Novel Automated Paced Fractionation Detection Algorithm for Ablating Ventricular Tachycardia

Abstract

Catheter ablation therapy has become a key intervention in treatment of ventriculartachycardia (VT). However, current fractionation mapping methods used to isolate the ablation targets in VT patients are done manually, and are therefore time consuming. They also have limited success rates (50% recurrence rate within 2 years). We present a fully automated fractionation detection algorithm for patients with VT which expands on previously defined fractionation features and which substantially decreases associated study times. Paced electrogram signals were collected from six patients during electrophysiologic study according to a modified paced electrogram fractionation analysis protocol. Data were exported and analyzed offline using custom written software. Electrograms from right ventricular pacing catheter were used as reference. Surface electrograms, along with ventricular geometry and relative catheter locations, were used to identify physiological interference and physiologically irrelevant features. A total of 264 electrograms, collected from a roving catheter, were manually and automatically annotated for fractionation as defined by three features: conduction time (CT), electrogram duration (ED), and number of deflections (ND). Of these, 60 were selected manually to have no discernable features and were successfully discarded by our algorithm; yielding a specificity of 100%. Of the remaining 204, 16 were erroneously discarded by our algorithm; yielding a sensitivity of 92.16%. A comparison between annotations showed correlations of 0.98, 0.97, and 0.94 for AL, ED, and ND respectively.