An automated fractionation mapping algorithm for mapping of scar-based ventricular tachycardia

Hunter Launer, Tom Clark, Thomas Dewland, Charles Henrikson, Babak Nazer

Research output: Contribution to journalArticle

Abstract

Background: Mapping and ablation of fractionated electrograms is a common treatment for scar-based ventricular tachycardia (VT). An automated algorithm has been developed for rapid “fractionation mapping.”. Methods: Electroanatomic maps from 21 ablation procedures (14 scar-based VT and seven control idiopathic VT/premature ventricular contractions with normal voltage) were retrospectively analyzed using the Ensite Precision fractionation map (fMap; Abbott Laboratories; Abbott Park, IL, USA) algorithm. For each study, voltage maps and 30 fMaps were generated using combinations of parameters: width (5, 10, 20 ms), refractory time (15, 30 ms), sensitivity (0.1, 0.2 mV), and fractionation threshold (2, 3, 5). Parameter sensitivity was assessed by overlap of fractionated areas (fArea) with successful VT ablation sites (defined by entrainment and/or pace mapping). Specificity was assessed by presence of fractionated areas in control patients. Results: Of the 30 fMap parameter sets tested, seven identified >50% of scar-based VT ablation sites, and 26 contained <5 cm2 fractionation on control fMaps. Three combinations of fMap width/refractory/sensitivity/threshold parameters met both of the above criteria, and 20/30/0.1/2 identified the most VT ablation sites (79%) and generated 42.3 ± 28.2 cm2 of fArea on scar-based VT maps compared with 4.9 ± 3.2 cm2 on control maps (P =.001). None of the control patients and 23% of the scar-based VT patients had VT recurrence at mean 15 month follow-up. Conclusion: Careful selection of signal processing parameters optimizes sensitivity and specificity of automated fractionation mapping for scar-based VT. Real-time use of fMap algorithms may reduce VT ablation procedure time and improve substrate modification, which may improve outcomes.

Original languageEnglish (US)
JournalPACE - Pacing and Clinical Electrophysiology
DOIs
StatePublished - Jan 1 2019

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Ventricular Tachycardia
Cicatrix
Ventricular Premature Complexes
Recurrence
Sensitivity and Specificity

Keywords

  • electroanatomic mapping
  • electrograms
  • substrate modification
  • ventricular tachycardia

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

@article{e5bd742f4f4f4d43bcb75ca9904d1f2d,
title = "An automated fractionation mapping algorithm for mapping of scar-based ventricular tachycardia",
abstract = "Background: Mapping and ablation of fractionated electrograms is a common treatment for scar-based ventricular tachycardia (VT). An automated algorithm has been developed for rapid “fractionation mapping.”. Methods: Electroanatomic maps from 21 ablation procedures (14 scar-based VT and seven control idiopathic VT/premature ventricular contractions with normal voltage) were retrospectively analyzed using the Ensite Precision fractionation map (fMap; Abbott Laboratories; Abbott Park, IL, USA) algorithm. For each study, voltage maps and 30 fMaps were generated using combinations of parameters: width (5, 10, 20 ms), refractory time (15, 30 ms), sensitivity (0.1, 0.2 mV), and fractionation threshold (2, 3, 5). Parameter sensitivity was assessed by overlap of fractionated areas (fArea) with successful VT ablation sites (defined by entrainment and/or pace mapping). Specificity was assessed by presence of fractionated areas in control patients. Results: Of the 30 fMap parameter sets tested, seven identified >50{\%} of scar-based VT ablation sites, and 26 contained <5 cm2 fractionation on control fMaps. Three combinations of fMap width/refractory/sensitivity/threshold parameters met both of the above criteria, and 20/30/0.1/2 identified the most VT ablation sites (79{\%}) and generated 42.3 ± 28.2 cm2 of fArea on scar-based VT maps compared with 4.9 ± 3.2 cm2 on control maps (P =.001). None of the control patients and 23{\%} of the scar-based VT patients had VT recurrence at mean 15 month follow-up. Conclusion: Careful selection of signal processing parameters optimizes sensitivity and specificity of automated fractionation mapping for scar-based VT. Real-time use of fMap algorithms may reduce VT ablation procedure time and improve substrate modification, which may improve outcomes.",
keywords = "electroanatomic mapping, electrograms, substrate modification, ventricular tachycardia",
author = "Hunter Launer and Tom Clark and Thomas Dewland and Charles Henrikson and Babak Nazer",
year = "2019",
month = "1",
day = "1",
doi = "10.1111/pace.13758",
language = "English (US)",
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T1 - An automated fractionation mapping algorithm for mapping of scar-based ventricular tachycardia

AU - Launer, Hunter

AU - Clark, Tom

AU - Dewland, Thomas

AU - Henrikson, Charles

AU - Nazer, Babak

PY - 2019/1/1

Y1 - 2019/1/1

N2 - Background: Mapping and ablation of fractionated electrograms is a common treatment for scar-based ventricular tachycardia (VT). An automated algorithm has been developed for rapid “fractionation mapping.”. Methods: Electroanatomic maps from 21 ablation procedures (14 scar-based VT and seven control idiopathic VT/premature ventricular contractions with normal voltage) were retrospectively analyzed using the Ensite Precision fractionation map (fMap; Abbott Laboratories; Abbott Park, IL, USA) algorithm. For each study, voltage maps and 30 fMaps were generated using combinations of parameters: width (5, 10, 20 ms), refractory time (15, 30 ms), sensitivity (0.1, 0.2 mV), and fractionation threshold (2, 3, 5). Parameter sensitivity was assessed by overlap of fractionated areas (fArea) with successful VT ablation sites (defined by entrainment and/or pace mapping). Specificity was assessed by presence of fractionated areas in control patients. Results: Of the 30 fMap parameter sets tested, seven identified >50% of scar-based VT ablation sites, and 26 contained <5 cm2 fractionation on control fMaps. Three combinations of fMap width/refractory/sensitivity/threshold parameters met both of the above criteria, and 20/30/0.1/2 identified the most VT ablation sites (79%) and generated 42.3 ± 28.2 cm2 of fArea on scar-based VT maps compared with 4.9 ± 3.2 cm2 on control maps (P =.001). None of the control patients and 23% of the scar-based VT patients had VT recurrence at mean 15 month follow-up. Conclusion: Careful selection of signal processing parameters optimizes sensitivity and specificity of automated fractionation mapping for scar-based VT. Real-time use of fMap algorithms may reduce VT ablation procedure time and improve substrate modification, which may improve outcomes.

AB - Background: Mapping and ablation of fractionated electrograms is a common treatment for scar-based ventricular tachycardia (VT). An automated algorithm has been developed for rapid “fractionation mapping.”. Methods: Electroanatomic maps from 21 ablation procedures (14 scar-based VT and seven control idiopathic VT/premature ventricular contractions with normal voltage) were retrospectively analyzed using the Ensite Precision fractionation map (fMap; Abbott Laboratories; Abbott Park, IL, USA) algorithm. For each study, voltage maps and 30 fMaps were generated using combinations of parameters: width (5, 10, 20 ms), refractory time (15, 30 ms), sensitivity (0.1, 0.2 mV), and fractionation threshold (2, 3, 5). Parameter sensitivity was assessed by overlap of fractionated areas (fArea) with successful VT ablation sites (defined by entrainment and/or pace mapping). Specificity was assessed by presence of fractionated areas in control patients. Results: Of the 30 fMap parameter sets tested, seven identified >50% of scar-based VT ablation sites, and 26 contained <5 cm2 fractionation on control fMaps. Three combinations of fMap width/refractory/sensitivity/threshold parameters met both of the above criteria, and 20/30/0.1/2 identified the most VT ablation sites (79%) and generated 42.3 ± 28.2 cm2 of fArea on scar-based VT maps compared with 4.9 ± 3.2 cm2 on control maps (P =.001). None of the control patients and 23% of the scar-based VT patients had VT recurrence at mean 15 month follow-up. Conclusion: Careful selection of signal processing parameters optimizes sensitivity and specificity of automated fractionation mapping for scar-based VT. Real-time use of fMap algorithms may reduce VT ablation procedure time and improve substrate modification, which may improve outcomes.

KW - electroanatomic mapping

KW - electrograms

KW - substrate modification

KW - ventricular tachycardia

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U2 - 10.1111/pace.13758

DO - 10.1111/pace.13758

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JO - PACE - Pacing and Clinical Electrophysiology

JF - PACE - Pacing and Clinical Electrophysiology

SN - 0147-8389

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