Functional electrographic flow patterns in patients with persistent atrial fibrillation predict outcome of catheter ablation

Szili-Török, Tamás; Kis, Zsolt; Bhagwandien, Rohit; Wijchers, Sip; Yap, Sing‐Chien; Hoogendijk, Mark G.; Dumas, Nadege; Haeusser, Philip; Géczy, Tamás; Конг, Ма; Ruppersberg, Peter

doi:10.1111/jce.15115

Cited by 13 publications

(17 citation statements)

References 52 publications

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“…6,13 Besides CFAEs, the use of dominant frequency analysis, phase transformation, AI-guided pattern classification, or low voltage regions have been used to highlight so-called "driver" or "substrate" regions during AF. 5,7,9,[18][19][20][21][22] By contrast VX1's analysis is not bound to the preconceived importance of a single electrogram analysis parameter but is supported by the multiparametric mimicking of human expertise and adjudications are disconnected from any of the operator's mechanistic hunch.…”

Section: Automated Approaches For Real-time Af Electrograms Analysismentioning

confidence: 99%

Artificial intelligence software standardizes electrogram‐based ablation outcome for persistent atrial fibrillation

Seitz

Durdez²,

Albenque

et al. 2022

Cardiovasc electrophysiol

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Introduction Multiple groups have reported on the usefulness of ablating in atrial regions exhibiting abnormal electrograms during atrial fibrillation (AF). Still, previous studies have suggested that ablation outcomes are highly operator‐ and center‐dependent. This study sought to evaluate a novel machine learning software algorithm named VX1 (Volta Medical), trained to adjudicate multipolar electrogram dispersion. Methods This study was a prospective, multicentric, nonrandomized study conducted to assess the feasibility of generating VX1 dispersion maps. In 85 patients, 8 centers, and 17 operators, we compared the acute and long‐term outcomes after ablation in regions exhibiting dispersion between primary and satellite centers. We also compared outcomes to a control group in which dispersion‐guided ablation was performed visually by trained operators. Results The study population included 29% of long‐standing persistent AF. AF termination occurred in 92% and 83% of the patients in primary and satellite centers, respectively, p = 0.31. The average rate of freedom from documented AF, with or without antiarrhythmic drugs (AADs), was 86% after a single procedure, and 89% after an average of 1.3 procedures per patient (p = 0.4). The rate of freedom from any documented atrial arrhythmia, with or without AADs, was 54% and 73% after a single or an average of 1.3 procedures per patient, respectively (p < 0.001). No statistically significant differences between outcomes of the primary versus satellite centers were observed for one (p = 0.8) or multiple procedures (p = 0.4), or between outcomes of the entire study population versus the control group (p > 0.2). Interestingly, intraprocedural AF termination and type of recurrent arrhythmia (i.e., AF vs. AT) appear to be predictors of the subsequent clinical course. Conclusion VX1, an expertise‐based artificial intelligence software solution, allowed for robust center‐to‐center standardization of acute and long‐term ablation outcomes after electrogram‐based ablation.

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Section: Automated Approaches For Real-time Af Electrograms Analysismentioning

confidence: 99%

Artificial intelligence software standardizes electrogram‐based ablation outcome for persistent atrial fibrillation

Seitz

Durdez²,

Albenque

et al. 2022

Cardiovasc electrophysiol

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“…The inter-procedural reproducibility and spatiotemporal stability of EGF maps and EGF-identified sources suggest that signal acquisition using a basket catheter is sufficient for the localization of AF sources ( 25 ). Its ability to classify AF as being source-dependent (S-type EGF signature) versus source-independent (C-type EGF signature) may be clinically useful for patient stratification and ablation strategy planning ( 7 ). Using this technology, non-PV sources (S-type signatures) can be detected and targeted with ablation to improve clinical outcomes.…”

Section: Discussionmentioning

confidence: 99%

“…Patients with no stable active source pattern and no leading source with a source activity above threshold were characterized having a C-Type EGF signature consistent with source-independent AF. The classification of patient EGF signatures into S-Type and C-Type has been previously published ( 7 ). EGF source parameters were compared between subgroups of de novo and redo-PVI patients.…”

Section: Methodsmentioning

confidence: 99%

Left atrial anatomical variations correlate with atrial fibrillation sources near the left atrial ridge

Gagyi

Szegedi

Simon

et al. 2022

Front. Cardiovasc. Med.

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IntroductionAnatomical variations and characteristics of the left atrium (LA) may have a previously undescribed effect on source locations in atrial fibrillation (AF). This is the first study aiming to investigate the relationship between anatomical characteristics of the LA and non-PV sources detected by electrographic flow (EGF) mapping in patients with persistent AF.Materials and methodsWe analyzed cardiac computed tomography (CT) and EGF mapping data in patients who underwent radiofrequency catheter ablation (CA). EGF mapping is a novel method based on Horn–Schunk flow estimation algorithm, used to estimate cardiac action potential flow in the atria that can detect AF sources in patients with persistent AF. By analyzing EGF maps obtained during CA procedures, we localized non-PV sources in the LA.ResultsThirty patients were included in this study (mean age 62.4 ± 6.8 years). Ten patients had AF sources near the LA ridge, while twenty patients had no leading source (source activity > 26%) near the LA ridge. LA anatomical characteristics, left atrial appendage (LAA) length, and ostial diameter showed no correlation with the presence of a leading source. We documented 19 patients with abutting LAA and left superior pulmonary vein (LSPV) (distance < 2 mm), and 11 patients with non-abutting LAA–LSPV (distance > 2 mm). Three out of 19 patients presented with a leading source near ridge in the abutting LAA–LSPV group, while 7 out of 11 patients presented with a leading source near the ridge in the non-abutting LAA-LSPV group (p = 0.01).ConclusionOur data suggests that non-abutting LAA-LSPV is associated with the presence of AF sources near the LA ridge.

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“…Patients with no stable active source pattern and no source with activity above threshold were characterized having source‐independent AF (C‐Type EGF signature). The stratification of patients with S‐Type and C‐Type EGF signatures has been previously published 5 . Here, we perform a subgroup analysis comparing long‐term outcomes data of patients with S‐Type EGF signatures versus patients with C‐Type EGF signatures.…”

Section: Methodsmentioning

confidence: 99%

Electrographic flow mapping guided catheter ablation offers advantages for patients with persistent atrial fibrillation

Gagyi

Bhagwandien

Yap

et al. 2023

Pacing Clinical Electrophis

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Background: Catheter ablation (CA) remains challenging due to suboptimal success rates in persistent atrial fibrillation (AF). Existing mapping technologies cannot reliably distinguish sources in this patient population. Recently, the novel electrographic flow (EGF) mapping system was developed using a modified Horn-Schunk optical flow algorithm to detect and quantify patterns of electrical wavefront propagation in the atria.Objectives: To test the hypothesis that targeted source ablation based on EGF mapping is superior to empiric AF ablation. Methods:We included all consecutive patients undergoing EGF guided ablation for persistent AF. All patients underwent pulmonary vein isolation (PVI) and were treated with the same EAM system (CARTO). The outcome of PVI+EGF guided CA was compared with data of PVI-only procedures (PVI-only group) and PVI plus additional empiric adjunctive linear and substrate ablations (PVI+LINES group). 12-months outcome as freedom from AF and atrial tachycardia/flutter (AT/AFL), procedural safety and efficiency characterized by procedure duration, fluoroscopy use, radiofrequency applications and duration, were analyzed. Both intention-to-treat and per protocol analysis were conducted.Results: A total number of 70 patients (39 in PVI+EGF, 16 in PVI-only and 15 patients in PVI+LINES group) were enrolled. Intention-to-treat analysis showed fewer AF recurrences in PVI+EGF as compared with the PVI-only or PVI+LINES groups at 12 months (25.6% vs. 62.5% vs. 53.3%, p = .02). There were no differences in AT/AFL recurrence (17.9% vs. 37.5% vs. 20.0%, p = .37). Procedure times were longer in PVI+EGF group (p < .01), and there were no differences in fluoroscopy use (p = .67). Conclusion:Our data suggest that patients treated with EGF-guided CA developed fewer AF recurrences. Although the procedure times are longer, it seems to be safe and offers a more targeted, patient-specific ablation strategy beyond PVI than adjunctive empiric lines and substrate ablation in this complex group of patients.

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Functional electrographic flow patterns in patients with persistent atrial fibrillation predict outcome of catheter ablation

Cited by 13 publications

References 52 publications

Artificial intelligence software standardizes electrogram‐based ablation outcome for persistent atrial fibrillation

Artificial intelligence software standardizes electrogram‐based ablation outcome for persistent atrial fibrillation

Left atrial anatomical variations correlate with atrial fibrillation sources near the left atrial ridge

Electrographic flow mapping guided catheter ablation offers advantages for patients with persistent atrial fibrillation

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