[en] [en] OBJECTIVES: Directed graph-mapping (DGM) is a novel operator-independent automatic tool that can be applied to the identification of the atrial tachycardia (AT) mechanism. In the present study, for the first time, DGM was applied in complex AT cases, and diagnostic accuracy was evaluated.
BACKGROUND: Catheter ablation of ATs still represents a challenge, as the identification of the correct mechanism can be difficult. New algorithms for high-density activation mapping (HDAM) render an easier acquisition of more detailed maps; however, understanding of the mechanism and, thus, identification of the ablation targets, especially in complex cases, remains strongly operator-dependent.
METHODS: HDAMs acquired with the latest algorithm (COHERENT version 7, Biosense Webster, Irvine, California) were interpreted offline by 4 expert electrophysiologists, and the acquired electrode recordings with corresponding local activation times (LATs) were analyzed by DGM (also offline). Entrainment maneuvers (EM) were performed to understand the correct mechanism, which was then confirmed by successful ablation (13 cases were centrifugal, 10 cases were localized re-entry, 22 cases were macro-re-entry, and 6 were double-loops). In total, 51 ATs were retrospectively analyzed. We compared the diagnoses made by DGM were compared with those of the experts and with additional EM results.
RESULTS: In total, 51 ATs were retrospectively analyzed. Experts diagnosed the correct AT mechanism and location in 33 cases versus DGM in 38 cases. Diagnostic accuracy varied according to different AT mechanisms. The 13 centrifugal activation patterns were always correctly identified by both methods; 2 of 10 localized reentries were identified by the experts, whereas DGM diagnosed 7 of 10. For the macro-re-entries, 12 of 22 were correctly identified using HDAM versus 13 of 22 for DGM. Finally, 6 of 6 double-loops were correctly identified by the experts, versus 5 of 6 for DGM.
CONCLUSIONS: Even in complex cases, DGM provides an automatic, fast, and operator-independent tool to identify the AT mechanism and location and could be a valuable addition to current mapping technologies.
Van Nieuwenhuyse, Enid; Department of Physics and Astronomy, Ghent University, Ghent, Belgium. Electronic address: enid.vannieuwenhuyse@ugent.be
Strisciuglio, Teresa; Cardiology Department, AZ Sint-Jan, Bruges, Belgium, Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy
Lorenzo, Giuseppe; Biosense Webster Inc., Irvine, California, USA
El Haddad, Milad; Cardiology Department, AZ Sint-Jan, Bruges, Belgium
Goedgebeur, Jan; Department of Applied Mathematics, Computer Science and Statistics, Ghent University, Ghent, Belgium, Computer Science Department, University of Mons, Mons, Belgium
Van Cleemput, Nico; Department of Applied Mathematics, Computer Science and Statistics, Ghent University, Ghent, Belgium
LEY, Christophe ; University of Luxembourg > Faculty of Science, Technology and Medicine (FSTM) > Department of Mathematics (DMATH) ; Department of Applied Mathematics, Computer Science and Statistics, Ghent University, Ghent, Belgium
Panfilov, Alexander V; Department of Physics and Astronomy, Ghent University, Ghent, Belgium, Laboratory of Computational Biology and Medicine, Ural Federal University, Ekaterinburg, Russia, Arrhythmia Department, Almazov National Medical Research Centre, Saint Petersburg, Russia
de Pooter, Jan; Cardiology Department, AZ Sint-Jan, Bruges, Belgium, Ghent University Hospital Heart Center, Ghent University, Ghent, Belgium
Vandekerckhove, Yves; Cardiology Department, AZ Sint-Jan, Bruges, Belgium
Tavernier, Rene; Cardiology Department, AZ Sint-Jan, Bruges, Belgium
Duytschaever, Mattias; Cardiology Department, AZ Sint-Jan, Bruges, Belgium, Ghent University Hospital Heart Center, Ghent University, Ghent, Belgium
Knecht, Sebastien; Cardiology Department, AZ Sint-Jan, Bruges, Belgium
Vandersickel, Nele; Department of Physics and Astronomy, Ghent University, Ghent, Belgium
Dr. Lorenzo is an employee of Biosense Webster. Dr. Goedgebeur is funded with a research grant of the Research Foundation Flanders/Fonds voor Wetenschappelijk Onderzoek (FWO). Dr. Strisciuglio is supported by a research grant from the Cardiopath PhD program. Dr. el Haddad is a consultant for Biosense Webster. Dr. Duytschaever is a consultant for Biosense Webster. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
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