1. Artificial intelligence software standardizes electrogram‐based ablation outcome for persistent atrial fibrillation
- Author
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Julien Seitz, Théophile Mohr Durdez, Jean P. Albenque, André Pisapia, Edouard Gitenay, Cyril Durand, Jacques Monteau, Ghassan Moubarak, Guillaume Théodore, Antoine Lepillier, Alexandre Zhao, Michel Bremondy, Alexandre Maluski, Bruno Cauchemez, Stéphane Combes, Yves Guyomar, Sébastien Heuls, Olivier Thomas, Guillaume Penaranda, Sabrina Siame, Anthony Appetiti, Paola Milpied, Clément Bars, and Jérôme Kalifa
- Subjects
Treatment Outcome ,Artificial Intelligence ,Pulmonary Veins ,Recurrence ,Physiology (medical) ,Atrial Fibrillation ,Catheter Ablation ,Humans ,Prospective Studies ,Cardiology and Cardiovascular Medicine ,Anti-Arrhythmia Agents ,Software - Abstract
Multiple groups have reported on the usefulness of ablating in atrial regions exhibiting abnormal electrograms during atrial fibrillation (AF). Still, previous studies have suggested that ablation outcomes are highly operator- and center-dependent. This study sought to evaluate a novel machine learning software algorithm named VX1 (Volta Medical), trained to adjudicate multipolar electrogram dispersion.This study was a prospective, multicentric, nonrandomized study conducted to assess the feasibility of generating VX1 dispersion maps. In 85 patients, 8 centers, and 17 operators, we compared the acute and long-term outcomes after ablation in regions exhibiting dispersion between primary and satellite centers. We also compared outcomes to a control group in which dispersion-guided ablation was performed visually by trained operators.The study population included 29% of long-standing persistent AF. AF termination occurred in 92% and 83% of the patients in primary and satellite centers, respectively, p = 0.31. The average rate of freedom from documented AF, with or without antiarrhythmic drugs (AADs), was 86% after a single procedure, and 89% after an average of 1.3 procedures per patient (p = 0.4). The rate of freedom from any documented atrial arrhythmia, with or without AADs, was 54% and 73% after a single or an average of 1.3 procedures per patient, respectively (p 0.001). No statistically significant differences between outcomes of the primary versus satellite centers were observed for one (p = 0.8) or multiple procedures (p = 0.4), or between outcomes of the entire study population versus the control group (p 0.2). Interestingly, intraprocedural AF termination and type of recurrent arrhythmia (i.e., AF vs. AT) appear to be predictors of the subsequent clinical course.VX1, an expertise-based artificial intelligence software solution, allowed for robust center-to-center standardization of acute and long-term ablation outcomes after electrogram-based ablation.
- Published
- 2022