Reconstruction of the Left Atrium for Atrial Fibrillation Ablation using the Machine Learning CARTO 3 m-FAM Software

IIntroduction: Atrial fibrillation (AF) ablation requires a precise reconstruction of the left atrium (LA) and pulmonary veins (PV). Model-based FAM (m-FAM) is a novel module recently developed for the CARTO system which applies machine-learning techniques to LA reconstruction. We aimed to evaluate the feasibility and safety of a m-FAM guided AF ablation as well as the accuracy of LA reconstruction using the cardiac computed tomography angiography (CTA) of the same patient LA as gold standard, in 32 patients referred for AF ablation. Methods: Consecutive patients undergoing AF ablation. The m-FAM reconstruction was performed with the ablation catheter (Group 1) or a Pentaray catheter (Group 2). The reconstruction accuracy was confirmed prior to the ablation by verification of pre-specified landmarks of the LA and PVs by intracardiac echocardiogram (ICE) visualization and fluoroscopy. A cardiac CTA performed before the ablation was used as gold standard of LA anatomy. For each patient, the m-FAM reconstruction was compared to his/her cardiac CTA. Results: The m-FAM reconstruction was accurate in all patients regardless the catheter used for mapping. In 12% re acquisition of the LA landmarks was necessary to improve the accuracy. m-FAM time was shorter in group 2 while the M-Fam fluoroscopy time was similar. Pulmonary vein isolation was achieved in 100% of patients without major complications. The m-FAM reconstructions accurately resemble the cardiac CTA of the same patients. Conclusions: The m-FAM module allows for rapid and precise reconstruction of the LA and PV anatomy, which can be safely used to guide AF ablation.