Ghent University Hospital, Heart Center, Ghent, Belgium.
Department of Cardiology, Sint-Jan Hospital, Bruges, Belgium.
J Cardiovasc Electrophysiol. 2018 Jan;29(1):177-185. doi: 10.1111/jce.13371. Epub 2017 Nov 10.
High-density automated mapping of regular atrial tachycardias (ATs) requires accurate assessment of local activation times (LATs).
To evaluate high-density mapping of ATs and compare the accuracy of different automated LAT annotation algorithms.
Fifteen patients underwent AT ablation guided by the automated ConfiDENSEۛ high-density mapping module (Carto 3 v4) allowing manual reannotation (edited maps). For each AT, unedited automated maps were reconstructed offline by three algorithms: maximum unipolar slope (LAT ), bipolar peak (LAT ), and a new hybrid annotation algorithm (LAT ). Five blinded experts were asked to define the (1) tachycardia mechanism, (2) ablation target, and (3) level of difficulty of these unedited maps.
Twenty-one ATs (cycle length 300 ± 46 ms, activation points 955 ± 421) were successfully ablated using LAT guided ablation with manual editing in a small number of points. At 6 months, 14 (93%) of the patients were free of AT recurrences. Unedited LAT maps showed the highest accuracy in defining the tachycardia mechanism (LAT : 49% vs. LAT : 27% vs. LAT : 28%, P < 0.001) and ablation target (LAT : 65% vs. LAT : 39% vs. LAT : 31%, P < 0.001). Overall, LAT -annotated maps were graded as "easier to interpret" by the experts (difficulty score 2.3 ± 0.9) versus LAT (2.8 ± 1) and LAT (3.2 ± 0.8) (P < 0.001). Only 12% of the LAT maps were annotated as uninterpretable compared to 31% of LAT and 45% of the LAT maps (P < 0.001).
Automated LAT annotation allows better and easier recognition of the tachycardia mechanism compared to automated LAT and LAT algorithms, although fully automated mapping still requires further improvements.
高密度自动标测规整性房性心动过速（ATs）需要精确评估局部激动时间（LATs）。
评估 ATs 的高密度标测并比较不同自动 LAT 标注算法的准确性。
15 名患者接受了自动化 ConfiDENSEۛ高密度标测模块（Carto 3 v4）引导的 AT 消融，该模块允许手动重新标注（编辑图）。对于每个 AT，离线重建了三种算法的未编辑自动图：最大单极斜率（LAT ）、双极峰值（LAT ）和新的混合标注算法（LAT ）。五名盲法专家被要求定义这些未编辑地图的（1）心动过速机制、（2）消融靶点和（3）难度级别。
使用 LAT 引导消融并在少数点进行手动编辑，成功消融了 21 种 AT（周长 300±46 ms，激活点 955±421）。6 个月时，14 名（93%）患者无 AT 复发。未编辑的 LAT 图在定义心动过速机制（LAT ：49% 比 LAT ：27% 比 LAT ：28%，P<0.001）和消融靶点（LAT ：65% 比 LAT ：39% 比 LAT ：31%，P<0.001）方面具有最高的准确性。总体而言，专家认为 LAT 标注的地图更容易解读（难度评分 2.3±0.9），而 LAT （2.8±1）和 LAT （3.2±0.8）则较难（P<0.001）。与 LAT （31%）和 LAT （45%）相比，只有 12%的 LAT 地图被标注为不可解读，而 LAT 地图则有 31%和 45%被标注为不可解读（P<0.001）。
与 LAT 和 LAT 算法相比，自动 LAT 标注能更好、更容易地识别心动过速机制，尽管全自动标测仍需要进一步改进。
