Locating Atrial Fibrillation Rotor and Focal Sources Using Iterative Navigation of Multipole Diagnostic Catheters

• Published in: Cardiovascular engineering and technology Vol. 10; no. 2; pp. 354 - 366
• Main Authors: Ganesan, Prasanth, Cherry, Elizabeth M., Huang, David T., Pertsov, Arkady M., Ghoraani, Behnaz
• Format: Journal Article
• Language: English
• Published: New York Springer US 01.06.2019; Springer Nature B.V
• Subjects: Ablation; Action Potentials; Algorithms; Atria; Atrial Fibrillation - diagnosis; Atrial Fibrillation - physiopathology; Biomedical Engineering and Bioengineering; Biomedicine; Cardiac arrhythmia; Cardiac Catheterization - instrumentation; Cardiac Catheters; Cardiology; Catheters; Computer Simulation; Diagnostic systems; Electrophysiologic Techniques, Cardiac - instrumentation; Electrophysiology; Engineering; Feasibility Studies; Fibrillation; Fibrosis; Heart Atria - pathology; Heart Atria - physiopathology; Heart Rate; Humans; Mapping; Multipoles; Predictive Value of Tests; Signal Processing, Computer-Assisted; Non-pulmonary-vein source detection; Patient-specific ablation strategy development; AF ablation target detection; Atrial fibrillation; Electrogram signal processing
• ISSN: 1869-408X; 1869-4098; 1869-4098
• DOI: 10.1007/s13239-019-00414-5

Purpose Multi-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. Methods Starting 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. Results Our 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. Conclusions The 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.