Automated Detection of Complex Fractionated Atrial Electrograms In Substrate-Based Atrial Fibrillation Ablation:...

Area of Science:

• Electrophysiology
• Cardiac Mapping
• Atrial Fibrillation Ablation

Background:

• Complex fractionated atrial electrogram (CFAE) ablation for atrial fibrillation (AF) is challenging due to subjective analysis and difficulty distinguishing critical areas.
• Existing 3D mapping systems (CARTO®) have limitations in CFAE detection selectivity, often identifying overly broad areas.

Purpose of the Study:

• To demonstrate the enhanced selectivity of a new customized CFAE algorithm setting for improved discrimination of CFAEs critical to AF perpetuation.
• To compare the accuracy of automated CFAE detection using a customized setting versus the nominal setting.

Main Methods:

• 32 patients with various forms of AF underwent CFAE ablation guided by visual analysis.
• CARTO® shortest complex interval (SCI) algorithm mapping was performed pre-ablation and reanalyzed with nominal (SCI 60-120ms/0.05-0.15mV) and customized (SCI 30-40ms/0.04-0.15mV) settings.
• Comparison of automatically detected CFAE areas (CFAE-CARTO® areas) and ablated surface area between the two settings.

Main Results:

• The customized CARTO® SCI setting significantly reduced detected CFAE-CARTO® areas (30.6±20.5cm² vs. 68.8±24.5cm², p<0.0001).
• Ablated CFAE surface within non-CFAE CARTO® areas was reduced (1.86±1.82% vs. 3±3%, p=0.003) with the customized setting.
• The proportion of ablated areas to detected CFAE-CARTO® areas was higher with the customized setting (38.2±19.6% vs. 20.4±17.5%, p=0.008).

Conclusions:

• The customized CFAE algorithm setting offers significantly greater selectivity compared to the nominal setting.
• This improved selectivity enables more accurate automated detection of CFAEs crucial for AF perpetuation, aligning with experienced operator analysis.