Use this URL to cite or link to this record in EThOS: | https://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.703122 |
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Title: | Mapping the site of origin of ventricular arrhythmias : the development and testing of a novel pacemapping algorithm | ||||
Author: | Li, Anthony |
ISNI:
0000 0004 6060 3903
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Awarding Body: | St George's, University of London | ||||
Current Institution: | St George's, University of London | ||||
Date of Award: | 2016 | ||||
Availability of Full Text: |
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Abstract: | |||||
Background: Catheter ablation is a successful tool for the treatment of ventricular
arrhythmias (VA) but procedures are long and complex. Pacemapping is used to
locate the site of origin (SO) of VA but there is currently no guide as to where the
catheter should be placed in order to locate the SO.
Aims:
1. To identify variables related to intracardiac catheter location that may alter
the paced QRS morphology.
2. To investigate the relationship between change in surface ECG morphology
and distance within the ventricles.
3. To test a novel software algorithm that uses the above relationship m
individual patients to prospectively locate the SO of VA.
Methods: Patients undergoing ablation of VAs were enrolled. Data from
pacemapping within tissue with preserved myocardial voltage was collected and
measurements made on QRS morphology and intracardiac electro grams. Data on
catheter position and chamber geometry were extracted from a 3D mapping system
into custom software to construct linear regression models of distance against
morphology difference. A novel software algorithm to automatically locate the SO of
VAs was prospectively tested.
Results: 935 pacemaps were collected in 68 patients over 74 procedures. QRS width
was associated with pacing within dense scar tissue. 6219 pacemap pairs were used
in distance-similarity regression models. Distance was significantly and positively
associated with change in ECG morphology between patients and across ventricles
despite the presence of structural heart disease. The software algorithm was tested on 46 clinical VAs in 35 separate procedures and correctly identified the exit site of 45/46 VAs.
Conclusions: There is a robust relationship between distance and difference in
surface EeG morphology when pacemapping in myocardium with preserved voltage.
This relationship can be constructed in individual patients using a software algorithm and used to identify the SO of VAs in an automated manner.
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Supervisor: | Not available | Sponsor: | Not available | ||
Qualification Name: | Thesis (Ph.D.) | Qualification Level: | Doctoral | ||
EThOS ID: | uk.bl.ethos.703122 | DOI: | Not available | ||
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