MANual vs. automatIC local activation time annotation for guiding Premature Ventricular Complex ablation procedures...

Area of Science:

• Cardiology
• Electrophysiology
• Medical Technology

Background:

• Premature ventricular complex (PVC) ablation procedures often rely on manual annotation of local activation time (LAT).
• Optimizing procedural efficiency is crucial for improving patient outcomes and resource utilization in electrophysiology labs.

Purpose of the Study:

• To evaluate the benefits of an automatic LAT acquisition protocol using wavefront annotation and ECG pattern matching (AUT-arm) in PVC ablation.
• To compare the procedural efficiency and success rates of the automatic protocol against conventional manual annotation (MAN-arm).

Main Methods:

• A prospective, randomized, controlled, international multicenter study enrolled 100 patients undergoing PVC ablation.
• Patients were randomized to either the automatic (AUT) or manual (MAN) LAT annotation protocol using the CARTO3 navigation system.
• Primary endpoint was mapping success; clinical success was defined as ≥80% PVC burden reduction at 6 months.

Main Results:

• The automatic protocol significantly reduced mapping and procedure times (P < 0.014) and increased acquired mapping points (P < 0.001).
• Both mapping and clinical success rates were similar between the AUT and MAN groups.
• No significant differences in radiofrequency time, RF applications, or procedure-related complications were observed.

Conclusions:

• The automatic LAT annotation protocol offers higher procedural efficiency in PVC ablation compared to manual methods.
• This automated approach achieves comparable clinical outcomes, demonstrating its potential as a valuable tool for electrophysiologists.
• The study supports the adoption of automated protocols to streamline PVC ablation procedures without compromising efficacy.