Abstract Introduction Pace mapping of atrial arrhythmia is a method to localize the origin of usually focal arrhythmias that are unstable or not persisting during EP-study and, therefore not eligible for LAT-Mapping. The technique applies pattern matching of p-waves from surface-electrocardiogram (sEKG) as well as intracardiac signals during atrial tachycardia and pacing from the site of suspected origin. The CARTO® 3 system Version 7.2 applies an automated algorithm for intracardiac pace mapping (ICPM) using the unipolar signal of the reference electrode, usually located in the coronary sinus. Methods We examined 12 consecutive patients undergoing RF pulmonary vein isolation (PVI). We performed local pacing at the anterior and posterior wall of the left atrium (LA) and the posterior and lateral wall of the right atrium (RA). The first pacing point was defined as the reference pacing site (RPS). The ICPM algorithm was applied to calculate the similarity of the IC pattern of the RPS to the IC pattern across various distances. The maps, including mesh, point locations and IC pattern similarity of each point, were exported for further analysis in the Python environment. The areas were calculated for the 5% similarity strata. Results The study assessed areas with a 95% or higher pattern similarity in different atrial regions, revealing notable differences in pattern similarity. The median area of pattern similarity was 1.48 cm² (IQR: 0.76 - 2.01 cm²) in the LA posterior, 0.62 cm² (IQR: 0.15 - 1.06 cm²) in the LA anterior, 0.60 cm² (IQR: 0.38 - 1.19 cm²) in the RA posterior, and 5.68 cm² (IQR: 2.89 - 11.1 cm²) in the RA lateral wall. Significant differences were found between the posterior and anterior walls of the LA and the RA lateral wall, as well as between the RA posterior and RA lateral wall, indicating variability in intracardiac pattern matching accuracy. Patterns below 2 cm² are acceptable for catheter ablation. An outlier was noted in the RA posterior region. Conclusion The intracardiac pattern matching for atrial arrhythmias employing the CARTO-ICPM algorithm is feasible with acceptable accuracy except for the lateral regions of the right atrium. This might be explained by the larger distance to the referent catheter in the coronary sinus and the preferred conduction direction in the crista terminalis. Enhancing localization accuracy may necessitate the adjunctive use of surface ECG-pace mapping or the deployment of an additional multipolar intracardiac reference catheter in the lateral RA.A: IC Pattern, B: Box plots similarity
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