How much information is needed to map AT?
A fundamental question in arrhythmia mapping is how much information is really needed. Kuroda et al. should be credited not only for performing a rigorous study, but also for acknowledging that the best results were achieved by methods “combining activation mapping, entrainment and termination as determinants of true arrhythmia mechanisms”[Kuroda JCE 2021 – editor to fill in]. One could imagine future algorithms using machine learning or rule-based logic to integrate multiple parameters such as electrogram amplitude to reflect vectorial direction, fractionated electrograms, beat-to-beat variability in cycle length or other characteristics. It is also important to compare this algorithm to other global vectorial approaches, such as those reflecting conduction velocity near scar 9 or those already applied to panoramic contact baskets10, 11. Each of these tests should ultimately be performed prospectively, and may need to be tuned for patients with or without prior ablation, with and without atrial structural remodeling, and so on.
In summary, the authors should be congratulated for this clinical study of a very innovative and physiologically plausible approach to provide ‘automated interpretation’ of electroanatomic maps in complex atrial arrhythmias. We look forward to future developments in this field.
References
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