Catheter configuration for mapping micro-anatomic reentries sustaining atrial fibrillation: A simulation study

Area of Science:

• Electrophysiology
• Computational Cardiology
• Medical Imaging

Background:

• Atrial fibrillation (AF) can be sustained by reentrant circuits in arrhythmogenic hubs.
• Identifying these micro-reentrant pathways with multi-electrode mapping (MEM) is crucial but challenging.

Purpose of the Study:

• To evaluate the efficacy of different MEM configurations for identifying micro-reentrant pathways sustaining AF.
• To determine optimal MEM parameters for detecting sub-endocardial reentrant circuits.

Main Methods:

• Simulated anisotropic atrial tissue with a sub-endocardial myobundle under persistent AF conditions.
• Evaluated 656 MEM configurations varying inter-electrode distance, orientation, contact distance, and position.
• Analyzed unipolar, bipolar, and omnipolar electrograms and local activation time maps for reentry visualization.

Main Results:

• Dense unipolar MEM (1-6 mm spacing) configurations effectively identified reentrant pathways.
• Bipolar MEM required specific electrode alignment with the myobundle.
• Omnipolar MEM showed advantages over unipolar only at larger spacings (9 mm).
• Detection was successful even for tracks thinner than electrode spacing.

Conclusions:

• Unipolar MEM (1-6 mm spacing) with optimal contact detects sub-endocardial AF reentrant pathways in 50-100% of simulations.
• Combining unipolar and omnipolar mapping may enhance AF micro-reentry detection.
• Findings offer insights for optimizing MEM techniques and improving AF ablation procedures.