Artificial intelligence software standardizes electrogram‐based ablation outcome for persistent atrial fibrillation

• Published in: Journal of cardiovascular electrophysiology Vol. 33; no. 11; pp. 2250 - 2260
• Main Authors: Seitz, Julien, Durdez, Théophile Mohr, Albenque, Jean P., Pisapia, André, Gitenay, Edouard, Durand, Cyril, Monteau, Jacques, Moubarak, Ghassan, Théodore, Guillaume, Lepillier, Antoine, Zhao, Alexandre, Bremondy, Michel, Maluski, Alexandre, Cauchemez, Bruno, Combes, Stéphane, Guyomar, Yves, Heuls, Sébastien, Thomas, Olivier, Penaranda, Guillaume, Siame, Sabrina, Appetiti, Anthony, Milpied, Paola, Bars, Clément, Kalifa, Jérôme
• Format: Journal Article
• Language: English
• Published: United States Wiley Subscription Services, Inc 01-11-2022; John Wiley and Sons Inc
• Subjects: Ablation; Anti-Arrhythmia Agents - therapeutic use; Arrhythmia; Artificial Intelligence; atrial fibrillation; Atrial Fibrillation - diagnosis; Atrial Fibrillation - drug therapy; Atrial Fibrillation - surgery; Cardiac arrhythmia; catheter ablation; Catheter Ablation - adverse effects; Catheter Ablation - methods; dispersion; driver; Fibrillation; Humans; mapping; Original; Patients; Population studies; Prospective Studies; Pulmonary Veins - surgery; Recurrence; sinus rhythm; Software; Standardization; Statistical analysis; Treatment Outcome; atrial fibrillation; mapping; driver; sinus rhythm; catheter ablation; dispersion; artificial intelligence
• ISSN: 1045-3873; 1540-8167
• DOI: 10.1111/jce.15657

Introduction
Multiple groups have reported on the usefulness of ablating in atrial regions exhibiting abnormal electrograms during atrial fibrillation (AF). Still, previous studies have suggested that ablation outcomes are highly operator‐ and center‐dependent. This study sought to evaluate a novel machine learning software algorithm named VX1 (Volta Medical), trained to adjudicate multipolar electrogram dispersion.
Methods
This study was a prospective, multicentric, nonrandomized study conducted to assess the feasibility of generating VX1 dispersion maps. In 85 patients, 8 centers, and 17 operators, we compared the acute and long‐term outcomes after ablation in regions exhibiting dispersion between primary and satellite centers. We also compared outcomes to a control group in which dispersion‐guided ablation was performed visually by trained operators.
Results
The study population included 29% of long‐standing persistent AF. AF termination occurred in 92% and 83% of the patients in primary and satellite centers, respectively, p = 0.31. The average rate of freedom from documented AF, with or without antiarrhythmic drugs (AADs), was 86% after a single procedure, and 89% after an average of 1.3 procedures per patient (p = 0.4). The rate of freedom from any documented atrial arrhythmia, with or without AADs, was 54% and 73% after a single or an average of 1.3 procedures per patient, respectively (p < 0.001). No statistically significant differences between outcomes of the primary versus satellite centers were observed for one (p = 0.8) or multiple procedures (p = 0.4), or between outcomes of the entire study population versus the control group (p > 0.2). Interestingly, intraprocedural AF termination and type of recurrent arrhythmia (i.e., AF vs. AT) appear to be predictors of the subsequent clinical course.
Conclusion
VX1, an expertise‐based artificial intelligence software solution, allowed for robust center‐to‐center standardization of acute and long‐term ablation outcomes after electrogram‐based ablation.
Ablation guided by Volta Medical, an expertise‐based artificial intelligence software solution, led to promising outcomes in persistent atrial fibrillation patients. Acute and long‐term outcomes between our primary center and satellite centers are not statistically different, demonstrating the standardization and the reproducibility of the approach.