Key result
A novel two-step algorithm correctly identified isolated versus nonisolated pulmonary vein electrograms with 93% sensitivity and 86% specificity in RF ablation, and 96% and 90% in CB ablation.
Why the study?
Does a novel two-step algorithm accurately verify pulmonary vein isolation in RF- and CB-guided ablation?
Observational (n=620)
Does a novel two-step algorithm accurately verify pulmonary vein isolation in RF- and CB-guided ablation?
A novel automated algorithm can accurately verify pulmonary vein isolation during RF and cryoballoon ablation without the need for pacing maneuvers.
May streamline pulmonary vein isolation verification without pacing maneuvers; leaves open whether this automated approach improves long-term.
BACKGROUND: Verification of pulmonary vein isolation (PVI) can be challenging due to the coexistence of pulmonary vein potentials and far-field potentials. This study aimed to prospectively validate a novel algorithm for automated verification of PVI in radiofrequency (RF)-guided and cryoballoon (CB)-guided ablation strategies. METHODS: A data set of 620 (RF: 516 EGMs and CB: 104 EGMs) bipolar electrograms (EGM), recorded by circular mapping catheter placed at the left atrium-pulmonary vein (PV) junction, were prospectively analyzed by a two-step algorithm. The algorithm differentiates isolated from nonisolated EGMs based on typology and specific parameters of the bipolar EGMs. EGMs were recorded at baseline and after proven isolation in RF- and CB-guided procedures. Additionally, in the RF group, EGMs during encircling of the PVs were analyzed. RESULTS: In the RF and CB group, the algorithm correctly identifies EGMs as isolated or nonisolated with respectively 93% and 96% sensitivity and 86% and 90% specificity. In the RF subgroups of (1) baseline and proven isolated EGMs, (2) EGMs during encircling, and (3) EGMs in redo procedures sensitivity was 96%, 88%, and 100%, respectively, with specificity of 81%, 91%, and 100%. Fourteen out of 14 (100%) reconnected PVs were correctly identified as containing PVPs. Eleven out of 12 (92%) failed freeze attempts were correctly identified as being nonisolated. CONCLUSION: We validated a two-step algorithm for automated PVI verification, applicable both for RF- and CB-guided PVI. The algorithm automatically differentiates isolated from nonisolated PVs with high accuracy and without the need for pacing maneuvers.
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Pooter et al. (2017) conducted an observational in Pulmonary vein isolation (n=620). Automated two-step algorithm for PVI verification vs. Proven isolation (manual verification) was evaluated on Correct identification of isolated vs nonisolated EGMs (93% sensitivity and 86% specificity (RF); 96% sensitivity and 90% specificity (CB)). A novel two-step algorithm correctly identified isolated versus nonisolated pulmonary vein electrograms with 93% sensitivity and 86% specificity in RF ablation, and 96% and 90% in CB ablation.
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