Excellent interobserver agreement and steep learning curve for target volume delineation for stereotactic arrhythmia radioablation using a commercial software

EP Europace, vol. 27

Abstract

AIMS: Stereotactic arrhythmia radioablation (STAR) has emerged as bail-out treatment for ventricular tachycardia (VT). Accurate, reproducible, and easy-to-use data transfer from electroanatomical mapping (EAM) systems to radiotherapy planning CT is desirable. We aim to evaluate interobserver variability, ease of use, and learning curve for EAM based target volume (CardTV-EPinv) creation and transfer using available software packages. METHODS AND RESULTS: In patients considered for STAR, CardTV-EPinv were created using ADAS and Slicer3D for workflow comparison. Four CardTV-EPinv (clinically targeted volume and three mock targets) were created by an experienced operator and a 2nd-year medical student, based on endocardial EAM tags indicating VT substrate location. CardTV-EPinv sizes, Hausdorff distances (HDs), and workflow duration were measured to assess interobserver variability and learning curve. Agreement between CardTV-EPinv was high using ADAS and Slicer3D workflows (HD 3.64 mm [2.7-4.5]). ADAS workflow was faster and more robust (ADAS 26 min [24-29] vs. Slicer3D 65 min [61-70], P < 0.001; system crashes: ADAS 0 vs. Slicer3D 7). In 20 patients (80% non-ischaemic cardiomyopathy, LVEF 35 ± 14%), 80 CardTV-EPinv were created using ADAS. CardTV-EPinv size was similar for both observers (11.8 mL [10.1-13.7] vs. 10.7 mL [9.6-11.8], P = 0.17), with high interobserver agreement (HD 1.68 mm [1.45-1.96]; 95th percentile HD < 4.8 mm [3.5-5.7]). Linear regression showed a steep learning curve for the student (P = 0.01). CONCLUSION: CardTV-EPinv creation showed excellent interobserver agreement and was faster and more robust using ADAS than 3D slicer. The steep learning curve appears clinically relevant given the limited use of STAR even in high-volume VT ablation centres.

Authors 14

1. Robert Rademaker Aachen Department of Cardiology, Leiden University Medical Center

   Leiden University Medical Center

   Affiliation as printed

   Department of Cardiology, Leiden University Medical Center , P.O. Box 9600, Leiden 2300 RC ,

   Willem Einthoven Center of Arrhythmia Research and Management, Leiden, The Netherlands , Aarhus ,

   Department of Cardiology, Leiden University Medical Center, P.O. Box 9600, Leiden 2300 RC, The Netherlands

   Willem Einthoven Center of Arrhythmia Research and Management, Leiden, The Netherlands, Aarhus, Denmark

   Willem Einthoven Center of Arrhythmia Research and Management, Leiden, the Netherlands , Aarhus ,

2. Simon Cirkel Aachen Department of Cardiology, Leiden University Medical Center

   Leiden University Medical Center

   Affiliation as printed

   Department of Cardiology, Leiden University Medical Center , P.O. Box 9600, Leiden 2300 RC ,

   Willem Einthoven Center of Arrhythmia Research and Management, Leiden, The Netherlands , Aarhus ,

   Department of Cardiology, Leiden University Medical Center, P.O. Box 9600, Leiden 2300 RC, The Netherlands

   Willem Einthoven Center of Arrhythmia Research and Management, Leiden, The Netherlands, Aarhus, Denmark

   Willem Einthoven Center of Arrhythmia Research and Management, Leiden, the Netherlands , Aarhus ,

3. Sharif Omara Aachen Department of Cardiology, Leiden University Medical Center

   Leiden University Medical Center

   Affiliation as printed

   Department of Cardiology, Leiden University Medical Center , P.O. Box 9600, Leiden 2300 RC ,

   Willem Einthoven Center of Arrhythmia Research and Management, Leiden, The Netherlands , Aarhus ,

   Department of Cardiology, Leiden University Medical Center, P.O. Box 9600, Leiden 2300 RC, The Netherlands

   Willem Einthoven Center of Arrhythmia Research and Management, Leiden, The Netherlands, Aarhus, Denmark

   Willem Einthoven Center of Arrhythmia Research and Management, Leiden, the Netherlands , Aarhus ,

4. Frank J. W. M. Dankers Aachen Department of Radiation Oncology

   Leiden University Medical Center

   Affiliation as printed

   Department of Radiation Oncology, Leiden University Medical Center , Leiden ,

   Department of Radiation Oncology, Leiden University Medical Center, Leiden, The Netherlands

5. Marek Šramko

   Institute of Clinical and Experimental Medicine

   Affiliation as printed

   Department of Cardiology, Institute for Clinical and Experimental Medicine , Prague ,

   Department of Cardiology, Institute for Clinical and Experimental Medicine, Prague, Czech Republic

6. Jorge Solana Muñoz

   Centre Hospitalier Universitaire Vaudois

   Affiliation as printed

   Department of Cardiology, Lausanne University Hospital , Lausanne ,

   Department of Cardiology, Lausanne University Hospital, Lausanne, Switzerland

7. Y S Kaya

   Maastricht University Medical Centre · Maastricht University

   Affiliation as printed

   Department of Cardiology, Maastricht University Medical Center+ (MUMC+), Cardiovascular Research Institute Maastricht (CARIM), Maastricht University , Maastricht ,

   Department of Cardiology, Maastricht University Medical Center+ (MUMC+), Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, Maastricht, The Netherlands

8. Rachel M.A. ter Bekke

   Maastricht University Medical Centre · Maastricht University

   Affiliation as printed

   Department of Cardiology, Maastricht University Medical Center+ (MUMC+), Cardiovascular Research Institute Maastricht (CARIM), Maastricht University , Maastricht ,

   Department of Cardiology, Maastricht University Medical Center+ (MUMC+), Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, Maastricht, The Netherlands

9. Luis Schiappacasse

   Centre Hospitalier Universitaire Vaudois

   Affiliation as printed

   Department of Radiation Oncology, Lausanne University Hospital , Lausanne ,

   Department of Radiation Oncology, Lausanne University Hospital, Lausanne, Switzerland

10. Cheryl C. Teres

    Centre Hospitalier Universitaire Vaudois

    Affiliation as printed

    Department of Cardiology, Lausanne University Hospital , Lausanne ,

    Department of Cardiology, Lausanne University Hospital, Lausanne, Switzerland

11. Karolien Verhoeven

    Maastricht University Medical Centre · Maastricht University

    Affiliation as printed

    Department of Radiation Oncology (Maastro), GROW-Research Institute for Oncology and Reproduction, Maastricht University Medical Center+ , Maastricht ,

    Department of Radiation Oncology (Maastro), GROW-Research Institute for Oncology and Reproduction, Maastricht University Medical Center+, Maastricht, The Netherlands

12. Etienne J. Pruvot

    Centre Hospitalier Universitaire Vaudois

    Affiliation as printed

    Department of Cardiology, Lausanne University Hospital , Lausanne ,

    Department of Cardiology, Lausanne University Hospital, Lausanne, Switzerland

13. Coen R. N. Rasch Aachen Department of Radiation Oncology

    Leiden University Medical Center

    Affiliation as printed

    Department of Radiation Oncology, Leiden University Medical Center , Leiden ,

    Department of Radiation Oncology, Leiden University Medical Center, Leiden, The Netherlands

14. Katja Zeppenfeld corresponding Aachen Department of Cardiology, Leiden University Medical Center

    Leiden University Medical Center

    Affiliation as printed

    Department of Cardiology, Leiden University Medical Center , P.O. Box 9600, Leiden 2300 RC ,

    Willem Einthoven Center of Arrhythmia Research and Management, Leiden, The Netherlands , Aarhus ,

    Department of Cardiology, Leiden University Medical Center, P.O. Box 9600, Leiden 2300 RC, The Netherlands

    Willem Einthoven Center of Arrhythmia Research and Management, Leiden, The Netherlands, Aarhus, Denmark

    Willem Einthoven Center of Arrhythmia Research and Management, Leiden, the Netherlands , Aarhus ,