Automatic identification of areas with low‐voltage fragmented electrograms for the detection of the critical isthmus of atypical atrial flutters.

Introduction: Critical isthmuses of atypical atrial flutters (AAFLs) are usually located at slow conduction areas that exhibit fractionated electrograms. We tested a novel software, intended for integration with a commercially available navigation system, that automatically detects fractionated elec...

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Publicado en:Journal of Cardiovascular Electrophysiology Vol. 34; no. 2; pp. 356 - 366
Autores principales: Franco, Eduardo, Lozano Granero, Cristina, Cortez‐Dias, Nuno, Nakar, Elad, Segev, Meytal, Matía, Roberto, Hernández‐Madrid, Antonio, Zamorano, José Luis, Moreno, Javier
Formato: pictorial research tables/charts tracings Journal Article
Publicado: Wiley-Blackwell Feb2023
Acceso en línea:Ver este registro en EBSCOhost
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      dt: Feb2023
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      pub: Wiley-Blackwell
      place: Malden, Massachusetts
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        atl: Automatic identification of areas with low‐voltage fragmented electrograms for the detection of the critical isthmus of atypical atrial flutters.
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        au:
          Franco, Eduardo
          Lozano Granero, Cristina
          Cortez‐Dias, Nuno
          Nakar, Elad
          Segev, Meytal
          Matía, Roberto
          Hernández‐Madrid, Antonio
          Zamorano, José Luis
          Moreno, Javier
        affil: Cardiology Department, University Hospital Ramón y Cajal, Madrid, Spain
      sug:
        subj:
          Atrial Flutter Diagnosis
          Tachycardia, Atrial Diagnosis
          Software
          Catheter Ablation Methods
          Decision Making, Clinical
          Human
          Retrospective Design
          Descriptive Statistics
          Data Analysis Software
          Chi Square Test
          Fisher's Exact Test
          Analysis of Variance
          Post Hoc Analysis
          Mann-Whitney U Test
          McNemar's Test
          Kruskal-Wallis Test
          Male
          Female
          Male
          Female
      ab: Introduction: Critical isthmuses of atypical atrial flutters (AAFLs) are usually located at slow conduction areas that exhibit fractionated electrograms. We tested a novel software, intended for integration with a commercially available navigation system, that automatically detects fractionated electrograms, to identify the critical isthmus in patients with AAFL ablation. Methods and Results: All available patients were analyzed; 27 patients with 33 AAFLs were included. The PentaRay NAV catheter (Biosense Webster) was used for mapping. The novel software was retrospectively applied; fractionated points with duration ≥80 ms and bipolar voltage between 0.05 and 0.5 mV were highlighted on the surface of maps. In 10 randomly chosen AAFLs, an expert electrophysiologist evaluated the positive predictive value of the algorithm to detect true fractionation: 74.4%. We tested the capacity of the software to identify areas of fractionation (defined as clusters of ≥3 adjacent points with fractionation) at the critical isthmus of the AAFLs (defined using conventional mapping criteria). An area of fractionation was identified at the critical isthmus in 30 cases (91%). Globally, 144 areas of fractionation (median number per AAFL 4 [3–6]) were identified. Duration of the fractionation or the surface of the areas was not different between areas at critical isthmuses and the rest. Setting the fractionation score filter of the software in nine provided best performance. Conclusions: The novel software detected areas of fractionation at the critical isthmus in most AAFLs, which may help identify the critical isthmus in clinical practice.
      pubtype: Academic Journal
      doctype:
        pictorial
        research
        tables/charts
        tracings
        Journal Article
      ougenre: Article
    language: English
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