A method to identify which patients will have VT substrate ablation targets prior to ablation procedure
Notice bibliographique
Résumé
Abstract Funding Acknowledgements Type of funding sources: Foundation. Main funding source(s): Dr Nanthakumar is a recipient of the Mid-career Investigator Award from the Heart & Stroke Foundation of Ontario Background Recent trials in ventricular tachycardia (VT) ablation suggest that early ablation could reduce VT burden. A method to predict which patients will have substrate ablation targets based on non-invasive testing prior to the procedure does not exist and could be of value in selecting ideal patients for early VT substrate ablation. Decrement-evoked potential (DeEP) mapping is used to identify VT substrate ablation targets.1 A method for predicting which patients would have DeEP targets on a pre-ablation 12-lead ECG has not yet been developed. Objective To develop a metric to predict the presence of physiological substrate VT ablation targets from the 12-lead ECG. Method 22 electrophysiology (EP) lab VT cases that had undergone DeEP mapping were extracted from the CARTO® 3 system and were analysed retrospectively. For each case, DeEP was calculated by subtracting last component of the nearfield evoked response in the pacing train (S1) from the latest component of the nearfield evoked decremented response of the extra stimulus (S2). By inference, 12-lead ECG prediction was calculated by subtracting the width of the 12-lead surface ECG envelope of S1 from the width of the 12-lead ECG envelope of S2. Cases were divided into three categories: - Cases displaying intracardiac DeEP between 0-10ms – no ablation targets - Cases displaying intracardiac DeEP between 10-50ms – DeEP positive - Cases displaying intracardiac DeEP >50ms – prominent DeEP present Results Out of the 22 cases, 8 were characterised as no ablation targets, 12 as DeEP positive, and 2 as prominent DeEP present. The 12-lead surface ECG measurement means were 3.5±4.6ms for the no ablation target group, 23.2±9.1ms for positive DeEP group, and 80.9±8.1ms for prominent DeEP group. The surface ECG decrement was significantly different P<0.0001 between the three groups. Consequently, we propose that ECG QRS widening of envelope width of 20ms or more may indicate the presence of DeEP targets during invasive mapping. Conclusion It may be possible to detect which patients will have substrate ablation targets based on 12-lead ECG, prior to the VT ablation procedure. Additionally, this prediction rule, based on its association with arrhythmogenic potentials, may be able to predict which ambulatory patients who have not had manifest VT, may be prone to develop VT thus help identify early VT ablation candidates. This concept should be validated in larger data sets and is ideal for training and testing using surface ECG envelopes with artificial intelligence algorithms.
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Comment cette classification a été obtenuedéplier
Prédiction distillée sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Apprise à partir de 10 348 étiquettes directes de Codex et de 10 348 étiquettes directes de Gemma. Le mode candidate est l'union des têtes enseignantes seuillées; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont ni des étiquettes humaines ni des étiquettes directes de modèles de pointe.
Scores Codex et Gemma par catégorie
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,000 | 0,000 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,000 | 0,000 |
| Bibliométrie | 0,000 | 0,001 |
| Études des sciences et des technologies | 0,000 | 0,000 |
| Communication savante | 0,000 | 0,000 |
| Science ouverte | 0,000 | 0,000 |
| Intégrité de la recherche | 0,000 | 0,000 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,000 | 0,001 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule tête enseignante, pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».