Initial multicenter experience with a new High-Density coloring module:
impact for complex atrial arrhythmias interpretation
Abstract
Background: High-density automated mapping of complex atrial
tachycardias (ATs) requires accurate assessment of activation maps. A
new local activation display module (HD Coloring, Biosense Webster®)
provides higher map resolution, a better delineation of potential block
reducing color interpolation, and a new propagation display. We
evaluated the accuracy of a dedicated local activation display compared
to standard algorithm. Methods: High density maps from 10 organized
atrial tachycardias were collected with a multipolar catheter and were
displayed with standard activation or HD Coloring. Six blinded expert
operators retrospectively analyzed activation maps and were asked to
define (1) the tachycardia mechanism, (2) ablation target, and (3) level
of difficulty to interpret those maps. Results: Using HD Coloring,
operators were able to reach a correct diagnosis in 93% vs. 63%,
p<0.05 compared to standard activation maps. Time to diagnosis
was shorter 1.9±1.0 min vs. 3.9±2.1 min, p<0.05. Confidence
level would have allowed ablation without necessity for entrainment
maneuvers in 87% vs. 53%, p<0.05. Operators would have
needed to remap or proceed with multiple entrainments in 3% vs. 13% of
cases, p<0.05. Finally, ablation strategy was more accurately
identified in 97% vs. 67%, p<0.05. Conclusion: Activation
mapping with the new HD Coloring Module allowed a more accurate,
reliable, and faster interpretation of complex ATs mechanisms compared
to standard activation maps.