Noninvasive Phase Mapping of Atrial Flutter in Humans – Comparison with Invasive Mapping

Abstract

Introduction: The present study compared invasive activation and phase mapping to noninvasive phase mapping in patients with cavotricuspid isthmus (CTI)-dependent atrial flutter (AFl) using a novel noninvasive epicardial and endocardial electrophysiology system (NEEES). Methods: Four patients with CTI-dependent AFl underwent simultaneous invasive and noninvasive mapping using an electroanatomical mapping system and the NEEES. A mapping catheter aligned along the tricuspid valve region provided data on local activation times analysing unipolar and bipolar electrograms (EGs). Invasive and noninvasive EGs were processed using the same phase mapping algorithm. Results: Activation times obtained invasively and noninvasively from phase-processed unipolar EGs demonstrated close correlation with activation times obtained from invasive bipolar EGs. Noninvasively reconstructed phase maps accurately delineated the activation sequence of CTI-dependent AFl. Conclusion: Noninvasive phase mapping can accurately delineate the activation pattern of CTIdependent AFl and may be useful in other types of macro-reentrant tachycardias.

Solving the Inverse Problem of Electrocardiography on the Endocardium Using a Single Layer Source

“…Nevertheless, solution of the endo-epicadial inverse problem was employed for detection of origins of focal ventricular tachycardia (Revishvili et al, 2015; Wissner et al, 2016), determination of electrical rotors in atrial fibrillation (Metzner et al, 2017), exploring morphology of unipolar epicardial and endocardial electrograms in the right ventricular outflow tract in patients with Brugada syndrome (Rudic et al, 2016), analysis of excitation patterns in reentrant ventricular tachycardia (Tsyganov et al, 2017) and atrial flutter (Wissner et al, 2018). In these studies, a numerical algorithm based on a combination of Tikhonov and iterative regularization was used (Bokeriya et al, 2008; Kalinin, 2011).…”