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Clinical assessment and comparison of annotation algorithms in high-density mapping of regular atrial tachycardias

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Abstract
Background: High-density automated mapping of regular atrial tachycardias (ATs) requires accurate assessment of local activation times (LATs). Objective: To evaluate high-density mapping of ATs and compare the accuracy of different automated LAT annotation algorithms. Methods: Fifteen patients underwent AT ablation guided by the automated ConfiDENSE high-density mapping module (Carto 3 v4) allowing manual reannotation (edited maps). For each AT, unedited automated maps were reconstructed offline by three algorithms: maximum unipolar slope (LAT(Slope)), bipolar peak (LAT(Peak)), and a new hybrid annotation algorithm (LAT(Hybrid)). Five blinded experts were asked to define the (1) tachycardia mechanism, (2) ablation target, and (3) level of difficulty of these unedited maps. Results: Twenty-one ATs (cycle length 300 +/- 46 ms, activation points 955 +/- 421) were successfully ablated using LAT(Hybrid) guided ablation with manual editing in a small number of points. At 6 months, 14 (93%) of the patients were free of AT recurrences. Unedited LAT(Hybrid) maps showed the highest accuracy in defining the tachycardia mechanism (LAT(Hybrid): 49% vs. LAT(Peak): 27% vs. LAT(slope): 28%, P < 0,001) and ablation target (LAT(Hybrid): 65% vs. LAT(Peak): 39% vs. LAT(slope): 31%, P < 0.001). Overall, LAT(Hybrid)-annotated maps were graded as "easier to interpret" by the experts (difficulty score 2.3 +/- 0.9) versus LAT(Peak)(2.8 +/- 1) and LAT(slope)(3.2 +/- 0.8) (P< 0.001), Only 12% of the LAT(Hybrid) maps were annotated as uninterpretable compared to 31% of LAT(stope) and 45% of the LAT(Peak) maps (P < 0.001). Conclusion: Automated LAT(Hybrid) annotation allows better and easier recognition of the tachycardia mechanism compared to automated LAT(Peak) and LAT(stope) algorithms, although fully automated mapping still requires further improvements.
Keywords
annotation, atrial tachycardia, catheter ablation, ConfiDENSE, high-density mapping, local activation time, LOCAL ACTIVATION, ELECTROGRAMS, EXPERIENCE, ABLATION, TIME

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MLA
De Pooter, Jan et al. “Clinical Assessment and Comparison of Annotation Algorithms in High-density Mapping of Regular Atrial Tachycardias.” JOURNAL OF CARDIOVASCULAR ELECTROPHYSIOLOGY 29.1 (2018): 177–185. Print.
APA
De Pooter, Jan, El Haddad, M., Wolf, M., Phlips, T., Van Heuverswyn, F., Timmers, L., Tavernier, R., et al. (2018). Clinical assessment and comparison of annotation algorithms in high-density mapping of regular atrial tachycardias. JOURNAL OF CARDIOVASCULAR ELECTROPHYSIOLOGY, 29(1), 177–185.
Chicago author-date
De Pooter, Jan, Milad El Haddad, Michael Wolf, Thomas Phlips, Frederic Van Heuverswyn, Liesbeth Timmers, René Tavernier, Sébastien Knecht, Yves Vandekerckhove, and Mattias Duytschaever. 2018. “Clinical Assessment and Comparison of Annotation Algorithms in High-density Mapping of Regular Atrial Tachycardias.” Journal of Cardiovascular Electrophysiology 29 (1): 177–185.
Chicago author-date (all authors)
De Pooter, Jan, Milad El Haddad, Michael Wolf, Thomas Phlips, Frederic Van Heuverswyn, Liesbeth Timmers, René Tavernier, Sébastien Knecht, Yves Vandekerckhove, and Mattias Duytschaever. 2018. “Clinical Assessment and Comparison of Annotation Algorithms in High-density Mapping of Regular Atrial Tachycardias.” Journal of Cardiovascular Electrophysiology 29 (1): 177–185.
Vancouver
1.
De Pooter J, El Haddad M, Wolf M, Phlips T, Van Heuverswyn F, Timmers L, et al. Clinical assessment and comparison of annotation algorithms in high-density mapping of regular atrial tachycardias. JOURNAL OF CARDIOVASCULAR ELECTROPHYSIOLOGY. 2018;29(1):177–85.
IEEE
[1]
J. De Pooter et al., “Clinical assessment and comparison of annotation algorithms in high-density mapping of regular atrial tachycardias,” JOURNAL OF CARDIOVASCULAR ELECTROPHYSIOLOGY, vol. 29, no. 1, pp. 177–185, 2018.
@article{8545023,
  abstract     = {Background: High-density automated mapping of regular atrial tachycardias (ATs) requires accurate assessment of local activation times (LATs). 
Objective: To evaluate high-density mapping of ATs and compare the accuracy of different automated LAT annotation algorithms. 
Methods: Fifteen patients underwent AT ablation guided by the automated ConfiDENSE high-density mapping module (Carto 3 v4) allowing manual reannotation (edited maps). For each AT, unedited automated maps were reconstructed offline by three algorithms: maximum unipolar slope (LAT(Slope)), bipolar peak (LAT(Peak)), and a new hybrid annotation algorithm (LAT(Hybrid)). Five blinded experts were asked to define the (1) tachycardia mechanism, (2) ablation target, and (3) level of difficulty of these unedited maps. 
Results: Twenty-one ATs (cycle length 300 +/- 46 ms, activation points 955 +/- 421) were successfully ablated using LAT(Hybrid) guided ablation with manual editing in a small number of points. At 6 months, 14 (93%) of the patients were free of AT recurrences. Unedited LAT(Hybrid) maps showed the highest accuracy in defining the tachycardia mechanism (LAT(Hybrid): 49% vs. LAT(Peak): 27% vs. LAT(slope): 28%, P < 0,001) and ablation target (LAT(Hybrid): 65% vs. LAT(Peak): 39% vs. LAT(slope): 31%, P < 0.001). Overall, LAT(Hybrid)-annotated maps were graded as "easier to interpret" by the experts (difficulty score 2.3 +/- 0.9) versus LAT(Peak)(2.8 +/- 1) and LAT(slope)(3.2 +/- 0.8) (P< 0.001), Only 12% of the LAT(Hybrid) maps were annotated as uninterpretable compared to 31% of LAT(stope) and 45% of the LAT(Peak) maps (P < 0.001). 
Conclusion: Automated LAT(Hybrid) annotation allows better and easier recognition of the tachycardia mechanism compared to automated LAT(Peak) and LAT(stope) algorithms, although fully automated mapping still requires further improvements.},
  author       = {De Pooter, Jan and El Haddad, Milad and Wolf, Michael and Phlips, Thomas and Van Heuverswyn, Frederic and Timmers, Liesbeth and Tavernier, René and Knecht, Sébastien and Vandekerckhove, Yves and Duytschaever, Mattias},
  issn         = {1045-3873},
  journal      = {JOURNAL OF CARDIOVASCULAR ELECTROPHYSIOLOGY},
  keywords     = {annotation,atrial tachycardia,catheter ablation,ConfiDENSE,high-density mapping,local activation time,LOCAL ACTIVATION,ELECTROGRAMS,EXPERIENCE,ABLATION,TIME},
  language     = {eng},
  number       = {1},
  pages        = {177--185},
  title        = {Clinical assessment and comparison of annotation algorithms in high-density mapping of regular atrial tachycardias},
  url          = {http://dx.doi.org/10.1111/jce.13371},
  volume       = {29},
  year         = {2018},
}

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