Non-invasive phase mapping: validation study in patients with atrial flutter

  • Petrovsky Russian Research Center of Surgery
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To study accuracy of phase mapping for assessment of the atrial activation sequence during typical atrial flutter, four patients were examined. The Amycard 01K device was used for the study purpose. In accordance with the data of surface ECG mapping, the personal rope geometry, personal heart geometry, and coordinates of electrode for surface mapping, local unipolar electrograms were reconstructed approximately in 2500 sites of the atrial surface. The electroanatomic mapping of the right atrium with activation map construction was made followed by linear ablation of the lower cavotricuspid isthmus with subsequent confirmation of presence of bidirectional conduction block. After termination of the catheter procedure, the data recorded using the CARTO system were exported and processed simultaneously with the data of non-invasive mapping. Three-dimensional atrial models created using the CARTO 3 system were superposed with models created using the tomography data. Non-invasive phase maps showed excitation patterns, which in generally corresponded appropriately to activation patterns obtained during the invasive mapping. Rotation of the activation front clockwise around the tricuspid ring in 3 cases and counterclockwise in 1 case were visualized correctly. In all cases, the onset time of bipolar spikes strongly correlated with phase jumps on unipolar electrograms (r=0.97 0.99 for typical atrial flutter and r=0.99 for atrial flutter with clockwise rotation of excitation). The corrected activation time by the phase jump was 5.7±1.7 ms; the normalized activation time: 2.3±0.5%. Thus, phase mapping permits one to assess correctly the activation sequence during typical atrial flutter with different directions of rotation of the excitation; phase mapping may be considered a promising technique of non-invasive mapping of re-entry arrhythmias.

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Heart arrhythmias may accompany virtually any cardiac disease. The problem of the preprocedure topical diagnostics of various arrhythmias remains fundamentally important and relevant, which is confirmed by numerous algorithms aimed at non-invasive detection of the arrhythmogenic focus location. Today, many different methods are available for non-invasive topical diagnostics of the arrhythmogenic foci in both ventricular and atrial arrhythmias. A non-invasive imaging of cardiac electrophysiology (NICE), based on the solution of the inverse problem of the electrocardiography, is the most advanced new technology. The accuracy of NICE reaches 90%, however, it is still inferior in its capabilities to the “reference” method of the invasive intracardiac electrophysiological examination. Currently, the market presents devices for both invasive mapping and NICE. However, in the context of surgery, an integrated system of non-invasive electrophysiological mapping with invasive three-dimensional electroanatomic mapping is of high demand. The creation of hybrid systems will allow to visualize electrophysiological processes in the epi- and endocardial surface in the real time with very high accuracy and to carry out the radiofrequency catheter ablation of arrhythmias with the simultaneous reduction of the radiation load on the patient and medical personnel.
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