Key result
A novel mapping algorithm integrating vector data identified the actual mechanism of scar-related atrial tachycardias more frequently than the standard algorithm (67.2% vs. 44.8%, p=0.009).
Why the study?
Activation maps of scar-related AT can be challenging to interpret due to inaccurate electrogram annotation and an arbitrarily predefined mapping window, prompting evaluation of a novel mapping algorithm.
Does a novel mapping algorithm integrating vector data improve the identification of the mechanism of scar-related atrial tachycardias compared to standard algorithms?
Observational (n=77)
Does a novel mapping algorithm integrating vector data improve the identification of the mechanism of scar-related atrial tachycardias compared to standard algorithms?
A novel mapping algorithm integrating vector data significantly improves the identification of arrhythmia mechanisms in scar-related atrial tachycardias compared to standard mapping.
May aid mechanism identification in scar-related atrial tachycardias; hypothesis-generating and should not yet change practice.
BACKGROUND: Activation maps of scar-related atrial tachycardias (AT) can be challenging to interpret due to difficulty in inaccurate annotation of electrograms, and an arbitrarily predefined mapping window. A novel mapping software integrating vector data and applying an algorithmic solution taking into consideration global activation pattern has been recently described (Coherent™, Biosense Webster "Investigational"). OBJECTIVE: We aimed to assess the investigational algorithm to determine the mechanism of AT compared with the standard algorithm. METHODS: This study included patients who underwent ablation of scar-related AT using the Carto 3 and the standard activation algorithm. The mapping data were analyzed retrospectively using the investigational algorithm, and the mechanisms were evaluated by two independent electrophysiologists. RESULTS: A total of 77 scar-related AT activation maps were analyzed (89.6% left atrium, median tachycardia cycle length of 273 ms). Of those, 67 cases with a confirmed mechanism of arrhythmia were used to compare the activation software. The actual mechanism of the arrhythmia was more likely to be identified with the investigational algorithm (67.2% vs. 44.8%, p = .009). In five patients with dual-loop circuits, 3/5 (60%) were correctly identified by the investigational algorithm compared to 0/5 (0%) with the standard software. The reduced atrial voltage was prone to lead to less capable identification of mechanism (p for trend: .05). The investigational algorithm showed higher inter-reviewer agreement (Cohen's kappa .62 vs. .47). CONCLUSIONS: In patients with scar-related ATs, activation mapping algorithms integrating vector data and "best-fit" propagation solution may help in identifying the mechanism and the successful site of termination.
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Kuroda et al. (2021) conducted an observational in Scar-related atrial tachycardias (n=77). Investigational mapping algorithm (Coherent) vs. Standard activation algorithm was evaluated on Identification of the actual mechanism of the arrhythmia (p=0.009). A novel mapping algorithm integrating vector data identified the actual mechanism of scar-related atrial tachycardias more frequently than the standard algorithm (67.2% vs. 44.8%, p=0.009).
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