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Locating Atrial Fibrillation Rotor and Focal Sources Using Iterative Navigation of Multipole Diagnostic Catheters.

Prasanth Ganesan1, Elizabeth M Cherry2, David T Huang3

  • 1Department of Computer and Electrical Engineering, Florida Atlantic University, Boca Raton, FL, USA.

Cardiovascular Engineering and Technology
|April 17, 2019
PubMed
Summary

This study introduces an algorithm to precisely locate atrial fibrillation (AF) sources using electrograms from multi-polar catheters. The novel method achieves over 95% success in identifying focal and rotor sources, improving ablation procedures.

Keywords:
AF ablation target detectionAtrial fibrillationElectrogram signal processingNon-pulmonary-vein source detectionPatient-specific ablation strategy development

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Area of Science:

  • Cardiovascular Electrophysiology
  • Medical Device Technology
  • Computational Biology

Background:

  • Multi-polar diagnostic catheters are crucial for 3D electro-anatomic mapping during atrial fibrillation (AF) ablation.
  • Locating specific AF-driving sites (focal and rotor sources) using recorded electrograms remains a challenge.

Purpose of the Study:

  • To develop and present the first algorithm for iterative navigation of a circular multi-polar catheter to pinpoint AF focal and rotor sources.
  • To achieve AF source localization without requiring complete atrial mapping.

Main Methods:

  • An algorithm was designed to iteratively advance a Lasso catheter based on electrogram characteristics, starting from an initial position.
  • The algorithm was blinded to AF source location and type, stopping upon identification of a source.
  • Algorithm efficiency was validated using simulated focal and rotor-driven arrhythmias in fibrotic human atrial tissue models (2D and 3D).

Main Results:

  • The algorithm demonstrated high feasibility, achieving a success rate exceeding 95.25% in locating AF sources.
  • Localization was accomplished within an average of 7.56 ± 2.28 catheter placements.
  • Performance was independent of the catheter's initial position and the type of AF source.

Conclusions:

  • The developed algorithm shows significant potential for clinical electrophysiology laboratories.
  • It can aid in mapping patient-specific AF sources outside the pulmonary veins.
  • This approach may lead to improved success rates for AF ablation procedures.