Introduction: Atrial tachycardias (AT) can present multiple sites of origin or circuits which complicates mapping, requiring creation of separate activation maps per site. Objective: To evaluate the Intra-Cardiac Pattern Matching (ICPM) software that automatically detects and assigns different arrhythmia sources to separate 3D activation maps in a porcine model. Methods: To simulate different ATs, continuous pacing at same cycle length was performed from 2-3 right atrial (RA) sites (2 screw-in leads and mapping catheter) for 60-90 seconds before alternating. RA was continuously mapped with a 48-electrode high-density mapping catheter (Octaray). The operator manually switched and added points to the respective maps when the AT changed. Conversely, the ICPM algorithm (Carto Mapping system) automatically assigned each beat to its respective map. Pacing electrodes were repositioned to create a second set of maps. Offline analysis (manual and automatic maps) was performed comparing local activation times (LAT) and mesh coloring values of adjacent points (<5 mm apart). Differences <10 msec were considered a match. Results: Twenty-three different pacing sites were analyzed in 6 swine with 1 manual/1 automatic map per site (46 maps); and 40,176 points were compared (manual and automatic). Individual LATs for manual and automatic maps were compared and matched 91.2% of the time (variance of <10 ms). Mesh coloring values matched using the same criteria. Conclusion: The ICPM algorithm accurately identified changing atrial activation sites and assigned points to appropriate maps >90% of the time compared to manual acquisition.

Background:The advent of TAVR changed the practice for treating patients with severe aortic stenosis. Heart-Teams improved their decision-making process to refer patients to the best and safest treatment. Evidence allowed centers to increase funding and TAVR volume and extend indications to different risk category of patients. This study evaluates the outcomes of intermediate-risk patients treated for severe aortic stenosis in an academic center. Methods:Between 2012 and 2019, 812 patients with aortic stenosis underwent TAVR or SAVR. A propensity score-matching analytic strategy was used to balance groups and adjust for time periods. Outcomes were recorded according to the Society of Thoracic Surgeons Guidelines; primary outcome being 30-day mortality and secondary outcomes being perioperative course and complications. Results:No difference in mortality was seen but complications differed: more postoperative transient ischemic attacks, permanent pacemaker implantations and perivalvular leaks in the transcatheter group, while more acute kidney injuries, atrial fibrillation, delirium, postoperative infections and bleeding, tamponade and need for reoperation in the surgical group as well as longer hospital length-of-stay. However, over the years, morbidities/mortality decreased for all patients treated for aortic stenosis. Conclusions:Data showed an improvement in morbidities/mortality for intermediate risk patients treated with SAVR or TAVR. Increased funding allowed for higher TAVR volume by increasing access to this technology. Also, the difference in complications could impact healthcare cost. By incorporating important metrics such as length-of-stay, readmission rates and complications into decision-making, the Heart-Team can improve clinical outcomes, healthcare economics and resource utilization.