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Jastrzębski M, Fijorek K, Futyma P, Orczykowski M, Pitak M, Zarębski Ł, Sajdak P, Góreczny S, Szumowski Ł, Rajzer M, Moskal P. Accessory pathway localization with probabilistic density maps generated by a mobile application: Assessment of a full pre-excitation net-vector method. J Cardiovasc Electrophysiol 2024. [PMID: 38514968 DOI: 10.1111/jce.16252] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2024] [Revised: 03/04/2024] [Accepted: 03/07/2024] [Indexed: 03/23/2024]
Abstract
INTRODUCTION Precise electrocardiographic localization of accessory pathways (AP) can be challenging. Seminal AP localization studies were limited by complexity of algorithms and sample size. We aimed to create a nonalgorithmic method for AP localization based on color-coded maps of AP distribution generated by a web-based application. METHODS APs were categorized into 19 regions/types based on invasive electrophysiologic mapping. Preexcited QRS complexes were categorized into 6 types based on polarity and notch/slur. For each QRS type in each lead the distribution of APs was visualized on a gradient map. The principle of common set was used to combine the single lead maps to create the distribution map for AP with any combination of QRS types in several leads. For the validation phase, a separate cohort of APs was obtained. RESULTS A total of 800 patients with overt APs were studied. The application used the exploratory data set of 553 consecutive APs and the corresponding QRS complexes to generate AP localization maps for any possible combination of QRS types in 12 leads. Optimized approach (on average 3 steps) for evaluation of preexcited electrcardiogram was developed. The area of maximum probability of AP localization was pinpointed by providing the QRS type for the subsequent leads. The exploratory data set was validated with the separate cohort of APs (n = 256); p = .23 for difference in AP distribution. CONCLUSIONS In the largest data set of APs to-date, a novel probabilistic and semi-automatic approach to electrocardiographic localization of APs was highly predictive for anatomic localization.
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Affiliation(s)
- Marek Jastrzębski
- First Department of Cardiology, Interventional Electrocardiology and Hypertension, Medical College, Jagiellonian University, Kraków, Poland
| | - Kamil Fijorek
- Department of Statistics, Cracow University of Economics, Kraków, Poland
| | - Piotr Futyma
- University of Rzeszów and St. Joseph's Heart Rhythm Center, Rzeszów, Poland
| | - Michał Orczykowski
- 1st. Arrhythmia Department, National Institute of Cardiology, Arrhythmia Center, Warsaw, Poland
| | - Maciej Pitak
- Department of Cardiology, Institute of Paediatrics, Jagiellonian University Medical College, Kraków, Poland
| | - Łukasz Zarębski
- University of Rzeszów and St. Joseph's Heart Rhythm Center, Rzeszów, Poland
| | - Piotr Sajdak
- University of Rzeszów and St. Joseph's Heart Rhythm Center, Rzeszów, Poland
| | - Sebastian Góreczny
- Department of Cardiology, Institute of Paediatrics, Jagiellonian University Medical College, Kraków, Poland
| | - Łukasz Szumowski
- 1st. Arrhythmia Department, National Institute of Cardiology, Arrhythmia Center, Warsaw, Poland
| | - Marek Rajzer
- First Department of Cardiology, Interventional Electrocardiology and Hypertension, Medical College, Jagiellonian University, Kraków, Poland
| | - Paweł Moskal
- Electrophysiology Laboratory, University Hospital in Krakow, Krakow, Poland
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Wu G, Luo Q, Bao Y, Wei Y, Lin C, Zhang N, Ling T, Chen K, Pan W, Wu L, Xie Y, Jin Q. The feasibility of using remote magnetic navigation system as the primary technological training tool for novice cardiac electrophysiology operators in the catheter ablation of left-sided accessory pathway. Cardiol J 2022; 30:VM/OJS/J/87161. [PMID: 35373327 PMCID: PMC10713225 DOI: 10.5603/cj.a2022.0015] [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: 11/28/2021] [Revised: 03/19/2022] [Accepted: 03/21/2022] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND For novice operators, mastering catheter ablation of left-sided accessory pathway (LSAP) in a short duration of time without compromising efficacy and safety remains a challenge. In this study an attempt to shorten the learning curve by using robotics via a remote magnetic navigation (RMN) system was performed. METHODS Novice physician fellows without prior catheter ablation experience initiated their process of learning LSAP ablation using the Niobe™ RMN system. Their procedure parameters were recorded and compared with experienced operators using RMN and manual catheter navigation (MCN). RESULTS Novice operators quickly shortened the total procedure time after their first five procedures. In subsequent procedures, no significant difference in procedure time, fluoroscopy exposure or ablation time was observed between novice and experienced RMN operators. When compared to MCN operators, novice operators avoided excessive radiation exposure beginning with their first RMN procedure, while lower fluoroscopy doses were noted after five procedures. It was observed that procedure parameters did not differ significantly according to LSAP location. CONCLUSION The RMN system is a practical and easy to use tool for novice electrophysiology operators to quickly master LSAP ablation, without compromising efficacy or safety. Additionally, when compared to MCN it also protects the operators and patients from excessive radiation exposure during the procedure.
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Affiliation(s)
- Guanhua Wu
- Department of Cardiovascular Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Qingzhi Luo
- Department of Cardiovascular Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yangyang Bao
- Department of Cardiovascular Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yue Wei
- Department of Cardiovascular Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Changjian Lin
- Department of Cardiovascular Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Ning Zhang
- Department of Cardiovascular Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Tianyou Ling
- Department of Cardiovascular Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Kang Chen
- Department of Cardiovascular Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Wenqi Pan
- Department of Cardiovascular Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Liqun Wu
- Department of Cardiovascular Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yun Xie
- Department of Cardiovascular Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
| | - Qi Jin
- Department of Cardiovascular Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
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