Abstract
BackgroundCatheter ablation therapy involving isolation of pulmonary veins (PVs) from the left atrium is performed to terminate atrial fibrillation (AF). Unfortunately, standalone PV isolation procedure has shown to be a suboptimal success with AF continuation or recurrence. One reason, especially in patients with persistent or high-burden paroxysmal AF, is known to be due to the formation of repeating-pattern AF sources with a meandering core inside the atria. However, there is a need for accurate mapping and localization of these sources during catheter ablation.MethodsA novel AF source area probability (ASAP) mapping algorithm was developed and evaluated in 2D and 3D atrial simulated tissues with various arrhythmia scenarios and a retrospective study with three cases of clinical human AF. The ASAP mapping analyzes the electrograms collected from a multipole diagnostic catheter that is commonly used during catheter ablation procedure to intelligently sample the atria and delineate the trajectory path of a meandering repeating-pattern AF source. ASAP starts by placing the diagnostic catheter at an arbitrary location in the atria. It analyzes the recorded bipolar electrograms to build an ASAP map over the atrium anatomy and suggests an optimal location for the subsequent catheter location. ASAP then determines from the constructed ASAP map if an AF source has been delineated. If so, the catheter navigation is stopped and the algorithm provides the area of the AF source. Otherwise, the catheter is navigated to the suggested location, and the process is continued until an AF-source area is delineated.ResultsASAP delineated the AF source in over 95% of the simulated human AF cases within less than eight catheter placements regardless of the initial catheter placement. The success of ASAP in the clinical AF was confirmed by the ablation outcomes and the electrogram patterns at the delineated area.ConclusionOur analysis indicates the potential of the ASAP mapping to provide accurate information about the area of the meandering repeating-pattern AF sources as AF ablation targets for effective AF termination. Our algorithm could improve the success of AF catheter ablation therapy by locating and subsequently targeting patient-specific and repeating-pattern AF sources inside the atria.
Highlights
Catheter ablation therapy involving isolation of pulmonary veins (PVs) from the left atrium is performed to terminate atrial fibrillation (AF)
K, AF source area probability (ASAP) analyzes the patterns of the recorded electrograms to estimate the principal wave direction (PWD), as the direction opposite to the direction of the propagating AF source wavefront relative to the current location of the catheter (Phase I), and updates an ASAP map on the atrial anatomy (Phase II)
The ASAP algorithm was implemented in MATLAB R2017b and the AF simulations were implemented in Fortran
Summary
Catheter ablation therapy involving isolation of pulmonary veins (PVs) from the left atrium is performed to terminate atrial fibrillation (AF). The 64-unipolar signals are recorded and processed using a proprietary algorithm based on phase mapping, which reveals a rotor or a focal source if it is present This technology is primarily dependent on whole-chamber, contact basket catheters with inherent shortcomings, such as low spatial resolution, incomplete atrial coverage, and poor electrode contact, which could be the reason for contradictory success rates at different centers [12]. Another approach, CartoFinder (Biosense Webster Inc., CA), uses either a 64-unipole basket catheter or a 20-unipole diagnostic catheter’s signals to locate reentries and focal impulses based on a combination of wavelet and phase analysis algorithm. The method has potential for detecting AF sources, the lack of electroanatomic mapping in this technique is still raising concerns about ablation accuracy assessment, low-voltage signal capturing, and inverse-solution accuracy in the presence of fibrosis [13, 14]
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