SuperMap algorithm: an efficient, safe and accurate modality for mapping and eliminating challenging cardiac arrhythmias

Figures & data

Figure 1. Rendering of the AcQMap non-contact catheter, displaying the interspersed electrodes and transducers at the distal end of a 10 French size catheter.

Figure 2. Sample orientation of the AcQMap catheter and the use of SuperMap to produce color-coded maps of the left atrium.

(A) Sample positions of the AcQMap catheter in relation to the walls of the left atrium. (B) SuperMap-derived display depicting a localized re-entrant circuit, with broken white arrow denoting directionality of the re-entrant circuit. (C) SuperMap-derived display depicting a focal source of automaticity, with white arrows denoting centrifugal depolarization.

AP: Anterior–posterior; LIPV: Left inferior pulmonary vein; LSPV: Left superior pulmonary vein; MV: Mitral valve; RIPV: Right inferior pulmonary vein; RSPV: Right superior pulmonary vein.

Table 1. Comparison of studies and patient selection.

Study	Ramak et al.	Liebregts et al. (persistent AF/atypical AFL)	Shi et al.	Pope et al.
Study design	Retrospective observational	Retrospective observational	Prospective cohort	Prospective observational/cohort
Arrhythmias (diagnoses at enrollment)	AT and AFL	AT and AFL	AT and AFL	AT and AFL
Mechanisms (uncovered during electrophysiology study)	Atypical flutter (4/7, 57%) Pulmonary vein focal tachycardia (2/7, 29%) Interatrial septum focal tachycardia (1/7, 14%)	Persistent AF (14/21, 67%) Atypical flutter (7/21, 33%)	Atypical flutter (21/26, 81%) Focal tachycardia (5/26, 19%)	Atypical flutter (9/31, 29%) Focal tachycardia (17/31, 55%)
Procedural end point	Conversion to sinus rhythm without further inducibility	Conversion to sinus rhythm	Termination of arrhythmia without further inducibility	Termination of arrhythmia without further inducibility
Sample size	7	21	20	31
Average patient age (years)	68	64 ± 8 / 68 ± 5	65	64
Prior ablation	7 (100%)	11/14 (79%) / 7/7 (100%)	12/20 (60%)	23/31 (74%)
Male sex	6/7 (86%)	11/14 (79%) / 5/7 (81%)	19/20 (95%)	18/31 (58%)
Comparison with contact mapping	No	No	Yes	Yes, subgroup (19/31)
Ref.	[33]	[34]	[32]	[31]

AF: Atrial fibrillation; AFL: Atrial flutter; AT: Atrial tachycardia.

Table 2. Study demonstration of procedural feasibility and safety.

Study	Ramak et al.	Liebregts et al. (persistent AF/atypical AFL)	Shi et al.	Pope et al.
Time to generate anatomical map (s)	166.0 ± 26.9	NR	NR	152
Time to generate activation map (s)	32.6 ± 54.8	NR	180 ± 60	394 ± 219
Time to generate contact map (s)	NR	NR	780 ± 360	611 ± 331
Total mapping time (min)	8.0 ± 1.0	NR	NR	314
Time to ablate (min)	18.2 ± 12.5	44/11	11.0 ± 8.0	NR
Procedural time (min)	56.4 ± 12.1	180/205	NR	NR
Complications	None	0 (0%)/2 (18.2%)	None	None
Ref.	[33]	[34]	[32]	[31]

AF: Atrial fibrillation; AFL: Atrial flutter; NR: Not reported.

Table 3. Procedural success and blinded comparison with traditional contact-based mapping.

Study	Ramak et al.	Liebregts et al. (persistent AF/atypical AFL)	Shi et al.	Pope et al.
Immediate post-procedure success rate	7/7 (100%)	11/14 (79%) / 6/7 (86%)	NR	NR
Follow-up success rate	NR	3-month follow-up: 5/14 (36%) / 4/7 (57%) 12-month follow-up: 4/14 (29%) / 4/7 (57%)	NR	NR
Sample size (number of pairs of maps compared)	NR	NR	26	19
Correct diagnosis by SuperMap	NR	NR	25/26 (96%)	59/62 (95%)
Correct identification of mechanism of arrhythmia by blinded reviewers and operators (AcQMap/contact map)	NR	NR	80%/100%	36/39 (92%) / 33/39 (85%)
Correct identification of arrhythmia termination by blinded reviewers (AcQMap/contact map)	NR	NR	76%/78%	NR
Ref.	[33]	[34]	[32]	[31]

AF: Atrial fibrillation; AFL: Atrial flutter; NR: Not reported.

Figure 3. Novel data confirming agreement between SuperMap and CARTO propagation maps on atypical flutters.

(A) Numerically ordered panels of SuperMap displaying the activation sequence of an atypical mitral flutter chronologically. (B) Corresponding CARTO vector map. (C) Numerically ordered panels of SuperMap portraying the activation sequence of an atypical roof flutter in the left atrium chronologically. (D) Corresponding CARTO activation map showing early activation meets latest activation in the left atrium (asterisk). Anatomical surfaces in red correspond to early activation, and surfaces in blue indicate late activation. Yellow arrows denote direction of flutter waves.

CL: Cycle length; LAA: Left atrial appendage; LAO: Left anterior oblique; LIPV: Left inferior pulmonary vein; LSPV: Left superior pulmonary vein; MV: Mitral valve; PA: Posterior–anterior; RIPV: Right inferior pulmonary vein; RSPV: Right superior pulmonary vein.

Ramak R , ChierchiaG , Paparellaet al. Novel noncontact charge density map in the setting of post-atrial fibrillation atrial tachycardias: first experience with the Acutus SuperMap Algorithm. J. Interv. Card. Electrophysiol.61(1), 187–195 (2021).

 PubMed Web of Science ®Google Scholar

Liebregts M , WijffelsMCEF , KlaverMN , van DijkVF , BaltJC , BoersmaLVA. Initial experience with AcQMap catheter for treatment of persistent atrial fibrillation and atypical atrial flutter. Neth. Heart J.30(5), 273–281 (2022).

 PubMed Web of Science ®Google Scholar

Shi R , ZamanJAB , ChenZet al. Novel aggregated multiposition noncontact mapping of atrial tachycardia in humans: from computational modeling to clinical validation. Heart Rhythm19(1), 61–69 (2022).

 PubMed Web of Science ®Google Scholar

Pope MTB , LeoM , Briosae Gala A , BettsTR. Clinical utility of non-contact charge density ’SuperMap’ algorithm for the mapping and ablation of organized atrial arrhythmias. Europace24(5), 747–754 (2022).

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