Abstract
BackgroundSpecific tools have been recently developed to map atrial fibrillation (AF) and help guide ablation. However, when used in clinical practice, panoramic AF maps generated from multipolar intracardiac electrograms have yielded conflicting results between centers, likely due to their complexity and steep learning curve, thus limiting the proper assessment of its clinical impact.ObjectivesThe main purpose of this trial was to assess the impact of online training on the identification of AF driver sites where ablation terminated persistent AF, through a standardized training program. Extending this concept to mobile health was defined as a secondary objective.MethodsAn online database of panoramic AF movies was generated from a multicenter registry of patients in whom targeted ablation terminated non-paroxysmal AF, using a freely available method (Kuklik et al–method A) and a commercial one (RhythmView–method B). Cardiology Fellows naive to AF mapping were enrolled and randomized to training vs no training (control). All participants evaluated an initial set of movies to identify sites of AF termination. Participants randomized to training evaluated a second set of movies in which they received feedback on their answers. Both groups re-evaluated the initial set to assess the impact of training. This concept was then migrated to a smartphone application (App).Results12 individuals (median age of 30 years (IQR 28–32), 6 females) read 480 AF maps. Baseline identification of AF termination sites by ablation was poor (40%±12% vs 42%±11%, P = 0.78), but similar for both mapping methods (P = 0.68). Training improved accuracy for both methods A (P = 0.001) and B (p = 0.012); whereas controls showed no change in accuracy (P = NS). The Smartphone App accessed AF maps from multiple systems on the cloud to recreate this training environment.ConclusionDigital online training improved interpretation of panoramic AF maps in previously inexperienced clinicians. Combining online clinical data, smartphone apps and other digital resources provides a powerful, scalable approach for training in novel techniques in electrophysiology.
Highlights
Portable diagnostic devices and mobile health are powerful technologies in healthcare [1,2]
Baseline identification of atrial fibrillation (AF) termination sites by ablation was poor
We applied the paradigm of digital online training and visualization to the novel and challenging task of interpreting complex panoramic AF maps, such as those obtained from multipolar intracardiac electrograms
Summary
Portable diagnostic devices and mobile health (mHealth) are powerful technologies in healthcare [1,2] Together, they have altered the paradigm in which students and healthcare providers train and acquire new competencies[1,3,4,5],[6], with a generally positive impact in education and practice[6,7], and are likely to become a dominant mode of clinical training. Tools designed to compare maps from multiple approaches/ technologies, on data from the same patient, are lacking It remains unclear if these factors contribute to variable results between centers.[20,23,24]. When used in clinical practice, panoramic AF maps generated from multipolar intracardiac electrograms have yielded conflicting results between centers, likely due to their complexity and steep learning curve, limiting the proper assessment of its clinical impact
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
