Initial Experience With Ultra High-Density Mapping of Human Right Atria

Area of Science:

• Cardiology
• Electrophysiology
• Medical Technology

Background:

• Previous animal studies showed promise for automatic high-resolution mapping of right atrial (RA) geometry and activation.
• Human data were lacking for this advanced mapping technique.
• Assessing clinical feasibility and accuracy in humans was necessary.

Purpose of the Study:

• To evaluate the clinical feasibility and accuracy of high-density electroanatomical mapping for various RA arrhythmias.
• To assess the performance of a novel automatic mapping system in human patients.

Main Methods:

• Utilized a novel mini-basket catheter with 64 electrodes for RA mapping in 23 patients.
• Employed automatic electrogram annotation for rapid data acquisition.
• Created partial and complete electroanatomical maps, recording median acquisition times.

Main Results:

• Successfully created electroanatomical maps (35 partial, 24 complete) with a median acquisition time of 6:43 minutes.
• Automatically annotated over 3,236 data points per map without manual correction.
• Identified consistent activation patterns during sinus rhythm and pacing, correlating with diagnosed arrhythmias like atrial flutter and ectopic atrial tachycardia.
• Successfully detected His bundle and fractionated potentials, guiding safe and effective ablation procedures.

Conclusions:

• Automatic high-density mapping of the RA is fast, feasible, and safe in a clinical setting.
• The system reliably identifies atrial activation propagation during sinus rhythm, tachycardias, and complex reentrant arrhythmias.
• This technology offers reproducible insights into RA electrophysiology, supporting clinical decision-making.