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Curso de Atualização em Medicina Cardiovascular 2019
Reunião Anual Conjunta dos Grupos de Estudo de Cirurgia Cardíaca, Doenças Valvulares e Ecocardiografia da SPC
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A. Basics
B. Imaging
C. Arrhythmias and Device Therapy
D. Heart Failure
E. Coronary Artery Disease, Acute Coronary Syndromes, Acute Cardiac Care
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01. History of Cardiology
02. Clinical Skills
03. Imaging
04. Arrhythmias, General
05. Atrial Fibrillation
06. Supraventricular Tachycardia (non-AF)
07. Syncope and Bradycardia
08. Ventricular Arrhythmias and Sudden Cardiac Death (SCD)
09. Device Therapy
10. Chronic Heart Failure
11. Acute Heart Failure
12. Coronary Artery Disease (Chronic)
13. Acute Coronary Syndromes
14. Acute Cardiac Care
15. Valvular Heart Disease
16. Infective Endocarditis
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18. Pericardial Disease
19. Tumors of the Heart
20. Congenital Heart Disease and Pediatric Cardiology
21. Pulmonary Circulation, Pulmonary Embolism, Right Heart Failure
22. Aortic Disease
23. Peripheral Vascular and Cerebrovascular Disease
24. Stroke
25. Interventional Cardiology
26. Cardiovascular Surgery
27. Hypertension
28. Risk Factors and Prevention
29. Rehabilitation and Sports Cardiology
30. Cardiovascular Disease in Special Populations
31. Pharmacology and Pharmacotherapy
32. Cardiovascular Nursing
33. e-Cardiology / Digital Health
34. Public Health and Health Economics
35. Research Methodology
36. Basic Science
37. Miscellanea
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The impact of a systematic training method in improving the identification of atrial fibrillation drivers – a randomized controlled trial
Session:
CO 01 - Arritmologia Invasiva
Speaker:
João Pedro Vilaça Delgado de Almeida e Mesquita
Congress:
CPC 2018
Topic:
C. Arrhythmias and Device Therapy
Theme:
05. Atrial Fibrillation
Subtheme:
05.9 Atrial Fibrillation - Other
Session Type:
Comunicações Orais
FP Number:
---
Authors:
João Mesquita; Natasha Maniar; Mark Swerdlow; Mahmood I Alhusseini; Fatemah Shenasa; Catarina Brízido; Daniel Nascimento Matos; Pedro Freitas; Gustavo Da Rocha Rodrigues; Paul Clopton; António Ferreira; Sanjiv M Narayan
Abstract
<p><strong>Background:</strong> </p> <p>Panoramic mapping of atrial fibrillation (AF) may help guide ablation, but maps can be complex and difficult to read.</p> <p> </p> <p><strong>Objectives: </strong></p> <p>To (1) develop a standardized training protocol for panoramic AF map reading and test its ability to improve diagnosis of potential AF drivers; and (2) assess baseline performance and compare learning curves between Kuklik and Abbott® proprietary mapping methods.</p> <p> </p> <p><strong>Methods:</strong> </p> <p>From a multicenter AF registry (63% males, 65 years (IQR 55-77)) we developed an online database of AF movies (Kuklik and Abbott®) in which driver-guided ablation terminated non-paroxysmal AF. Each map had at least 1 driver, up to a maximum of 3. Cardiology fellows with little AF map reading experience (<20 maps) from Europe, USA and South America were randomized to training (intervention) vs. no training (control) and took a pre-test in which they read 16 AF movies to identify potential ablation targets - blinded to correct answers. Score (%) was based on correctly identified sites/total sites (37). The intervention group was then given a fully automated training session in which fellows were asked to grade an entirely different set of 16 movies, shown the correct answers and then reviewed maps. Both groups then took a final test consisting of the initial set of maps reshuffled into a new sequence to assess training impact.</p> <p> </p> <p><strong>Results:</strong> </p> <p>12 participants (30 years (IQR 28-32), 6 females) were randomized, yielding well-balanced groups. A total of 480 map readings were evaluated. Pre-test results were similar between control vs training groups for both methods (P=0.74). Performance rose by 13±4% after training (P<0.001), but not in controls (P=0.439; P<0.001 for delta comparison). Training improved reading of both Kuklik (Fig A) and Abbott® (Fig B) maps (P=0.001 and P=0.012, respectively), whereas control did not (P=NS). Although the training group performed better than control, final test results were comparable for Kuklik method (P=0.285, Fig C).</p> <p> </p> <p><strong>Conclusion:</strong> </p> <p>Proof-of-concept randomized-controlled trial in which digital online training improved identification of potential drivers in complex AF maps. Non-experienced readers could more easily identify AF sources using Kuklik method. This novel paradigm might prove a powerful, scalable tool for complex visual training tasks in electrophysiology.</p> <p> </p> <p>Figure legend: PT - pre-test; FT - final test</p>
Slides
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