If any of these high-risk features are present, ablation needs to be stopped immediately in hopes that any damage to the AV node is reversible. Real-time electrograms (EGM) may show signs of an impending permanent AV block, such as prolongation of the AV interval, antegrade AV block, retrograde VA block, or fast junctional rhythm ( 9, 10). Despite the overall safety profile, heart block still occurs in approximately 1%–2.3% of ablations ( 6– 8). Catheter radiofrequency ablation (RFA) is a proven effective treatment for this condition, with a cure rate of over 95% ( 2– 5). If HREF were recognized by both human and program, ablations were terminated earlier by the program 90.2% of times, by a median of 574 ms (interquartile range 412–807 ms, p < 0.001).Ĭonclusion: Algorithmic-driven monitoring of slow pathway modification can supplement human judgement to improve ablation safety.Ītrioventricular nodal reentrant tachycardia (AVNRT) is the most common cause of supraventricular tachycardia (SVT) ( 1). Sensitivity and specificity for the program in the validation set were 95.2% and 91.1% respectively, which were comparable to that of human performance at 93.5% and 95.4%. Cutoffs for the program were set to maximize program sensitivity. Results: Reasons for ablation termination in the training set include short AA time, short VV time, AV block and VA block. Timing of ablation termination, sensitivity, and specificity were compared between human and program. The videos were played to three independent electrophysiologists who each determined when to stop ablation. Simulation ablation videos were rendered using validation set electrogram data. Then a program was developed with cutoff values decided from training set to capture all these HREF. They were divided into training and validation sets which contained 126 and 206 ablation runs respectively. Methods: Digital electrogram data from 332 ablation runs from February 2020 to June 2022 were included. Objectives: To develop an automatic algorithm to monitor HREF and terminate ablation earlier than human reaction. 3Division of Cardiology, Department of Medicine, Queen Elizabeth Hospital, Hong Kong, Hong Kong SAR, Chinaīackground: During slow pathway modification for atrioventricular nodal reentrant tachycardia, heart block may occur if ablation cannot be stopped in time in response to high risk electrogram features (HREF).2Heart & Vascular Institute, The Chinese University of Hong Kong, Hong Kong, Hong Kong SAR, China.1Division of Cardiology, Department of Medicine and Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, Hong Kong SAR, China.Au 1, Chin Pang Chan 1, Yuet Wong Cheng 3 and Bryan P.
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