Abstract
Background
High-density automated mapping of complex atrial tachycardias (ATs) requires accurate assessment of activation maps. A new local activation display module (HD coloring, Biosense Webster®) provides higher map resolution, a better delineation of potential block reducing color interpolation, and a new propagation display. We evaluated the accuracy of a dedicated local activation display compared with standard algorithm.
Methods
High-density maps from 10 AT were collected with a multipolar catheter and were displayed with standard activation or HD coloring. Six expert operators retrospectively analyzed activation maps and were asked to define (1) the tachycardia mechanism, (2) ablation target, and (3) level of difficulty to interpret those maps.
Results
Using HD coloring, operators were able to reach a correct diagnosis in 93% vs. 63%, p < 0.05 compared to standard activation maps. Time to diagnosis was shorter 1.9 ± 1.0 min vs. 3.9 ± 2.1 min, p < 0.05. Confidence level would have allowed ablation without necessity for entrainment maneuvers in 87% vs. 53%, p < 0.05. Operators would have needed to remap or proceed with multiple entrainments in 3% vs. 13% of cases, p < 0.05. Finally, ablation strategy was more accurately identified in 97% vs. 67%, p < 0.05.
Conclusion
Activation mapping with the new HD coloring module allowed a more accurate, reliable, and faster interpretation of complex ATs mechanisms compared to standard activation maps.
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Data availability
Dataset is available on request.
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Acknowledgements
The authors would like to thank Miss Susana Marcelino for her technical support.
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Vincent Roger is an employee of Biosense Webster, Inc. The remaining authors declare that they have no conflict of interest.
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Video 1
3D activation map of a left atrium without the stdLAT module (left panel), and with the HDc module feature (right panel). The stdLAT activation displays an anterior focal pseudo-reentry. HDc module identifies two area of conduction block and delineates an anterior practical isthmus (AVI 17852 kb)
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Massoullié, G., Moubarak, G., Thomas, O. et al. Initial multicenter experience with a new high-density coloring module: impact for complex atrial arrhythmias interpretation. J Interv Card Electrophysiol 60, 313–319 (2021). https://doi.org/10.1007/s10840-020-00802-1
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DOI: https://doi.org/10.1007/s10840-020-00802-1