Abstract
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.
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Data availability
The data that support the findings of this study are available from the corresponding author upon reasonable request.
References
Dong J, Dickfeld T, Dalal D, et al. Initial experience in the use of integrated electroanatomic mapping with three-dimensional MR/CT images to guide catheter ablation of atrial fibrillation. J Cardiovasc Electrophysiol. 2006;17(5):459–66. https://doi.org/10.1111/j.1540-8167.2006.00425.x [publishedOnlineFirst:2006/05/11].
Kistler PM, Earley MJ, Harris S, et al. Validation of three-dimensional cardiac image integration: use of integrated CT image into electroanatomic mapping system to perform catheter ablation of atrial fibrillation. J Cardiovasc Electrophysiol. 2006;17(4):341–8. https://doi.org/10.1111/j.1540-8167.2006.00371.x [publishedOnlineFirst:2006/04/29].
Kistler PM, Rajappan K, Jahngir M, et al. The impact of CT image integration into an electroanatomic mapping system on clinical outcomes of catheter ablation of atrial fibrillation. J Cardiovasc Electrophysiol. 2006;17(10):1093–101. https://doi.org/10.1111/j.1540-8167.2006.00594.x [publishedOnlineFirst:2006/09/23].
Martinek M, Nesser HJ, Aichinger J, et al. Impact of integration of multislice computed tomography imaging into three-dimensional electroanatomic mapping on clinical outcomes, safety, and efficacy using radiofrequency ablation for atrial fibrillation. Pacing Clin Electrophysiol. 2007;30(10):1215–23. https://doi.org/10.1111/j.1540-8159.2007.00843.x [publishedOnlineFirst:2007/09/28].
Mikaelian BJ, Malchano ZJ, Neuzil P, et al. Images in cardiovascular medicine. Integration of 3-dimensional cardiac computed tomography images with real-time electroanatomic mapping to guide catheter ablation of atrial fibrillation. Circulation 2005;112(2):e35–6. doi: https://doi.org/10.1161/01.CIR.0000161085.58945.1C [published Online First: 2005/07/13]
Rordorf R, Chieffo E, Savastano S, et al. Anatomical mapping for atrial fibrillation ablation: a head-to-head comparison of ultrasound-assisted reconstruction versus fast anatomical mapping. Pacing Clin Electrophysiol. 2015;38(2):187–95. https://doi.org/10.1111/pace.12539 [publishedOnlineFirst:2014/12/04].
Subbarao Choudry MD WWM, Aamir Sofi MD, Meir Bar-Tal MSc,, Jacob S. Koruth MD MAMM, Stephanie M. Harcum MS, Felicia Biondo BA, Srinivas R. Dukkipati MD, and Vivek Y. Reddy MD. Rendering of left atrial - pulmonary vein anatomy using a model-based software algorithm: first use in humans. Abstract presented at the Heart Rhythm Society Meeting, Boston (USA) 2019
Subbarao Choudry M, William Whang, MD, FHRS, Aamir A.. Sofi, MD, Jose Osorio, MD, FHRS, Raphael Rosso, MD, Niels Sandgaard, MD, Alexis Mechulan, PhD, Michael Wolf, MD, Martin Huemer, MD, Meir Bar-tal, Marc A. Miller, MD, Jacob S. Koruth, MBBS, MD, Stephanie M.. Harcum, BA, Srinivas R.. Dukkipati, MD, FHRS and Vivek Y.. Reddy, MD. . Utility of an intelligent model-based software algorithm for rendering left atrial anatomy during AF ablation. Abstract accepted at the Heart Rhythm Society Meeting, San Diego (USA) 2020 2020
Rosso R, Chorin E, Levi Y, et al. Radiofrequency ablation of atrial fibrillation: nonrandomized comparison of circular versus point-by-point “smart” ablation for achieving circumferential pulmonary vein isolation and curing arrhythmic symptoms. J Cardiovasc Electrophysiol. 2016;27(11):1282–7. https://doi.org/10.1111/jce.13058 [publishedOnlineFirst:2016/07/30].
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The study protocol was approved by the local ethical committee and registered in the Israel Ministry of Health (MOH 2020–06-22_009053). Written informed consent was obtained from all study subjects.
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Dr. Rosso serves as a consultant for Biosense Webster. All other authors declare no competing interests.
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Schwartz, A.L., Chorin, E., Mann, T. et al. Reconstruction of the left atrium for atrial fibrillation ablation using the machine learning CARTO 3 m-FAM software. J Interv Card Electrophysiol 64, 39–47 (2022). https://doi.org/10.1007/s10840-021-01045-4
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DOI: https://doi.org/10.1007/s10840-021-01045-4