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High-Resolution Endocardial and Epicardial Optical Mapping in a Sheep Model of Stretch-Induced Atrial Fibrillation
Published on: July 29, 2011
Endocardial mapping of atrial fibrillation in the human right atrium using a non-contact catheter
R J Schilling1, A H Kadish, N S Peters
1St. Mary's Hospital and Imperial College School of Medicine, London, UK.
Insights
Non-contact mapping reveals atrial fibrillation initiation and termination patterns in the right atrium. Findings suggest the left atrium may sustain atrial fibrillation in some patients, requiring further study.
Area of Science:
- Cardiology
- Electrophysiology
- Medical Imaging
Background:
- Human endocardial mapping of atrial fibrillation (AF) faces limitations due to low resolution and complex atrial anatomy.
- Understanding AF mechanisms requires advanced mapping techniques.
Purpose of the Study:
- To investigate the initiation and termination mechanisms of atrial fibrillation using non-contact mapping.
- To characterize right atrial activation patterns during AF.
Main Methods:
- A non-contact multielectrode catheter was used in 11 patients with AF to reconstruct 3360 electrograms.
- Inverse solution mathematics and computer-simulated endocardial models were employed to create isopotential maps.
- Electrogram reconstruction was validated against contact electrograms.
Main Results:
- Non-contact mapping identified varying wavefronts (1-5) in the right atrium during AF.
- Electrical silence periods were observed, with activity re-emerging from septal sites, suggesting a left atrial origin.
- AF termination was observed spontaneously or via pacing, with flecainide administration leading to sinus rhythm or atrial tachycardia.
Conclusions:
- Non-contact mapping elucidated AF initiation/termination modes and right atrial activation patterns.
- Findings suggest the left atrium may play a role in sustaining AF in some individuals.
- Simultaneous right and left atrial mapping is recommended for comprehensive understanding of human AF mechanisms.
Background:
Endocardial mapping of atrial fibrillation in humans is limited by its low resolution and by complexities in the arrhythmia and atrial anatomy.
Methods And Results:
A catheter mounted non-contact multielectrode was deployed in the right atrium of 11 patients with atrial fibrillation and used to reconstruct 3360 electrograms, superimposed onto a computer-simulated model of the endocardium, using inverse solution mathematics. This allows construction of isopotential maps of the right atrium. Patients had either sustained atrial fibrillation (n=3) for >6 months or developed atrial fibrillation during the study (n=8). Spontaneous initiation of atrial fibrillation was recorded in one patient and was demonstrated by the non-contact system to arise from two successive atrial ectopic beats from the site of a roving contact catheter. Reconstruction of electrograms recorded during atrial fibrillation was validated by comparison with contact electrograms with cross-correlation. During established atrial fibrillation, four patients predominantly had a single right atrial wave front, two had two wave fronts and five patients had three to five wave fronts for most of the time. Periods of electrical silence were seen in the right atrium in eight patients, after which, activity emerged from consistent septal sites alone, suggesting a left atrial origin. During intravenous administration of flecainide, atrial fibrillation in two patients terminated spontaneously or following pacing manoeuvres, while in the remaining patient sinus rhythm was restored via atrial tachycardia.
Conclusion:
Non-contact mapping of the right atrium has demonstrated modes of initiation and termination of atrial fibrillation, characterized different patterns of right atrial activation in atrial fibrillation and suggests that the left atrium may sustain atrial fibrillation in some patients. Simultaneous mapping of the right and left atrium is required to further elucidate the mechanisms of human atrial fibrillation.
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