Basket-Type Catheters: Diagnostic Pitfalls Caused by Deformation and Limited Coverage

Abstract

Whole-chamber mapping using a 64-pole basket catheter (BC) has become a featured approach for the analysis of excitation patterns during atrial fibrillation. A flexible catheter design avoids perforation but may lead to spline bunching and influence coverage. We aim to quantify the catheter deformation and endocardial coverage in clinical situations and study the effect of catheter size and electrode arrangement using an in silico basket model. Atrial coverage and spline separation were evaluated quantitatively in an ensemble of clinical measurements. A computational model of the BC was implemented including an algorithm to adapt its shape to the atrial anatomy. Two clinically relevant mapping positions in each atrium were assessed in both clinical and simulated data. The simulation environment allowed varying both BC size and electrode arrangement. Results showed that interspline distances of more than 20 mm are common, leading to a coverage of less than 50% of the left atrial (LA) surface. In an ideal in silico scenario with variable catheter designs, a maximum coverage of 65% could be reached. As spline bunching and insufficient coverage can hardly be avoided, this has to be taken into account for interpretation of excitation patterns and development of new panoramic mapping techniques.

A Computational Framework to Benchmark Basket Catheter Guided Ablation

“…This adds up to previous modelling studies pointing to the potential pitfalls of multi-electrode catheters for AF mapping [6].…”

Panoramic atrial mapping with basket catheters: A quantitative analysis to optimize practice, patient selection, and catheter choice

“…Previous studies have shown that LA coverage achieved with the Constellation catheter is limited to approximately half of the LA, which was consistent with the findings in this study. We have shown that the differences implemented in the FIRMap catheter compared to the Constellation catheter results in not only an absolute increase in LA coverage by almost 30% but also almost 50% greater LA septal coverage, a known blind spot of the Constellation catheter . The improved coverage owes partly to the reduction in interspline bunching and catheter distortion seen with the FIRMap catheter.…”

“…We have shown that the differences implemented in the FIRMap catheter compared to the Constellation catheter results in not only an absolute increase in LA coverage by almost 30% but also almost 50% greater LA septal coverage, a known blind spot of the Constellation catheter. 11 The improved coverage owes partly to the reduction in interspline bunching and catheter distortion seen with the FIRMap catheter. Previous studies have documented more than one AF driver per patient 12,13 with these distributed throughout the LA 12,14 but in small discreet locations.…”

A Computational Framework to Benchmark Basket Catheter Guided Ablation in Atrial Fibrillation

“…We used the algorithm presented in Oesterlein et al ( 2016 ) to position a simulated basket catheter inside the specific atrial anatomy. In brief, a set of Frenet-Serret parameterized spline pairs of a given size are deformed to minimize the inner tension energy while fulfilling the constraints posed by the atrial surface as well as the distal and proximal end of the basket catheter.…”