Why the study?
Data directly comparing the automated NavX Ensite Precision latency-map algorithm with conventional mapping to identify atrial tachycardia mechanisms were scarce.
Does mapping with the automated NavX Ensite Precision latency-map algorithm improve intraprocedural AT termination compared to conventional mapping in patients scheduled for AT ablation?
Does mapping with the automated NavX Ensite Precision latency-map algorithm improve intraprocedural AT termination compared to conventional mapping in patients scheduled for AT ablation?
Automated 3D activation mapping alone is less accurate than conventional mapping for identifying atrial tachycardia mechanisms, though overall procedural termination rates are similar when conventional methods are used as backup.
Answers are grounded in this paper and cite their sources.
LM algorithm alone misidentifies most AT mechanisms; cautions against standalone use and challenges automated mapping superiority in AT ablation.
Background: The automated NavX Ensite Precision latency-map (LM) algorithm aims to identify atrial tachycardia (AT) mechanisms. However, data on a direct comparison of this algorithm with conventional mapping are scarce. Methods: Patients scheduled for AT ablation were randomized to mapping with the LM- algorithm (LM group) or to conventional mapping (conventional only group: ConvO), using entrainment and local activation mapping techniques. Several outcomes were exploratively analyzed. Primary endpoint was intraprocedural AT Termination. If AT termination with only automated 3D-Mapping failed, additional conventional methods were applied (conversion). Results: A total of 63 patients (mean 67 years, 34 % female) were enrolled. In the LM group (n = 31), the correct AT mechanism was identified in 14 patients (45 %) using the algorithm alone compared to 30 patients (94 %) with conventional methods. Time to termination of the first AT was not different between groups (LM group 34 ± 20 vs. ConvO 43.1 ± 28.3 min; p = 0.2). However, when AT termination did not occur with LM algorithm, time to termination prolonged significantly (65 ± 35 min; p = 0.01). After applying conventional methods (conversion), procedural termination rates did not differ between LM group (90 %) vs. ConvO (94 %) (p = 0.3). During a follow-up time of 20 ± 9 months, no differences were observed in clinical outcomes. Conclusion: In this small prospective, randomized study, the use of the LM algorithm alone may lead to AT termination, but less accurate than conventional methods.
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Spittler et al. (2023) studied this question.
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