Claire A Martin1, Masateru Takigawa2, Ruairidh Martin3, Philippe Maury4, Christian Meyer5, Tom Wong6, Rui Shi6, Parag Gajendragadkar7, Antonio Frontera2, Ghassen Cheniti2, Nathaniel Thompson2, Takeshi Kitamura2, Konstantinos Vlachos2, Michael Wolf2, Felix Bourier2, Anna Lam2, Josselin Duchâteau2, Grégoire Massoullié2, Thomas Pambrun2, Arnaud Denis2, Nicolas Derval2, Mélèze Hocini2, Michel Haïssaguerre2, Pierre Jaïs2, Frédéric Sacher2. 1. Electrophysiology and Ablation Unit, Bordeaux University Hospital (Centre Hospitalier Universitaire [CHU]), Pessac, France; Institut Hospitalo-Universitaire (IHU), LIRYC, Electrophysiology and Heart Modeling Institute, Fondation Bordeaux Université, Pessac- Bordeaux, France; Université Bordeaux, Institut National de la Santé et de la Recherche Médicale U1045, Bordeaux, France; Department of Electrophysiology, Royal Papworth Hospital National Health Service Foundation Trust, Cambridge, United Kingdom. Electronic address: clairemartin@gmail.com. 2. Electrophysiology and Ablation Unit, Bordeaux University Hospital (Centre Hospitalier Universitaire [CHU]), Pessac, France; Institut Hospitalo-Universitaire (IHU), LIRYC, Electrophysiology and Heart Modeling Institute, Fondation Bordeaux Université, Pessac- Bordeaux, France; Université Bordeaux, Institut National de la Santé et de la Recherche Médicale U1045, Bordeaux, France. 3. Electrophysiology and Ablation Unit, Bordeaux University Hospital (Centre Hospitalier Universitaire [CHU]), Pessac, France; Institut Hospitalo-Universitaire (IHU), LIRYC, Electrophysiology and Heart Modeling Institute, Fondation Bordeaux Université, Pessac- Bordeaux, France; Université Bordeaux, Institut National de la Santé et de la Recherche Médicale U1045, Bordeaux, France; Department of Cardiology, Newcastle University, Newcastle, United Kingdom. 4. Unité Inserm U 1048, University Hospital Rangueil, Toulouse, France. 5. Department of Cardiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany. 6. Department of Electrophysiology, Brompton Hospital, London, United Kingdom. 7. Department of Electrophysiology, Royal Papworth Hospital National Health Service Foundation Trust, Cambridge, United Kingdom.
Abstract
OBJECTIVES: This study reports the use of a novel "Lumipoint" algorithm in ventricular tachycardia (VT) ablation. BACKGROUND: Automatic mapping systems aid rapid acquisition of activation maps. However, they may annotate farfield rather than nearfield signal in low voltage areas, making maps difficult to interpret. The Lumipoint algorithm analyzes the complete electrogram tracing and therefore includes nearfield signals in its analysis. METHODS: Twenty-two patients with ischemic cardiomyopathy and 5 with dilated cardiomyopathy underwent mapping using the ultra-high density Rhythmia system. Lumipoint algorithms were applied retrospectively. RESULTS: In all left ventricular substrate maps, changing the window of interest to the post-QRS phase automatically identified late potentials. In 25 of 27 left ventricular VT activation maps, a minimum spatial window of interest correctly identified the VT isthmus as seen by the manually annotated map, entrainment, and response to ablation. In 6 maps, the algorithm identified the isthmus where the standard automatically annotated map did not. CONCLUSIONS: The Lumipoint algorithm automatically highlights areas with electrograms having specific characteristics or timings. This can identify late and fractionated potentials and regions that exhibit discontinuous activation, as well as the isthmus of a VT circuit. These features may enhance human interpretation of the electrogram signals during a case, particularly where the circuit lies in partial scar with low amplitude nearfield signals and potentially allow a more targeted ablation strategy.
OBJECTIVES: This study reports the use of a novel "Lumipoint" algorithm in ventricular tachycardia (VT) ablation. BACKGROUND: Automatic mapping systems aid rapid acquisition of activation maps. However, they may annotate farfield rather than nearfield signal in low voltage areas, making maps difficult to interpret. The Lumipoint algorithm analyzes the complete electrogram tracing and therefore includes nearfield signals in its analysis. METHODS: Twenty-two patients with ischemic cardiomyopathy and 5 with dilated cardiomyopathy underwent mapping using the ultra-high density Rhythmia system. Lumipoint algorithms were applied retrospectively. RESULTS: In all left ventricular substrate maps, changing the window of interest to the post-QRS phase automatically identified late potentials. In 25 of 27 left ventricular VT activation maps, a minimum spatial window of interest correctly identified the VT isthmus as seen by the manually annotated map, entrainment, and response to ablation. In 6 maps, the algorithm identified the isthmus where the standard automatically annotated map did not. CONCLUSIONS: The Lumipoint algorithm automatically highlights areas with electrograms having specific characteristics or timings. This can identify late and fractionated potentials and regions that exhibit discontinuous activation, as well as the isthmus of a VT circuit. These features may enhance human interpretation of the electrogram signals during a case, particularly where the circuit lies in partial scar with low amplitude nearfield signals and potentially allow a more targeted ablation strategy.