Purpose

Atrial fibrillation (AF) ablation requires a precise reconstruction of the left atrium (LA) and pulmonary veins (PV). Model-based FAM (m-FAM) is a novel module recently developed for the CARTO system which applies machine learning techniques to LA reconstruction. We aimed to evaluate the feasibility and safety of a m-FAM-guided AF ablation as well as the accuracy of LA reconstruction using the cardiac computed tomography angiography (CTA) of the same patient LA as the gold standard, in 32 patients referred for AF ablation.

Methods

Consecutive patients undergoing AF ablation. The m-FAM reconstruction was performed with the ablation catheter (group 1) or a Pentaray and ablation catheters (group 2). The reconstruction accuracy was confirmed prior to the ablation by verification of pre-specified landmarks of the LA and PVs by an intracardiac echocardiogram (ICE) visualization and fluoroscopy. A cardiac CTA performed before the ablation was used as the gold standard of LA anatomy. For each patient, the m-FAM reconstruction was compared to his/her cardiac CTA.

Results

The m-FAM reconstruction was accurate in all patients regardless of the catheter used for mapping. Twelve percent re-acquisition of the LA landmarks was necessary to improve the accuracy. m-FAM time was shorter in group 2 while the M-Fam fluoroscopy time was similar. Pulmonary vein isolation was achieved in 100% of patients without major complications. The m-FAM reconstructions accurately resemble the cardiac CTA of the same patients.

Conclusions

The m-FAM module allows for rapid and precise reconstruction of the LA and PV anatomy, which can be safely used to guide AF ablation.

中文翻译：

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使用机器学习 CARTO 3 m-FAM 软件重建左心房用于房颤消融

目的

心房颤动 (AF) 消融需要精确重建左心房 (LA) 和肺静脉 (PV)。基于模型的 FAM (m-FAM) 是最近为 CARTO 系统开发的一个新模块，它将机器学习技术应用于 LA 重建。我们旨在评估 m-FAM 引导的 AF 消融的可行性和安全性，以及使用同一患者 LA 作为金标准的心脏 CT 血管造影 (CTA) 重建 LA 的准确性，在 32 名转诊为 AF 的患者中消融。

方法

连续接受 AF 消融的患者。使用消融导管（第 1 组）或 Pentaray 和消融导管（第 2 组）进行 m-FAM 重建。在消融之前，通过心内超声心动图 (ICE) 可视化和透视检查预先指定的 LA 和 PV 标志来确认重建准确性。消融前进行的心脏 CTA 被用作 LA 解剖学的金标准。对于每位患者，将 m-FAM 重建与他/她的心脏 CTA 进行比较。

结果

无论用于标测的导管如何，所有患者的 m-FAM 重建都是准确的。需要 12% 的 LA 地标重新采集以提高准确性。第 2 组的 m-FAM 时间较短，而 M-Fam 透视时间相似。100% 的患者实现了肺静脉隔离，没有严重并发症。m-FAM 重建准确地类似于同一患者的心脏 CTA。

结论

m-FAM 模块允许快速和精确地重建 LA 和 PV 解剖结构，可以安全地用于指导 AF 消融。