Comparison of first deflection annotation algorithm and near-field annotation algorithm in premature ventricular...

Area of Science:

• Electrophysiology
• Cardiac Mapping

Background:

• Accurate identification of the earliest activation site is crucial for successful catheter ablation of premature ventricular complexes (PVCs).
• Current mapping techniques require optimization for precise localization.

Purpose of the Study:

• To compare the efficacy of First Deflection (FD) and Near-Field (NF) detection using Turbomap on the Ensite X system for identifying earliest activation sites in PVC ablation.
• To assess differences in local activation time (LAT), peak frequency, activation area, and spatial distance between FD and NF detection.

Main Methods:

• Retrospective analysis of 59 patients undergoing first-time PVC ablation.
• Remapping using Turbomap to extract FD and NF parameters at earliest activation sites.
• Comparison of ΔLAT, Δ peak frequency, Δ activation area, and spatial distance between techniques.

Main Results:

• FD detection yielded significantly earlier LAT compared to NF detection.
• NF detection identified significantly higher peak frequencies than FD detection.
• A shorter spatial distance between FD and NF earliest activation sites correlated with successful PVC elimination within two ablation attempts.

Conclusions:

• FD detection is superior for identifying earlier activation times, while NF detection excels at capturing higher-frequency signals.
• The spatial proximity of FD and NF earliest activation sites may predict ablation success.
• Mapping parameters did not significantly differ across PVC origin or ablation strategy groups, but spatial correlation is key.