Identification of Repetitive Activation Patterns Using Novel Computational Analysis of Multielectrode Recordings During Atrial Fibrillation and Flutter in Humans

Self Cite

Introduction Recent studies have characterized drivers in persistent atrial fibrillation using automated algorithm detection with panoramic endocardial mapping by means of basket catheters. We aimed to identify repetitive atrial activation patterns (RAAPs) during ongoing atrial fibrillation (AF) based upon automated annotation of unipolar electrograms (EGMs) recorded with a high‐density regional endocardial contact mapping catheter. Methods In 14 persistent AF patients, high‐resolution EGMs were recorded for 30 seconds at sequential PentaRay (Biosense Inc) positions covering the entire biatrial surface. All recordings were reviewed off‐line with dedicated software allowing automated annotation of the local activation time of the unipolar fibrillatory EGMs (CARTOFINDER; Biosense Inc). RAAPs were defined as a consistent activation pattern (for ≥3 consecutive beats) of either focal activity with centrifugal spread (RAAPfocal) or rotational activity across the PentaRay splines spanning the AF cycle length (RAAProtational). Results A total of 498 PentaRay recordings were analyzed (35.6 ± 7.6 per patient). The number of PentaRay recordings displaying RAAP was 9.8 ± 3.1 per patient (range = 3‐15), of which 2.4 ± 2.4 RAAProtational (range = 0‐7), and 7.4 ± 4.4 RAAPfocal (range = 1‐13). 77% of RAAPs portrayed focal firing. The median number of repetitions per 30 second recording was 11 (range = 3‐225) per recording. RAAPs were observed both in the right atrium (RA) (35%) and left atrium (LA) (65%), with the majority being near the left PVs/appendage (35% of all RAAPs) and the superior vena cava/right appendage (23% of all RAAPs). Conclusion High‐resolution, sequential endocardial EGM‐based mapping allows identification of RAAPs in persistent AF. In our series, focal firing was the most frequently observed pattern.

Section: Discussionmentioning

confidence: 50%

Section: Discussionmentioning

confidence: 99%

Identification of repetitive atrial activation patterns in persistent atrial fibrillation by direct contact high‐density electrogram mapping

Wolf

Tavernier

Zeidan³

et al. 2019

Self Cite

“…CARTO has recently produced CARTOFINDER (Biosense Webster) which times electrograms relative to each other in a 250 ms window which then moves through a continuous recording to show wavefront movement over time. This has enjoyed some success demonstrating focal and rotational activations in AF and an automated approach to their detection has been developed . The Topera and ECGi mapping systems rely on phase mapping to identify drivers.…”

Section: Discussionmentioning

confidence: 99%

Development, in vitro validation and human application of a novel method to identify arrhythmia mechanisms: The stochastic trajectory analysis of ranked signals mapping method

Honarbakhsh

Hunter

Finlay

et al. 2019

Introduction Stochastic trajectory analysis of ranked signals (STAR) is a novel method for mapping arrhythmia. The aim was to describe its development and validation as a mapping tool. Methods and Results The method ranks electrodes in terms of the proportion of the time they lead relative to neighboring electrodes and ascribes a predominant direction of activation between electrodes. This was conceived with the aim of mapping atrial fibrillation (AF) drivers. Validation of this approach was performed in stages. First, in vitro simultaneous multi‐electrode array and optical mapping were performed on spontaneously fibrillating HL1 cell cultures, to determine if such a method would be able to determine early sites of activation (ESA). A clinical study acquiring unipolar electrograms using a 64‐pole basket for the purposes of STAR mapping in patients undergoing atrial tachycardia (AT) ablation. STAR maps were analyzed by physicians to see if arrhythmia mechanisms could be correctly determined. Mapping was then repeated during atrial pacing. STAR mapping of in vitro activation sequences accurately correlated to the optical maps of planar and rotational activation. Thirty‐two ATs were mapped in 25 patients. The ESA accurately identified focal/micro‐reentrant ATs and the mechanism of macro‐reentrant ATs was effectively demonstrated. STAR method accurately identified four pacing sites in all patients. Conclusions This novel STAR method correlated well with the gold standard of optical mapping in vitro and was able to accurately identify AT mechanisms. Further analysis is needed to determine whether the method might be of use mapping AF.

“…Mapping systems developed to detect drivers in AF either through mapping rotors or wavefront propagation depend on recording unipolar data over a time period. Locational electrode data at the start of recording are used by these systems with the assumption that the basket catheter remains in a stable position.…”

Section: Discussionmentioning

confidence: 99%

“…Identification of the mechanisms sustaining persistent atrial fibrillation (AF) is an ongoing challenge. “Panoramic mapping” of the left atrium (LA) using whole‐chamber basket catheters has been fundamental to several recent approaches aiming to identify drivers in AF . However, such mapping can be limited by electrode position, with poor tissue contact and clustering of basket splines reducing the electrical coverage of the chamber of interest …”

Section: Introductionmentioning

confidence: 99%

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

Honarbakhsh

Schilling

Providência

et al. 2017