Author + information
- Received January 22, 2019
- Revision received September 17, 2019
- Accepted September 19, 2019
- Published online February 17, 2020.
- Rui Shi, MD, PhDa,b,
- Paras Parikh, PhDc,
- Zhong Chen, MBBS, PhDb,
- Nathan Angel, PhDc,
- Mark Norman, MDb,
- Wajid Hussain, MDb,
- Charlie Butcher, MBBSb,
- Shouvik Haldar, MDb,
- David G. Jones, MDb,
- Omar Riad, MDb,
- Vias Markides, MDb and
- Tom Wong, MDb,∗ ()
- aDepartment of Cardiovascular Medicine, The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, China
- bHeart Rhythm Centre, The Royal Brompton and Harefield National Health Service Foundation Trust, National Heart and Lung Institute, Imperial College London, United Kingdom
- cAcutus Medical, Carlsbad, California
- ↵∗Address for correspondence:
Dr. Tom Wong, Heart Rhythm Centre, The Royal Brompton and Harefield National Health Service Foundation Trust, National Heart and Lung Institute, Imperial College London, Sydney Street, London SW3 6NP, United Kingdom.
Objectives This study sought to validate the accuracy of noncontact electrograms against contact electrograms in the left atrium during sinus rhythm (SR) and atrial fibrillation (AF).
Background Noncontact mapping offers the opportunity to assess global cardiac activation in the chamber of interest. A novel noncontact mapping system, which records intracardiac voltage to derive cellular charge sources (dipole density), allows real-time mapping of AF to guide ablation.
Methods Noncontact and contact unipolar electrogram pairs were recorded simultaneously from multiple locations. Morphology correlation and timing difference of reconstructed electrograms obtained from a noncontact catheter were compared with those from contact electrograms obtained from a contact catheter at the same endocardial locations.
Results A total of 796 electrogram pairs in SR and 969 electrogram pairs in AF were compared from 20 patients with persistent AF. The median morphology correlation and timing difference (ms) in SR was 0.85 (interquartile range [IQR]: 0.71 to 0.94) and 6.4 ms (IQR: 2.6 to 17.1 ms); in AF was 0.79 (IQR: 0.69 to 0.88) and 14.4 ms (IQR: 6.7 to 26.2 ms), respectively. The correlation was stronger and the timing difference was less when the radial distance (r) from the noncontact catheter center to the endocardium was ≤ 40 versus > 40 mm; 0.87 (IQR: 0.72 to 0.94) versus 0.73 (IQR: 0.56 to 0.88) and 5.7 ms (IQR: 2.6 to 15.4 ms) versus 15.1 ms (IQR: 4.1 to 27.7 ms); p < 0.01 when in SR; 0.81 (IQR: 0.69 to 0.89) versus 0.67 (IQR: 0.45 to 0.82) and 12.3 ms (IQR: 5.9 to 21.8 ms) versus 28.3 ms (IQR: 16.2 to 36.0 ms); p < 0.01 when in AF.
Conclusions This novel noncontact dipole density mapping system provides comparable reconstructed atrial electrogram measurements in SR or AF in human left atrium when the anatomical site of interest is ≤40 mm from the mapping catheter.
- atrial fibrillation
- contact mapping
- noncontact dipole density mapping
- unipolar signal
Dr. Shi has received a fellowship scholarship from the China Scholarship Council (No. 201606285148) paid to the institution. Drs. Parikh and Angel are employees of Acutus Medical, and both hold stock options. Dr. Markides has a consulting agreement with Biosense Webster. Dr. Wong has received support from National Institute for Health Research. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
The 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 January 22, 2019.
- Revision received September 17, 2019.
- Accepted September 19, 2019.
- 2020 The Authors