Novel "late potential map" algorithm: Abnormal potentials and scar channels detection for ventricular tachycardia
Nuno Cortez-Dias1,2, Gustavo Lima da Silva1,2, Afonso Nunes-Ferreira1,2
1Cardiology Department, Lisbon Academic Medical Centre, Santa Maria University Hospital (CHULN), Lisbon, Portugal.
Journal of Cardiovascular Electrophysiology
|March 26, 2022
Summary
A new late potential map (LPM) algorithm improves automated annotation of ventricular tachycardia (VT) substrate maps. Local conduction velocity (LCV) analysis successfully identified VT isthmuses, enhancing scar-related VT characterization.
Area of Science:
- Electrophysiology
- Cardiac Mapping
- Medical Device Technology
Background:
- Automated substrate mapping for ventricular tachycardia (VT) ablation can misinterpret signals, hindering map interpretability.
- Accurate quantitative assessment of local conduction velocity (LCV) is currently lacking in clinical practice for VT ablation.
- Identifying critical VT isthmuses within myocardial scar remains a challenge.
Purpose of the Study:
- To evaluate a novel late potential map (LPM) algorithm for automatic and reliable annotation of ventricular electrograms (EGMs).
- To assess the capability of localized bipolar voltage measurement using the LPM algorithm.
- To determine if LCV analysis can identify intrascar conduction corridors serving as VT isthmuses.
Main Methods:
- 16 patients undergoing scar-related VT ablation were included.
- VT activation and high-density substrate maps were acquired.
- The LPM algorithm's performance was compared against manual annotations and a prior algorithm; LCV analysis was performed on substrate maps to identify VT isthmuses.
Main Results:
- The LPM algorithm demonstrated superior overall (94.5%) and local (81.1%) abnormal ventricular activity (LAVA) annotation accuracy compared to the previous algorithm.
- The LPM algorithm's maps showed 88.1% spatial concordance in delineating LAVA regions.
- LCV analysis identified a median of two intrascar conduction corridors per patient, including the VT isthmus in all cases.
Conclusions:
- The novel LPM algorithm offers improved automated substrate characterization for scar-related VT.
- LCV analysis is a valuable tool for identifying VT isthmuses within myocardial scar.
- Combined LPM algorithm and LCV analysis hold promise for enhancing VT ablation strategies.
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