Noninvasive phase mapping of persistent atrial fibrillation in humans: Comparison with invasive catheter mapping

A novel noninvasive epicardial and endocardial electrophysiology system (NEEES) to identify electrical rotors and focal activity in patients with atrial fibrillation (AF) was recently introduced. Comparison of NEEES data with results from invasive mapping is lacking.

Six male patients (59 ± 11 years) with persistent AF underwent cardiac mapping with the NEEES, which included the creation of isopotential and phase maps. Then patients underwent catheter mapping using a PentaRay NAV catheter and the CARTO 3 system. Signals acquired by the catheter were analyzed by customized software that applied the same phase mapping algorithm as for the NEEES data.

In all patients, noninvasive phase mapping revealed short-lived electrical rotors occurring 1.8 ± 0.3 times per second and demonstrating 1-4 (mean 1.2 ± 0.6) rotation cycles. Most of these rotors (72.7%) aggregated in 2-3 anatomical clusters. In two patients, focal excitation from pulmonary veins was observed. Invasive catheter mapping in the dominant rotor aggregation sites and in the three control sites demonstrated the presence of electrical rotors with properties similar to noninvasively detected rotors. Spearman's correlation coefficient between rotor occurrence rate by noninvasive and invasive mapping was 0.97 (p < .0001). Mean rotors' cycle length at dominant aggregation sites, scores of their full rotations, and the proportion of rotors with clockwise rotation were not significantly different between the mapping modalities.

In patients with persistent AF, phase processing of unipolar electrograms recorded by catheter mapping could reproduce electrical rotors as characterized by NEEES-based phase mapping.