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Jaffery OA, Melki L, Slabaugh G, Good WW, Roney CH. A Review of Personalised Cardiac Computational Modelling Using Electroanatomical Mapping Data. Arrhythm Electrophysiol Rev 2024; 13:e08. [PMID: 38807744 PMCID: PMC11131150 DOI: 10.15420/aer.2023.25] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Accepted: 12/27/2023] [Indexed: 05/30/2024] Open
Abstract
Computational models of cardiac electrophysiology have gradually matured during the past few decades and are now being personalised to provide patient-specific therapy guidance for improving suboptimal treatment outcomes. The predictive features of these personalised electrophysiology models hold the promise of providing optimal treatment planning, which is currently limited in the clinic owing to reliance on a population-based or average patient approach. The generation of a personalised electrophysiology model entails a sequence of steps for which a range of activation mapping, calibration methods and therapy simulation pipelines have been suggested. However, the optimal methods that can potentially constitute a clinically relevant in silico treatment are still being investigated and face limitations, such as uncertainty of electroanatomical data recordings, generation and calibration of models within clinical timelines and requirements to validate or benchmark the recovered tissue parameters. This paper is aimed at reporting techniques on the personalisation of cardiac computational models, with a focus on calibrating cardiac tissue conductivity based on electroanatomical mapping data.
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Affiliation(s)
- Ovais A Jaffery
- School of Engineering and Materials Science, Queen Mary University of London London, UK
| | - Lea Melki
- R&D Algorithms, Acutus Medical Carlsbad, CA, US
| | - Gregory Slabaugh
- Digital Environment Research Institute, Queen Mary University of London London, UK
| | | | - Caroline H Roney
- School of Engineering and Materials Science, Queen Mary University of London London, UK
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Hawson J, Anderson RD, Das SK, Al-Kaisey A, Chieng D, Segan L, Watts T, Campbell T, Morton J, McLellan A, Sparks P, Lee A, Gerstenfeld EP, Hsia HH, Voskoboinik A, Pathik B, Kumar S, Kistler PM, Kalman J, Lee G. Optimal Annotation of Local Activation Time in Ventricular Tachycardia Substrate Mapping. JACC Clin Electrophysiol 2024; 10:206-218. [PMID: 38099880 DOI: 10.1016/j.jacep.2023.10.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Revised: 10/12/2023] [Accepted: 10/13/2023] [Indexed: 03/01/2024]
Abstract
BACKGROUND Accurate annotation of electrogram local activation time (LAT) is critical to the functional assessment of ventricular tachycardia (VT) substrate. Contemporary methods of annotation include: 1) earliest bipolar electrogram (LATearliest); 2) peak bipolar electrogram (LATpeak); 3) latest bipolar electrogram (LATlatest); and 4) steepest unipolar -dV/dt (LAT-dV/dt). However, no direct comparison of these methods has been performed in a large dataset, and it is unclear which provides the optimal functional analysis of the VT substrate. OBJECTIVES This study sought to investigate the optimal method of LAT annotation during VT substrate mapping. METHODS Patients with high-density VT substrate maps and a defined critical site for VT re-entry were included. All electrograms were annotated using 5 different methods: LATearliest, LATpeak, LATlatest, LAT-dV/dt, and the novel steepest unipolar -dV/dt using a dynamic window of interest (LATDWOI). Electrograms were also tagged as either late potentials and/or fractionated signals. Maps, utilizing each annotation method, were then compared in their ability to identify critical sites using deceleration zones. RESULTS Fifty cases were identified with 1,.813 ± 811 points per map. Using LATlatest, a deceleration zone was present at the critical site in 100% of cases. There was no significant difference with LATearliest (100%) or LATpeak (100%). However, this number decreased to 54% using LAT-dV/dt and 76% for LATDWOI. Using LAT-dV/dt, only 33% of late potentials were correctly annotated, with the larger far field signals often annotated preferentially. CONCLUSIONS Annotation with LAT-dV/dt and LATDWOI are suboptimal in VT substrate mapping. We propose that LATlatest should be the gold standard annotation method, as this allows identification of critical sites and is most suited to automation.
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Affiliation(s)
- Joshua Hawson
- Department of Cardiology, Royal Melbourne Hospital, Melbourne, Victoria, Australia; Faculty of Medicine, Dentistry and Health Science, University of Melbourne, Melbourne, Victoria, Australia
| | - Robert D Anderson
- Department of Cardiology, Royal Melbourne Hospital, Melbourne, Victoria, Australia; Faculty of Medicine, Dentistry and Health Science, University of Melbourne, Melbourne, Victoria, Australia
| | - Souvik K Das
- Department of Cardiology, Royal Melbourne Hospital, Melbourne, Victoria, Australia; Faculty of Medicine, Dentistry and Health Science, University of Melbourne, Melbourne, Victoria, Australia
| | - Ahmed Al-Kaisey
- Department of Cardiology, Royal Melbourne Hospital, Melbourne, Victoria, Australia; Faculty of Medicine, Dentistry and Health Science, University of Melbourne, Melbourne, Victoria, Australia
| | - David Chieng
- Faculty of Medicine, Dentistry and Health Science, University of Melbourne, Melbourne, Victoria, Australia; Department of Cardiology, The Alfred Hospital, Melbourne, Victoria, Australia
| | - Louise Segan
- Faculty of Medicine, Dentistry and Health Science, University of Melbourne, Melbourne, Victoria, Australia; Department of Cardiology, The Alfred Hospital, Melbourne, Victoria, Australia
| | - Troy Watts
- Department of Cardiology, Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - Timothy Campbell
- Department of Cardiology, Westmead Hospital and Westmead Applied Research Centre, Westmead, New South Wales, Australia
| | - Joseph Morton
- Department of Cardiology, Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - Alexander McLellan
- Department of Cardiology, Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - Paul Sparks
- Department of Cardiology, Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - Adam Lee
- Division of Cardiology, Department of Medicine, University of California-San Francisco, San Francisco, California, USA
| | - Edward P Gerstenfeld
- Division of Cardiology, Department of Medicine, University of California-San Francisco, San Francisco, California, USA
| | - Henry H Hsia
- Division of Cardiology, Department of Medicine, University of California-San Francisco, San Francisco, California, USA
| | - Aleksandr Voskoboinik
- Faculty of Medicine, Dentistry and Health Science, University of Melbourne, Melbourne, Victoria, Australia; Department of Cardiology, The Alfred Hospital, Melbourne, Victoria, Australia
| | - Bhupesh Pathik
- Department of Cardiology, Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - Saurabh Kumar
- Department of Cardiology, Westmead Hospital and Westmead Applied Research Centre, Westmead, New South Wales, Australia; Western Clinical School, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
| | - Peter M Kistler
- Faculty of Medicine, Dentistry and Health Science, University of Melbourne, Melbourne, Victoria, Australia; Department of Cardiology, The Alfred Hospital, Melbourne, Victoria, Australia
| | - Jonathan Kalman
- Department of Cardiology, Royal Melbourne Hospital, Melbourne, Victoria, Australia; Faculty of Medicine, Dentistry and Health Science, University of Melbourne, Melbourne, Victoria, Australia
| | - Geoffrey Lee
- Department of Cardiology, Royal Melbourne Hospital, Melbourne, Victoria, Australia; Faculty of Medicine, Dentistry and Health Science, University of Melbourne, Melbourne, Victoria, Australia.
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Arps K, Barnett AS, Koontz JI, Pokorney SD, Jackson KP, Bahnson TD, Piccini JP, Sun AY. Use of Ripple mapping to enhance localization and ablation of outflow tract premature ventricular contractions. J Cardiovasc Electrophysiol 2023; 34:1552-1560. [PMID: 37293826 DOI: 10.1111/jce.15963] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Revised: 05/16/2023] [Accepted: 05/24/2023] [Indexed: 06/10/2023]
Abstract
INTRODUCTION Accurate localization of septal outflow tract premature ventricular contractions (PVCs) is often difficult due to frequent mid-myocardial or protected origin. Compared with traditional activation mapping, CARTO Ripple mapping provides visualization of all captured electrogram data without assignment of a specific local activation time and thus may enhance PVC localization. METHODS Electroanatomic maps for consecutive catheter ablation procedures for septal outflow tract PVCs (July 2018-December 2020) were analyzed. For each PVC, we identified the earliest local activation point (EA), defined by the point of maximal -dV/dt in a simultaneously recorded unipolar electrogram, and the earliest Ripple signal (ERS), defined as the earliest point at which three grouped simultaneous Ripple bars appeared in late diastole. Immediate success was defined as full suppression of the clinical PVC. RESULTS Fifty-seven unique PVCs in 55 procedures were included. When ERS and EA were in the same chamber (RV, LV, or CS), the odds ratio for the successful procedure was 13.1 (95% confidence interval [CI] 2.2-79.9, p = .005). Discordance between sites was associated with a higher likelihood of needing multi-site ablation (odds ratio [OR] 7.9 [1.4-4.6; p = .020]). Median EA-ERS distance in successful versus unsuccessful cases was 4.6 mm (interquartile range 2.9-8.5) versus 12.5 mm (7.8-18.5); (p = .020). CONCLUSION Greater EA-ERS concordance was associated with higher odds of single-site PVC suppression and successful septal outflow tract PVC ablation. Visualization of complex signals via automated Ripple mapping may offer rapid localization information complementary to local activation mapping for PVCs of mid-myocardial origin.
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Affiliation(s)
- Kelly Arps
- Division of Cardiovascular Disease, Section of Cardiac Electrophysiology, Duke University Medical Center, Durham, North Carolina, USA
- Duke Clinical Research Institute, Durham, North Carolina, USA
| | - Adam S Barnett
- Division of Cardiovascular Disease, Section of Cardiac Electrophysiology, Duke University Medical Center, Durham, North Carolina, USA
- Prisma Health, Greenville, South Carolina, USA
| | - Jason I Koontz
- Division of Cardiovascular Disease, Section of Cardiac Electrophysiology, Duke University Medical Center, Durham, North Carolina, USA
- Durham VA Medical Center, Durham, North Carolina, USA
| | - Sean D Pokorney
- Division of Cardiovascular Disease, Section of Cardiac Electrophysiology, Duke University Medical Center, Durham, North Carolina, USA
- Duke Clinical Research Institute, Durham, North Carolina, USA
| | - Kevin P Jackson
- Division of Cardiovascular Disease, Section of Cardiac Electrophysiology, Duke University Medical Center, Durham, North Carolina, USA
| | - Tristram D Bahnson
- Division of Cardiovascular Disease, Section of Cardiac Electrophysiology, Duke University Medical Center, Durham, North Carolina, USA
| | - Jonathan P Piccini
- Division of Cardiovascular Disease, Section of Cardiac Electrophysiology, Duke University Medical Center, Durham, North Carolina, USA
- Duke Clinical Research Institute, Durham, North Carolina, USA
| | - Albert Y Sun
- Division of Cardiovascular Disease, Section of Cardiac Electrophysiology, Duke University Medical Center, Durham, North Carolina, USA
- Durham VA Medical Center, Durham, North Carolina, USA
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Hellar J, Cosentino R, John MM, Post A, Buchan S, Razavi M, Aazhang B. Manifold Approximating Graph Interpolation of Cardiac Local Activation Time. IEEE Trans Biomed Eng 2022; 69:3253-3264. [PMID: 35404808 PMCID: PMC9549513 DOI: 10.1109/tbme.2022.3166447] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Objective: Local activation time (LAT) mapping of cardiac chambers is vital for targeted treatment of cardiac arrhythmias in catheter ablation procedures. Current methods require too many LAT observations for an accurate interpolation of the necessarily sparse LAT signal extracted from intracardiac electrograms (EGMs). Additionally, conventional performance metrics for LAT interpolation algorithms do not accurately measure the quality of interpolated maps. We propose, first, a novel method for spatial interpolation of the LAT signal which requires relatively few observations; second, a realistic sub-sampling protocol for LAT interpolation testing; and third, a new color-based metric for evaluation of interpolation quality that quantifies perceived differences in LAT maps. Methods: We utilize a graph signal processing framework to reformulate the irregular spatial interpolation problem into a semi-supervised learning problem on the manifold with a closed-form solution. The metric proposed uses a color difference equation and color theory to quantify visual differences in generated LAT maps. Results: We evaluate our approach on a dataset consisting of seven LAT maps from four patients obtained by the CARTO electroanatomic mapping system during premature ventricular complex (PVC) ablation procedures. Random sub-sampling and re-interpolation of the LAT observations show excellent accuracy for relatively few observations, achieving on average 6% lower error than state-of-the-art techniques for only 100 observations. Conclusion: Our study suggests that graph signal processing methods can improve LAT mapping for cardiac ablation procedures. Significance: The proposed method can reduce patient time in surgery by decreasing the number of LAT observations needed for an accurate LAT map.
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Lousinha A. Ablation of idiopathic premature ventricular contractions - exploring the electrophysiologist's toolbox in complex procedures. Rev Port Cardiol 2021; 40:433-435. [PMID: 34274084 DOI: 10.1016/j.repce.2021.07.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Affiliation(s)
- Ana Lousinha
- Arrhythmology, Pacing and Electrophysiology Unit, Cardiology Department, Santa Marta Hospital, Central Lisbon University Hospital Center, Portugal; Unidade de Arritmologia, Pacing e Eletrofisiologia, Serviço de Cardiologia, Hospital de Santa Marta, Centro Hospitalar Universitário de Lisboa Central, Lisboa, Portugal.
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Jáuregui B, Fernández-Armenta J, Acosta J, Penela D, Terés C, Ordóñez A, Soto-Iglesias D, Silva E, Chauca A, Carreño JM, Scherer C, Pedrote A, Berruezo A. MANual vs. automatIC local activation time annotation for guiding Premature Ventricular Complex ablation procedures (MANIaC-PVC study). Europace 2021; 23:1285-1294. [PMID: 33846728 DOI: 10.1093/europace/euab080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Accepted: 03/17/2021] [Indexed: 11/13/2022] Open
Abstract
AIMS To assess potential benefits of a local activation time (LAT) automatic acquisition protocol using wavefront annotation plus an ECG pattern matching algorithm [automatic (AUT)-arm] during premature ventricular complex (PVC) ablation procedures. METHODS AND RESULTS Prospective, randomized, controlled, and international multicentre study (NCT03340922). One hundred consecutive patients with indication for PVC ablation were enrolled and randomized to AUT (n = 50) or manual (MAN, n = 50) annotation protocols using the CARTO3 navigation system. The primary endpoint was mapping success. Clinical success was defined as a PVC-burden reduction of ≥80% in the 24-h Holter within 6 months after the procedure. Mean age was 56 ± 14 years, 54% men. The mean baseline PVC burden was 25 ± 13%, and mean left ventricular ejection fraction (LVEF) 55 ± 11%. Baseline characteristics were similar between the groups. The most frequent PVC-site of origin were right ventricular outflow tract (41%), LV (25%), and left ventricular outflow tract (17%), without differences between groups. Radiofrequency (RF) time and number of RF applications were similar for both groups. Mapping and procedure times were significantly shorter in the AUT-arm (25.5 ± 14.3 vs. 32.8 ± 12.6 min, P = 0.009; and 54.8 ± 24.8 vs. 67.4 ± 25.2, P = 0.014, respectively), while more mapping points were acquired [136 (94-222) AUT vs. 79 (52-111) MAN; P < 0.001]. Mapping and clinical success were similar in both groups. There were no procedure-related complications. CONCLUSION The use of a complete automatic protocol for LAT annotation during PVC ablation procedures allows to achieve similar clinical endpoints with higher procedural efficiency when compared with conventional, manual annotation carried out by expert operators.
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Affiliation(s)
- Beatriz Jáuregui
- Heart Institute, Teknon Medical Center, C/Vilana, 12, 08022 Barcelona, Spain
| | | | - Juan Acosta
- Virgen del Rocío University Hospital, Sevilla, Spain
| | - Diego Penela
- Heart Institute, Teknon Medical Center, C/Vilana, 12, 08022 Barcelona, Spain.,Ospedale Guglielmo da Saliceto, Piacenza, Italy
| | - Cheryl Terés
- Heart Institute, Teknon Medical Center, C/Vilana, 12, 08022 Barcelona, Spain
| | - Augusto Ordóñez
- Heart Institute, Teknon Medical Center, C/Vilana, 12, 08022 Barcelona, Spain
| | - David Soto-Iglesias
- Heart Institute, Teknon Medical Center, C/Vilana, 12, 08022 Barcelona, Spain
| | | | - Alfredo Chauca
- Heart Institute, Teknon Medical Center, C/Vilana, 12, 08022 Barcelona, Spain
| | - José M Carreño
- Heart Institute, Teknon Medical Center, C/Vilana, 12, 08022 Barcelona, Spain
| | - Claudia Scherer
- Heart Institute, Teknon Medical Center, C/Vilana, 12, 08022 Barcelona, Spain
| | | | - Antonio Berruezo
- Heart Institute, Teknon Medical Center, C/Vilana, 12, 08022 Barcelona, Spain
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Lousinha A. Ablation of idiopathic premature ventricular contractions - exploring the electrophysiologist's toolbox in complex procedures. Rev Port Cardiol 2021. [PMID: 33678482 DOI: 10.1016/j.repc.2020.12.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Affiliation(s)
- Ana Lousinha
- Arrhythmology, Pacing and Electrophysiology Unit, Cardiology Department, Santa Marta Hospital, Central Lisbon University Hospital Center, Portugal; Unidade de Arritmologia, Pacing e Eletrofisiologia, Serviço de Cardiologia, Hospital de Santa Marta, Centro Hospitalar Universitário de Lisboa Central, Lisboa, Portugal.
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Abstract
Arrhythmias arising from the ventricular outflow tracts are commonly encountered. Although largely benign, they can also present with heart failure and sudden cardiac death. Mapping and ablation of these arrhythmias is commonly performed in the electrophysiology laboratory with a high success rate, but occasionally can prove challenging to abolish. This article discusses the mapping and ablation of outflow tract arrhythmias and the challenges that can be overcome by a systematic approach.
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Affiliation(s)
- Magdi M Saba
- Cardiology Clinical Academic Group, St. George's University of London, Cranmer Terrace, London SW17 OQT, UK.
| | - Anthony Li
- Cardiology Clinical Academic Group, St. George's University of London, Cranmer Terrace, London SW17 OQT, UK
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Stevenson WG, Hindricks G. Ventricular arrhythmias and sudden cardiac death: new research insights with clinical implications. Europace 2018. [DOI: 10.1093/europace/euy207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- William G Stevenson
- Division of Cardiovascular Medicine, Arrhythmia Section, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Gerhard Hindricks
- Department of Electrophysiology, Heart Center Leipzig, Strümpellstr. 39, Leipzig, Germany
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