Automatic detection of slow conducting channels during substrate ablation of scar-related ventricular arrhythmias

Alcaine, Alejandro ; Jáuregui, Beatriz ; Soto-Iglesias, David ; Acosta, Juan ; Penela, Diego ; Fernández-Armenta, Juan ; Linhart, Markus ; Andreu, David ; Mont, Lluis ; Laguna, Pablo (Universidad de Zaragoza) ; Cámara, Óscar ; Martínez, Juan Pablo (Universidad de Zaragoza) ; Berruezo, Antonio

Resumen: Background. Voltage mapping allows identifying the arrhythmogenic substrate during scar-related ventricular arrhythmia (VA) ablation procedures. Slow conducting channels (SCCs), defined by the presence of electrogram (EGM) signals with delayed components (EGM-DC), are responsible for sustaining VAs and constitute potential ablation targets. However, voltage mapping, as it is currently performed, is time-consuming, requiring a manual analysis of all EGMs to detect SCCs, and its accuracy is limited by electric far-field. We sought to evaluate an algorithm that automatically identifies EGM-DC, classifies mapping points, and creates new voltage maps, named "Slow Conducting Channel Maps" (SCC-Maps). Methods. Retrospective analysis of electroanatomic maps (EAM) from 20 patients (10 ischemic, 10 with arrhythmogenic right ventricular dysplasia/cardiomyopathy) was performed. EAM voltage maps were acquired during sinus rhythm and used for ablation. Preprocedural contrast-enhanced cardiac magnetic resonance (Ce-CMR) imaging was available for the ischemic population. Three mapping modalities were analysed: (i) EAM voltage maps using standard (EAM standard) or manual (EAM screening) thresholds for defining core and border zones; (ii) SCC-Maps derived from the use of the novel SCC-Mapping algorithm that automatically identify EGM-DCs measuring the voltage of the local component; and (iii) Ce-CMR maps (when available). The ability of each mapping modality in identifying SCCs and their agreement was evaluated. Results. SCC-Maps and EAM screening identified a greater number of SCC entrances than EAM standard (3.45 ± 1.61 and 2.95 ± 2.31, resp., vs. 1.05 ± 1.10; p<0.01). SCC-Maps and EAM screening highly correlate with Ce-CMR maps in the ischemic population when compared to EAM standard (Lin''s correlation = 0.628 and 0.679, resp., vs. 0.212, p<0.01). Conclusion. The SCC-Mapping algorithm allows an operator-independent analysis of EGM signals showing better identification of the arrhythmogenic substrate characteristics when compared to standard voltage EAM.

Idioma: Inglés

DOI: 10.1155/2020/4386841

Año: 2020

Publicado en: Journal of Interventional Cardiology 2020 (2020), 4386841 [13 pp.]
ISSN: 0896-4327

Originalmente disponible en: Texto completo de la revista

Factor impacto JCR: 2.279 (2020)

Categ. JCR: CARDIAC & CARDIOVASCULAR SYSTEMS rank: 94 / 141 = 0.667 (2020) - Q3 - T3

Factor impacto SCIMAGO: 0.764 - Radiology, Nuclear Medicine and Imaging (Q2) - Cardiology and Cardiovascular Medicine (Q2)

Financiación: info:eu-repo/grantAgreement/ES/DGA-FSE/T39-20R-BSICoS group
Financiación: info:eu-repo/grantAgreement/ES/ISCIII-FEDER/PI14-00759

Tipo y forma: Artículo (Versión definitiva)

Área (Departamento): Área Teoría Señal y Comunicac. (Dpto. Ingeniería Electrón.Com.)