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M. Tamboli, C. Kowaleski, B. Imielski, M. Alhusseini, T. Baykaner, J. Zaman, F. Shenasa, D. Krummen, M. Viswanathan, P. Wang, J. Brachmann, J. Miller, D. Vidmar, W.J. Rappel, S. Narayan, 59
Interobserver variability in identifying regions where targeted ablation terminates persistent atrial fibrillation using different mapping approaches, European Heart Journal, Volume 38, Issue suppl_1, August 2017, ehx501.59, https://doi.org/10.1093/eurheartj/ehx501.59Close - Share Icon Share
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Introduction: Identifying organized sources for atrial fibrillation (AF) is controversial since different mapping approaches have shown to have variable success of ablation. We hypothesized that retrospective blinded reads of these mapping data may yield concordance between 2 published mapping algorithms.
Purpose: To characterize interobserver variability in identifying AF sources between two independent phase mapping methods, in patients in whom targeted ablation was proven to terminate persistent AF, thereby implying their potential mechanistic value. Data and software will be made available online.
Methods: We studied 33 patients (62±9 years, 26 males, 100% persistent AF) in whom targeted ablation before PVI terminated AF to sinus rhythm (n=23) or atrial tachycardia. Ablation was guided by 64 electrode basket recordings analyzed by method (1) Phase (FIRM, Narayan JACC 2012) and re-analyzed by method (2) Phase (Kuklik, IEEE 2006). A panel of 3 blinded readers visually interpreted maps from each algorithm retrospectively.
Results: Fourteen patients (42%) showed spatially concordant sources (i.e. ≤1.5 electrode) by all 3 reviewers, an additional 13 (40%) were concordant by 2/3 reviewers (i.e. 82% combined, Fig. A). The figure shows a counterclockwise AF-terminating source identified by 3 reviewers by both methods, analyzed by method (1) (Fig. B) and method (2) (Fig. C). Interobserver reproducibility was higher if spatial concordance was defined loosely (<1.5 electrode; p=0.032) than tightly (<1 electrode; p=0.059), and higher for method (1) than (2) for both definitions. Six patients (18%) had no detectable sources by 2/3 reviewers, with only partial rotations/foci, even though ablation at a site identified intra-procedurally terminated persistent AF.
