- https://doi.org/10.1109/embc53108.2024.10781948
Validation of an algorithm for automatic calculation of inter-lesion distance in radiofrequency catheter ablation of atrial fibrillation.
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Take Notes Atrial Fibrillation (AF) is a heart rhythm disorder characterized by rapid and irregular atrial contractions, which can increase the risk of stroke and decrease patients' quality of life. One of the main techniques to treat AF is RF catheter ablation, which involves electrically isolating the pulmonary veins from the rest of the atrium, based on point lesions surrounding the veins. There is still discussion in the community as to what is the optimal interlesion distance to improve the long-term results of AF ablation. A Python tool has been developed that, starting from the AF ablation procedure data, finds the optimal sequence of ablations surrounding the pulmonary veins and thus can calculate the distance between the entire sequence of lesions. The automated algorithm proved to be effective in most cases and in almost all cases semi-automatically. The work provides a tool for the community that can help to optimize AF ablation. In the future, the algorithm could be improved to be 100% automatic, although right now it is already useful and several clinical studies are underway using this tool.
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During the past decade, catheter ablation of atrial fibrillation (AF) has emerged as an important treatment option for patients with symptomatic AF refractory to ≥1 antiarrhythmic agents. Electric isolation of the pulmonary vein musculature (PVI) has been identified as the primary end point for both catheter- and surgical-based AF ablation procedures.1 What is less clear is whether the addition of “linear lesions” or ablation of atrial sites demonstrating complex atrial electrograms improves outcome for patients with paroxysmal, persistent, or long-standing persistent AF.2,3 This issue remains an area of active discussion, debate, and investigation. Article see p 269 In this issue of Circulation: Arrhythmia and Electrophysiology , Gaita et al2 report the results of a prospective single-center randomized study of 204 patients who underwent catheter ablation for treatment of paroxysmal or persistent/permanent AF. Patients were stratified according to whether they had paroxysmal (n=125) or persistent/permanent (n=79) AF and were then randomized in a 2:1 fashion to undergo PVI alone or PVI combined with a “roof line” and a “left mitral line.” Follow-up visits that included an ECG, 24-hour Holter, and an echocardiogram were set up at 1, 3, 6, 12, 18, 24, and 30 months and then every year thereafter. If a patient experienced symptoms between follow-up visits, an event monitor was prescribed. A recurrence was defined as a symptomatic or asymptomatic episode of AF or atrial flutter lasting ≥30 seconds after a 2-month blanking period. Patients who developed a recurrence after the blanking period were offered a repeat ablation procedure. The outcome of ablation was evaluated at 12 months of follow-up and at completion of the study. Each patient was followed for a minimum of 3 years. Among the 125 patients with paroxysmal AF, the single-procedure success rate at 12 months was 46% with PVI alone versus …
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▪ Abstract Atrial fibrillation is frequently disabling and resistant to antiarrhythmic drugs. Curative treatment by catheter-based ablation has been shown to be feasible either by achieving long linear lesions, mainly in the left atrium, or by targeting the initiating focus, most frequently in the pulmonary veins. This paper reviews the different ablation approaches, their results, potential complications, and relative merits.
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