Novel algorithm for accelerated electroanatomic mapping and prediction of earliest activation of focal cardiac arrhythmias using mathematical optimization.

Background: Premature beats (PBs) are a common finding in patients suffering from structural heart disease, but they can also be present in healthy individuals. Catheter ablation represents a suitable therapeutic approach. However, the exact localization of the origin can be challenging, especially...

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Published in:Heart Rhythm Vol. 14; no. 6; pp. 875 - 883
Main Authors: Weber, Tobias, Katus, Hugo A., Sager, Sebastian, Scholz, Eberhard P.
Format: research Journal Article
Published: Elsevier B.V. Jun2017
Online Access:View this record in EBSCOhost
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      dt: Jun2017
      vid: 14
      iid: 6
      pid: 467
      pub: Elsevier B.V.
      place: New York, New York
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        123132272
        123132272
        NLM28279745
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        10.1016/j.hrthm.2017.03.001
        NLM28279745
        123132272
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        atl: Novel algorithm for accelerated electroanatomic mapping and prediction of earliest activation of focal cardiac arrhythmias using mathematical optimization.
      aug:
        au:
          Weber, Tobias
          Katus, Hugo A.
          Sager, Sebastian
          Scholz, Eberhard P.
        affil: Faculty of Mathematics, University of Magdeburg, Magdeburg, Germany
      sug:
        subj:
          Body Surface Potential Mapping Methods
          Algorithms
          Imaging, Three-Dimensional Methods
          Models, Theoretical
          Arrhythmia Diagnosis
          Heart Conduction System Physiopathology
          Heart Conduction System Surgery
          Male
          Catheter Ablation
          Female
          Prospective Studies
          Middle Age
          Arrhythmia Surgery
          Retrospective Design
          Arrhythmia Physiopathology
          Human
          Middle Aged: 45-64 years
          Male
          Female
      ab: Background: Premature beats (PBs) are a common finding in patients suffering from structural heart disease, but they can also be present in healthy individuals. Catheter ablation represents a suitable therapeutic approach. However, the exact localization of the origin can be challenging, especially in cases of low PB burden during the procedure.Objective: The aim of this study was to develop an automated mapping algorithm on the basis of the hypothesis that mathematical optimization would significantly accelerate the localization of earliest activation.Methods: The algorithm is based on iterative regression analyses. When acquiring local activation times (LATs) within a 3-dimensional anatomic map of the corresponding heart chamber, this algorithm is able to identify that exact position where a next LAT measurement adds maximum information about the predicted site of origin. Furthermore, on the basis of the acquired LAT measurements, the algorithm is able to predict earliest activation with high accuracy.Results: A systematic retrospective analysis of the mapping performance comparing the operator with simulated search processes by the algorithm within 17 electroanatomic maps of focal spreading arrhythmias revealed a highly significant reduction of necessary LAT measurements from 55 ± 8.8 to 10 ± 0.51 (n = 17; P < .0001).Conclusion: On the basis of mathematical optimization, we developed an algorithm that is able to reduce the number of LAT measurements necessary to locate the site of earliest activation. This algorithm might significantly accelerate the mapping procedure by guiding the operator to the optimal position for the next LAT measurement. Furthermore, the algorithm would be able to predict the site of origin with high accuracy early during the mapping procedure.
      pubtype: Academic Journal
      doctype:
        research
        Journal Article
      ougenre: Article
    language: English
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