The management of cardiac arrhythmias remains the largest problem in cardiac electrophysiology. The prevalence of the most frequent arrhythmia, atrial fibrillation (AF), is expected is expected to rise steeply due to the ageing population. In spite of intensive research, the mechanism of atrial fibrillation remains unclear, leading to poor results in its treatment and a lack of long-lasting success. As a result, ablation of AF often results complex atrial tachycardia (AT). Ablation of atrial tachycardias (AT) occurring after a first persistent AF ablation or after a previous surgical procedure is very challenging despite recent improvements in mapping technologies. New high density activation mapping (HDAM) systems using velocity vectors help by showing activation wavefronts, suggesting potential circuits and or foci responsible for the AT. However, these systems have limitations as they often suggest more than one potential activation route and as automatic annotation of low voltage and fractionated potentials could render the activation maps confusing. Very recently, my group developed Directed Graph Mapping (DGM), a novel technique based on the creation of a directed network to represent the cardiac excitation, which automatically shows the correct circuit of the mapped heart. DGM has been evaluated in in-silico, experimental and clinical models of arrhythmias. DGM has been proved to be effective in detecting the mechanism and the precise circuit of any regular AT, automatically and instantaneously. In our latest submitted work, we have shown that DG-mapping can compete with the latest HDAM systems in case of complex ATs.
At this stage, our tool is equally good as the systems on the market. Therefore, we still need to improve the tool, so it will work significantly better than the current HDAM systems in order to create interest from companies. This is exactly the goal of this project. In most of the cases where DG-mapping fails to give the correct mechanism, it shows two different mechanisms and it cannot distinguish between the two. Therefore, we need to add additional tools to DG-mapping to improve this aspect. Second, we have only shown the potential of DGM in a single hospital with the single HDAM system. Therefore, the second goal of this project is to set up a multicenter study and to test all different HDAM systems on the market.
Final outcome of the project
This final outcome of project is to find a potential collaboration with an HDAM system (e.g. RHYTHMIA of Boston Scienfitic, CARTO of Biosense Webster) to actually bring our technology to the patient. As we are in the process of patenting our technology, the ultimate goal is the find a licensee of our patent on DGM.