Author + information
- Received March 31, 2017
- Revision received June 1, 2017
- Accepted June 9, 2017
- Published online January 15, 2018.
- Bhupesh Pathik, MBBSa,b,
- Jonathan M. Kalman, MBBS, PhDa,b,
- Tomos Walters, MBBS, PhDa,b,
- Pawel Kuklik, PhDc,
- Jichao Zhao, PhDd,
- Andrew Madry, PhDa,
- Sandeep Prabhu, MBBSa,b,e,
- Chrishan Nalliah, MBBSa,b,
- Peter Kistler, MBBS, PhDb,e and
- Geoffrey Lee, MBChB, PhDa,b,∗ ()
- aRoyal Melbourne Hospital, Parkville, Australia
- bUniversity of Melbourne, Parkville, Australia
- cUniversity Medical Center Hamburg-Eppendorf, Hamburg, Germany
- dAuckland Bioengineering Institute, University of Auckland, Auckland, New Zealand
- eAlfred Hospital and Baker IDI, Melbourne, Australia
- ↵∗Address for correspondence:
Dr. Geoffrey Lee, Department of Cardiology, Royal Melbourne Hospital, Grattan Street, Parkville, Victoria 3052, Australia.
Objectives This study sought to validate a 3-dimensional (3D) phase mapping system and determine the distribution of dominant propagation patterns in persistent atrial fibrillation (AF).
Background Currently available systems display phase as simplified 2-dimensional maps. We developed a novel 3D phase mapping system that uses the 3D location of basket catheter electrodes and the patient’s 3D left atrial surface geometry to interpolate phase and create a 3D representation of phase progression.
Methods Six-min AF recordings from the left atrium were obtained in 14 patients using the Constellation basket catheter and analyzed offline. Exported signals underwent both phase and traditional activation analysis and were then visualized using a novel 3D mapping system. Analysis involved: 1) validation of phase analysis by comparing beat-to-beat AF cycle length calculated using phase inversion with that determined from activation timing in the same 20-s segment; 2) validation of 3D phase by comparing propagation patterns observed using 3D phase with 3D activation in the same 1-min segment; and 3) determining the distribution of dominant propagation patterns in 6-min recordings using 3D phase.
Results There was strong agreement of beat-to-beat AF cycle length between activation analysis and phase inversion (R2 = 0.91). There was no significant difference between 3D activation and 3D phase in mean percentage of propagation patterns classified as single wavefronts (p = 0.99), focal activations (p = 0.26), disorganized activity (p = 0.76), or multiple wavefronts (p = 0.70). During prolonged 3D phase, single wavefronts were the most common propagation pattern (50.2%). A total of 34 rotors were seen in 9 of 14 patients. All rotors were transient with mean duration of 1.0 ± 0.6 s. Rotors were only observed in areas of high electrode density where the interelectrode distance was significantly shorter than nonrotor sites (7.4 [interquartile range: 6.3 to 14.6] vs. 15.3 mm [interquartile range: 10.1 to 22.2]; p < 0.001).
Conclusions During prolonged 3D phase mapping, transient rotors were observed in 64% of patients and reformed at the same anatomic location in 44% of patients. The electrode density of the basket catheter may limit the detection of rotors.
Dr. Pathik is a recipient of the Postgraduate Research Scholarship from the National Health and Medical Research Council of Australia (NHMRC) and the National Heart Foundation of Australia. Dr. Kalman is supported by a Practitioner Fellowship from the NHMRC; and fellowship support from Medtronic, St. Jude Medical, Biosense Webster, and Boston Scientific. Dr. Kuklik has received lecture fees from Abbott. Dr. Zhao is supported by the Health Research Council of New Zealand. Dr. Kistler is supported by a Practitioner Fellowship from the NHMRC. Dr. Lee is supported by an Early Career Fellowship from the NHMRC. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
All authors attest they are in compliance with human studies committees and animal welfare regulations of the authors’ institutions and Food and Drug Administration guidelines, including patient consent where appropriate. For more information, visit the JACC: Clinical Electrophysiology author instructions page.
- Received March 31, 2017.
- Revision received June 1, 2017.
- Accepted June 9, 2017.
- 2018 American College of Cardiology Foundation
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