Directed Graph Mapping for Ventricular Tachycardia: A Comparison to Established Mapping Techniques

Joshua Hawson; Enid Van Nieuwenhuyse; Robin Van Den Abeele; Ahmed Al-Kaisey; Robert D Anderson; David Chieng; Louise Segan; Troy Watts; Timothy Campbell; Sander Hendrickx; Joseph Morton; Alexander McLellan; Peter Kistler; Adam Lee; Edward P Gerstenfeld; Henry H Hsia; Aleksander Voskoboinik; Bhupesh Pathik; Saurabh Kumar; Jonathan Kalman; Geoffrey Lee; Nele Vandersickel

doi:10.1016/j.jacep.2022.08.013

Directed Graph Mapping for Ventricular Tachycardia: A Comparison to Established Mapping Techniques

JACC Clin Electrophysiol. 2023 Jul;9(7 Pt 1):907-922. doi: 10.1016/j.jacep.2022.08.013. Epub 2022 Oct 26.

Authors

Joshua Hawson¹, Enid Van Nieuwenhuyse², Robin Van Den Abeele², Ahmed Al-Kaisey¹, Robert D Anderson¹, David Chieng³, Louise Segan³, Troy Watts⁴, Timothy Campbell⁵, Sander Hendrickx², Joseph Morton⁴, Alexander McLellan⁴, Peter Kistler³, Adam Lee⁶, Edward P Gerstenfeld⁶, Henry H Hsia⁶, Aleksander Voskoboinik⁷, Bhupesh Pathik⁴, Saurabh Kumar⁸, Jonathan Kalman¹, Geoffrey Lee⁹, Nele Vandersickel²

Affiliations

¹ Department of Cardiology, Royal Melbourne Hospital, Melbourne, Victoria, Australia; Faculty of Medicine, Dentistry and Health Science, University of Melbourne, Melbourne, Victoria, Australia.
² Department of Physics and Astronomy, Ghent University, Ghent, Belgium.
³ Faculty of Medicine, Dentistry and Health Science, University of Melbourne, Melbourne, Victoria, Australia; Department of Cardiology, The Alfred Hospital, Melbourne, Victoria, Australia.
⁴ Department of Cardiology, Royal Melbourne Hospital, Melbourne, Victoria, Australia.
⁵ Western Clinical School, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia.
⁶ Division of Cardiology, Department of Medicine, University of California San Francisco, San Francisco, California, USA.
⁷ Department of Cardiology, The Alfred Hospital, Melbourne, Victoria, Australia.
⁸ Western Clinical School, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia; Department of Cardiology, Westmead Hospital and Westmead Applied Research Centre, Westmead, New South Wales, Australia.
⁹ Department of Cardiology, Royal Melbourne Hospital, Melbourne, Victoria, Australia; Faculty of Medicine, Dentistry and Health Science, University of Melbourne, Melbourne, Victoria, Australia. Electronic address: Geoff.Lee@mh.org.au.

PMID: 36752465
DOI: 10.1016/j.jacep.2022.08.013

Abstract

Background: Understanding underlying mechanism(s) and identifying critical circuit components are fundamental to successful ventricular tachycardia (VT) ablation. Directed graph mapping (DGM) offers a novel technique to identify the mechanism and critical components of a VT circuit.

Objectives: This study sought to evaluate the accuracy of DGM in VT ablation compared with traditional mapping techniques and a commercially available automated conduction velocity mapping (ACVM) tool.

Methods: Patients with structural heart disease who had undergone a VT ablation with entrainment-proven critical isthmus and a high-density electroanatomical activation map were included. Traditional mapping (TM) consisted of a combination of local activation time and entrainment mapping and was considered the gold standard for determining the VT mechanism, circuit, and isthmus location. The same local activation time values were then processed using DGM and a commercially available ACVM (Coherent Mapping, Biosense Webster) tool. The aim of this study was to compare TM vs DGM and ACVM in their ability to identify the VT mechanism, characterize the VT circuit, and locate the critical isthmus.

Results: Thirty-five cases were identified. TM classified the VT mechanism as focal in 7 patients and re-entrant in 28 patients. TM classified 11 VTs as single-loop re-entry, 15 as dual-loop re-entry, 1 as complex, and 1 case was indeterminant. The overall agreement between DGM and TM for determining VT mechanism and circuit type was strong (kappa value = 0.79; P < 0.01), as was the agreement between ACVM and TM (kappa value = 0.66; P < 0.01). Both DGM and ACVM identified the putative VT isthmus in 25 (89%) of the re-entrant cases. Focal activation was correctly identified by both techniques in all cases.

Conclusions: DGM is a rapid automated algorithm that has a strong level of agreement with TM for manually re-annotated VT maps.

Keywords: Coherent Mapping; directed graph mapping; ventricular arrhythmias; ventricular tachycardia.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Catheter Ablation*
Heart Diseases* / surgery
Humans
Tachycardia, Ventricular* / diagnosis
Tachycardia, Ventricular* / surgery