Automated verification of pulmonary vein isolation in radiofrequency- and cryoballoon-guided ablation

作者：De Pooter Jan^*; Phlips Thomas; El Haddad Milad; Van Heuverswyn Frederic; Timmers Lie**eth; Tavernier Rene; Knecht Sebastien; Vandekerckhove Yves; Duytschaever Mattias

来源：Pacing and Clinical Electrophysiology, 2017, 40(7): 779-787.

DOI：10.1111/pace.13121

• ablation
• algorithm
• atrial fibrillation
• bipolar electrograms
• cryoballoon
• pulmonary vein isolation
• radiofrequency

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.

• 出版日期2017-7