Basket-Type Catheters: Diagnostic Pitfalls Caused by Deformation and Limited Coverage

Area of Science:

• Electrophysiology
• Medical Device Engineering
• Computational Modeling

Background:

• Whole-chamber mapping using 64-pole basket catheters (BC) is crucial for analyzing atrial fibrillation (AF) excitation patterns.
• Flexible BC designs, while preventing perforation, can cause spline bunching, impacting endocardial coverage and data accuracy.

Purpose of the Study:

• To quantify BC deformation and endocardial coverage in clinical settings.
• To investigate the impact of BC size and electrode configuration on coverage using an in silico model.

Main Methods:

• Quantitative evaluation of atrial coverage and spline separation from clinical measurements.
• Development of a computational BC model with an anatomy-adaptive shape algorithm.
• Assessment of clinical and simulated data in two atrial mapping positions, varying BC size and electrode arrangement.

Main Results:

• Common interspline distances exceed 20 mm, resulting in less than 50% left atrial (LA) surface coverage.
• In silico simulations suggest a maximum achievable coverage of 65% with optimized catheter designs.
• Spline bunching and suboptimal coverage are inherent challenges in current BC technology.

Conclusions:

• Inherent limitations in basket catheter design lead to significant gaps in atrial coverage during electrophysiological mapping.
• These coverage limitations must be considered when interpreting excitation patterns in atrial fibrillation.
• Further advancements in panoramic mapping techniques are necessary to overcome current BC limitations.