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.
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