic mapping data in a space-efficient and easily accessible manner.MethodsA data structure was defined capturing the available anatomic and electrical data. OpenEP, implemented in MATLAB, was developed to parse and interrogate this data. Functions are provided for analysis of chamber geometry, activation mapping, conduction velocity mapping, voltage mapping, ablation sites, and electrograms as well as visualization and input/output functions. Performance benchmarking for data import and storage was performed. Data import and analysis validation was performed for chamber geometry, activation mapping, voltage mapping and ablation representation. Finally, systematic analysis of electrophysiology literature was performed to determine the suitability of OpenEP for contemporary electrophysiology research.ResultsThe average time to parse clinical datasets was 400 ± 162 s per patient. OpenEP data was two orders of magnitude smaller than compressed clinical data (OpenEP: 20.5 ± 8.7 Mb, vs clinical: 1.46 ± 0.77 Gb). OpenEP-derived geometry metrics were correlated with the same clinical metrics (Area: R 2 = 0.7726, P < 0.0001; Volume: R 2 = 0.5179, P < 0.0001). Investigating the cause of systematic bias in these correlations revealed OpenEP to outperform the clinical platform in recovering accurate values. Both activation and voltage mapping data created with OpenEP were correlated with clinical values (mean voltage R 2 = 0.8708, P < 0.001; local activation time R 2 = 0.8892, P < 0.0001). OpenEP provides the processing necessary for 87 of 92 qualitatively assessed analysis techniques (95%) and 119 of 136 quantitatively assessed analysis techniques (88%) in a contemporary cohort of mapping studies.ConclusionsWe present the OpenEP framework for evaluating electroanatomic mapping data. OpenEP provides the core functionality necessary to conduct electroanatomic mapping research. We demonstrate that OpenEP is both space-efficient and accurately representative of the original data. We show that OpenEP captures the majority of data required for contemporary electroanatomic mapping-based electrophysiology research and propose a roadmap for future development.

Dataset Information

Our approach to minimize risk of epicardial access: standard techniques with the addition of electroanatomic mapping guidance.

Publications

Our approach to minimize risk of epicardial access: standard techniques with the addition of electroanatomic mapping guidance.

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