Novel algorithm for accelerated electroanatomic mapping and prediction of earliest activation of focal cardiacarrhythmias using mathematical optimization

Abstract

BACKGROUNDPremature beats (PBs) are a commonfinding in pa-tients suffering from structural heart disease, but they can also bepresent in healthy individuals. Catheter ablation represents a suit-able therapeutic approach. However, the exact localization of theorigin can be challenging, especially in cases of low PB burden dur-ing the procedure.OBJECTIVEThe aim of this study was to develop an automatedmapping algorithm on the basis of the hypothesis that mathemat-ical optimization would significantly accelerate the localization ofearliest activation.METHODSThe algorithm is based on iterative regression analyses.When acquiring local activation times (LATs) within a 3-dimensionalanatomic map of the corresponding heart chamber, this algorithm isable to identify that exact position where a next LAT measurementadds maximum information about the predicted site of origin.Furthermore, on the basis of the acquired LAT measurements, thealgorithm is able to predict earliest activation with high accuracy.RESULTSA systematic retrospective analysis of the mapping per-formance comparing the operator with simulated search processesby the algorithm within 17 electroanatomic maps of focal spreadingarrhythmias revealed a highly significant reduction of necessary LATmeasurements from 5568.8 to 1060.51 (n517;P,.0001).CONCLUSIONOn the basis of mathematical optimization, wedeveloped an algorithm that is able to reduce the number of LATmeasurements necessary to locate the site of earliest activation.This algorithm might significantly accelerate the mapping proced-ure by guiding the operator to the optimal position for the nextLAT measurement. Furthermore, the algorithm would be able to pre-dict the site of origin with high accuracy early during the mappingprocedure.