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Directed graph mapping for ventricular tachycardia : a comparison to established mapping techniques

Joshua Hawson, Enid Van Nieuwenhuyse, Robin Van Den Abeele (UGent) , Ahmed Al-kaisey, Robert D. Anderson, David Chieng, Louise Segan, Troy Watts, Timothy Campbell, Sander Hendrickx (UGent) , et al.
(2023) JACC-CLINICAL ELECTROPHYSIOLOGY. 9(7). p.907-922
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Abstract
BACKGROUND: Understanding underlying mechanism(s) and identifying critical circuit components are fundamental to successful ventricular tachycardia (VT) ablation. Directed graph mapping (DGM) offers a novel technique to identify the mechanism and critical components of a VT circuit. OBJECTIVES: This study sought to evaluate the accuracy of DGM in VT ablation compared with traditional mapping techniques and a commercially available automated conduction velocity mapping (ACVM) tool. METHODS: Patients with structural heart disease who had undergone a VT ablation with entrainment-proven critical isthmus and a high-density electroanatomical activation map were included. Traditional mapping (TM) consisted of a combination of local activation time and entrainment mapping and was considered the gold standard for determining the VT mechanism, circuit, and isthmus location. The same local activation time values were then processed using DGM and a commercially available ACVM (Coherent Mapping, Biosense Webster) tool. The aim of this study was to compare TM vs DGM and ACVM in their ability to identify the VT mechanism, characterize the VT circuit, and locate the critical isthmus. RESULTS: Thirty-five cases were identified. TM classified the VT mechanism as focal in 7 patients and re-entrant in 28 patients. TM classified 11 VTs as single-loop re-entry, 15 as dual-loop re-entry, 1 as complex, and 1 case was indeterminant. The overall agreement between DGM and TM for determining VT mechanism and circuit type was strong (kappa value = 0.79; P < 0.01), as was the agreement between ACVM and TM (kappa value = 0.66; P < 0.01). Both DGM and ACVM identified the putative VT isthmus in 25 (89%) of the re-entrant cases. Focal activation was correctly identified by both techniques in all cases. CONCLUSIONS: DGM is a rapid automated algorithm that has a strong level of agreement with TM for manually re annotated VT maps. (c) 2023 by the American College of Cardiology Foundation.
Keywords
Coherent Mapping, directed graph mapping, ventricular arrhythmias, ventricular tachycardia, ABLATION, IDENTIFICATION, ENTRAINMENT, MULTICENTER, REENTRY

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MLA
Hawson, Joshua, et al. “Directed Graph Mapping for Ventricular Tachycardia : A Comparison to Established Mapping Techniques.” JACC-CLINICAL ELECTROPHYSIOLOGY, vol. 9, no. 7, 2023, pp. 907–22, doi:10.1016/j.jacep.2022.08.013.
APA
Hawson, J., Van Nieuwenhuyse, E., Van Den Abeele, R., Al-kaisey, A., Anderson, R. D., Chieng, D., … Vandersickel, N. (2023). Directed graph mapping for ventricular tachycardia : a comparison to established mapping techniques. JACC-CLINICAL ELECTROPHYSIOLOGY, 9(7), 907–922. https://doi.org/10.1016/j.jacep.2022.08.013
Chicago author-date
Hawson, Joshua, Enid Van Nieuwenhuyse, Robin Van Den Abeele, Ahmed Al-kaisey, Robert D. Anderson, David Chieng, Louise Segan, et al. 2023. “Directed Graph Mapping for Ventricular Tachycardia : A Comparison to Established Mapping Techniques.” JACC-CLINICAL ELECTROPHYSIOLOGY 9 (7): 907–22. https://doi.org/10.1016/j.jacep.2022.08.013.
Chicago author-date (all authors)
Hawson, Joshua, Enid Van Nieuwenhuyse, Robin Van Den Abeele, Ahmed Al-kaisey, Robert D. Anderson, David Chieng, Louise Segan, Troy Watts, Timothy Campbell, Sander Hendrickx, Joseph Morton, Alexander McLellan, Peter Kistler, Adam Lee, Edward P. Gerstenfeld, Henry H. Hsia, Aleksander Voskoboinik, Bhupesh Pathik, Saurabh Kumar, Jonathan Kalman, Geoffrey Lee, and Nele Vandersickel. 2023. “Directed Graph Mapping for Ventricular Tachycardia : A Comparison to Established Mapping Techniques.” JACC-CLINICAL ELECTROPHYSIOLOGY 9 (7): 907–922. doi:10.1016/j.jacep.2022.08.013.
Vancouver
1.
Hawson J, Van Nieuwenhuyse E, Van Den Abeele R, Al-kaisey A, Anderson RD, Chieng D, et al. Directed graph mapping for ventricular tachycardia : a comparison to established mapping techniques. JACC-CLINICAL ELECTROPHYSIOLOGY. 2023;9(7):907–22.
IEEE
[1]
J. Hawson et al., “Directed graph mapping for ventricular tachycardia : a comparison to established mapping techniques,” JACC-CLINICAL ELECTROPHYSIOLOGY, vol. 9, no. 7, pp. 907–922, 2023.
@article{01HND8RC26K979JE7J5F4J7ZVV,
  abstract     = {{BACKGROUND: Understanding underlying mechanism(s) and identifying critical circuit components are fundamental to successful ventricular tachycardia (VT) ablation. Directed graph mapping (DGM) offers a novel technique to identify the mechanism and critical components of a VT circuit.

 OBJECTIVES: This study sought to evaluate the accuracy of DGM in VT ablation compared with traditional mapping techniques and a commercially available automated conduction velocity mapping (ACVM) tool.

 METHODS: Patients with structural heart disease who had undergone a VT ablation with entrainment-proven critical isthmus and a high-density electroanatomical activation map were included. Traditional mapping (TM) consisted of a combination of local activation time and entrainment mapping and was considered the gold standard for determining the VT mechanism, circuit, and isthmus location. The same local activation time values were then processed using DGM and a commercially available ACVM (Coherent Mapping, Biosense Webster) tool. The aim of this study was to compare TM vs DGM and ACVM in their ability to identify the VT mechanism, characterize the VT circuit, and locate the critical isthmus.

 RESULTS: Thirty-five cases were identified. TM classified the VT mechanism as focal in 7 patients and re-entrant in 28 patients. TM classified 11 VTs as single-loop re-entry, 15 as dual-loop re-entry, 1 as complex, and 1 case was indeterminant. The overall agreement between DGM and TM for determining VT mechanism and circuit type was strong (kappa value = 0.79; P < 0.01), as was the agreement between ACVM and TM (kappa value = 0.66; P < 0.01). Both DGM and ACVM identified the putative VT isthmus in 25 (89%) of the re-entrant cases. Focal activation was correctly identified by both techniques in all cases.

 CONCLUSIONS: DGM is a rapid automated algorithm that has a strong level of agreement with TM for manually re annotated VT maps. (c) 2023 by the American College of Cardiology Foundation.}},
  author       = {{Hawson, Joshua and Van Nieuwenhuyse, Enid and Van Den Abeele, Robin and  Al-kaisey, Ahmed and  Anderson, Robert D. and  Chieng, David and  Segan, Louise and  Watts, Troy and  Campbell, Timothy and Hendrickx, Sander and  Morton, Joseph and  McLellan, Alexander and  Kistler, Peter and  Lee, Adam and  Gerstenfeld, Edward P. and  Hsia, Henry H. and  Voskoboinik, Aleksander and  Pathik, Bhupesh and  Kumar, Saurabh and  Kalman, Jonathan and Lee, Geoffrey and Vandersickel, Nele}},
  issn         = {{2405-500X}},
  journal      = {{JACC-CLINICAL ELECTROPHYSIOLOGY}},
  keywords     = {{Coherent Mapping,directed graph mapping,ventricular arrhythmias,ventricular tachycardia,ABLATION,IDENTIFICATION,ENTRAINMENT,MULTICENTER,REENTRY}},
  language     = {{eng}},
  number       = {{7}},
  pages        = {{907--922}},
  title        = {{Directed graph mapping for ventricular tachycardia : a comparison to established mapping techniques}},
  url          = {{http://doi.org/10.1016/j.jacep.2022.08.013}},
  volume       = {{9}},
  year         = {{2023}},
}
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