Further Developments -
🤝Ongoing collaboration with Usha Tedrow & John Whitaker @BrighamWomens for colocalization of PFZs with LV wall thickness using Inheart digital ♊️
inheartmedical.com

Limitations:
1. Small series
2. Uncertain utility with a) minimal substrate, and b) extensive substrate

#EPeeps with ❓❓ feel free to reach out to winterfj@musc.edu
joshua.payne@integrishealth.org

🎉🎉Conclusions:
1. A novel automated PF algorithm accurately annotated fractionated signals during mapping of the LV.
2. The algorithm is complementary to current mapping standards but may be predictive of target ablation sites, including Deceleration Zones .

**Prospective Cohort
🌟PFZ predicted the main DZ targets in 9/10 pts.

Colocalization of PFZs with DZs
*Retrospective Cohort
- High PF (>220 Hz) within low-voltage (<1.5 mV) or PFZs colocalized with DZ in all pts, defined as >50% surface area overlap

A. Voltage map
B. ILAM
C. PFZ >-220 Hz superimposed upon voltage map
D. VT Activation map

⭐️Findings –
*⃣ Low voltage areas w LP and LAVA had a higher median PF of 358 Hz c/w scar only (156 Hz).
*⃣*⃣ROC analysis revealed an optimal threshold of 216.5 Hz with 92.5% sensitivity & 85.4% specificity.
*⃣*⃣*⃣ Peak Frequency (PF) cutoff >=220 Hz ➡️ 91% sensitivity & 85% specificity for LAVA and LP

Results:
*25 pts (after exclusion) – 72% ischemic

*2 measures catalogued and assigned to each EGM
(1) the highest PF magnitude (PFmax)
(2) the LAT timing corresponding to the instance of PFmax (Fig 1B)

**Comparison to traditional FFT (Fig 1D)
- ⬆️⬆️ amplitude-independent measure for LAT detection
- Only operates on EGMs > 0.04 mV (system noise)

Description of Algorithm

*Proprietary - EnSite OT Near Field™
** Automatically measures & annotates the highest PF associated with intracardiac EGMs
*** To discriminate near-field vs. far-field components

Methodology –
*Ischemic or Non-Isch CMP
**Ensite EAM system
***Voltage mapping, ILAM->DZs, LAVA, LPs
****Peak-Frequency (PF)>=220 Hz maps were overlaid over voltage maps
*****PFZ (Peak frequency Zones) maps were correlated with DZs

Study Hypothesis –
1. Test an automated algorithm to annotate local ventricular signal using peak frequency (PF) during EAM.
2. Evaluate accuracy in identifying LAVA and LP and assess influence on ILAM.

Background –
💪 Substrate modification mb preferable for VT RFA.
Myriad SM modalities
Voltage mapping
Late Potentials (doi.org/10.1161/CIRC... LAVA (doi.org/10.1161/CIRC...), ** ILAM (doi.org/10.1161/CIRC...)
Evoked delayed potential (doi.org/10.1016/j.ja...)
🤔 Manual annotation w some automation

**‘A novel automated peak frequency annotation algorithm for identifying deceleration zones and ventricular tachycardia ablation sites’ Heart Rhythm, Volume 21, Issue 1, 27 – 33 heartrhythmjournal.com/article/S154...