Abstract
PurposeMulti-polar diagnostic catheters are used to construct the 3D electro-anatomic mapping of the atrium during atrial fibrillation (AF) ablation procedures; however, it remains unclear how to use the electrograms recorded by these catheters to locate AF-driving sites known as focal and rotor source types. The purpose of this study is to present the first algorithm to iteratively navigate a circular multi-polar catheter to locate AF focal and rotor sources without the need to map the entire atria.MethodsStarting from an initial location, the algorithm, which was blinded to the location and type of the AF source, iteratively advanced a Lasso catheter based on its electrogram characteristics. The algorithm stopped the catheter when it located of an AF source and identified the type. The efficiency of the algorithm is validated using a set of simulated focal and rotor-driven arrhythmias in fibrotic human 2D and 3D atrial tissue.ResultsOur study shows the feasibility of locating AF sources with a success rate of greater than 95.25% within average 7.56 ± 2.28 placements independently of the initial position of the catheter and the source type.ConclusionsThe algorithm could play a critical role in clinical electrophysiology laboratories for mapping patient-specific ablation of AF sources located outside the pulmonary veins and improving the procedure success.
Highlights
Atrial fibrillation (AF), characterized by an irregular beating of the atria due to disorganized electrical signals, is a major cause of stroke and affects more than 2.7 million people in the US.[3]
Catheter ablation involving isolation of pulmonary veins (PVs) attempts to block the ectopic signals originating from PVs that are believed to be triggering the arrhythmia
During AF ablation procedures, the electroanatomic mapping of the left atrium is constructed by maneuvering a multipolar diagnostic catheter along the left atrial endocardial surface
Summary
Atrial fibrillation (AF), characterized by an irregular beating of the atria due to disorganized electrical signals, is a major cause of stroke and affects more than 2.7 million people in the US.[3] Catheter ablation involving isolation of pulmonary veins (PVs) attempts to block the ectopic signals originating from PVs that are believed to be triggering the arrhythmia. During AF ablation procedures, the electroanatomic mapping of the left atrium is constructed by maneuvering a multipolar diagnostic catheter along the left atrial endocardial surface. Current non-PV source detection techniques use the single-electrode electrogram characteristics and construct a 3D electroanatomic AF map of the entire atria and use it to identify non-PV ablation targets.[1,6,15,21,25,30] the contradictory clinical outcomes from these techniques suggest that there is a need for a new technique that can effectively utilize the information recorded
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