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Absence of rotational activity detected using 2-dimensional phase mapping in the corresponding 3-dimensional phase maps in human persistent atrial fibrillation

Published:September 13, 2017DOI:https://doi.org/10.1016/j.hrthm.2017.09.010

      Background

      Current phase mapping systems for atrial fibrillation create 2-dimensional (2D) maps. This process may affect the accurate detection of rotors. We developed a 3-dimensional (3D) phase mapping technique that uses the 3D locations of basket electrodes to project phase onto patient-specific left atrial 3D surface anatomy.

      Objective

      We sought to determine whether rotors detected in 2D phase maps were present at the corresponding time segments and anatomical locations in 3D phase maps.

      Methods

      One-minute left atrial atrial fibrillation recordings were obtained in 14 patients using the basket catheter and analyzed off-line. Using the same phase values, 2D and 3D phase maps were created. Analysis involved determining the dominant propagation patterns in 2D phase maps and evaluating the presence of rotors detected in 2D phase maps in the corresponding 3D phase maps.

      Results

      Using 2D phase mapping, the dominant propagation pattern was single wavefront (36.6%) followed by focal activation (34.0%), disorganized activity (23.7%), rotors (3.3%), and multiple wavefronts (2.4%). Ten transient rotors were observed in 9 of 14 patients (64%). The mean rotor duration was 1.1 ± 0.7 seconds. None of the 10 rotors observed in 2D phase maps were seen at the corresponding time segments and anatomical locations in 3D phase maps; 4 of 10 corresponded with single wavefronts in 3D phase maps, 2 of 10 with 2 simultaneous wavefronts, 1 of 10 with disorganized activity, and in 3 of 10 there was no coverage by the basket catheter at the corresponding 3D anatomical location.

      Conclusion

      Rotors detected in 2D phase maps were not observed in the corresponding 3D phase maps. These findings may have implications for current systems that use 2D phase mapping.

      Keywords

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      References

        • Narayan S.M.
        • Krummen D.E.
        • Rappel W.-J.
        Clinical mapping approach to diagnose electrical rotors and focal impulse sources for human atrial fibrillation.
        J Cardiovasc Electrophysiol. 2012; 23: 447-454
        • Haïssaguerre M.
        • Hocini M.
        • Denis A.
        • et al.
        Driver domains in persistent atrial fibrillation.
        Circulation. 2014; 130: 530-538
        • Lee G.
        • Kumar S.
        • Teh A.
        • et al.
        Epicardial wave mapping in human long-lasting persistent atrial fibrillation: transient rotational circuits, complex wavefronts, and disorganized activity.
        Eur Heart J. 2014; 35: 86-97
        • de Groot N.
        • van der Does L.
        • Yaksh A.
        • et al.
        Direct proof of endo-epicardial asynchrony of the atrial wall during atrial fibrillation in humans.
        Circ Arrhythm Electrophysiol. 2016; 9 (https://doi.org/10.1161/CIRCEP.115.003648): e003648
        • Mandapati R.
        • Skanes A.
        • Chen J.
        • Berenfeld O.
        • Jalife J.
        Stable microreentrant sources as a mechanism of atrial fibrillation in the isolated sheep heart.
        Circulation. 2000; 101: 194-199
        • Narayan S.M.
        • Krummen D.E.
        • Shivkumar K.
        • Clopton P.
        • Rappel W.J.
        • Miller J.M.
        Treatment of atrial fibrillation by the ablation of localized sources: CONFIRM (Conventional Ablation for Atrial Fibrillation With or Without Focal Impulse and Rotor Modulation) trial.
        J Am Coll Cardiol. 2012; 60: 628-636
        • Miller J.M.
        • Kalra V.
        • Das M.K.
        • et al.
        Clinical benefit of ablating localized sources for human atrial fibrillation: the Indiana University FIRM Registry.
        J Am Coll Cardiol. 2017; 69: 1247-1256
        • Buch E.
        • Share M.
        • Tung R.
        • et al.
        Long-term clinical outcomes of focal impulse and rotor modulation for treatment of atrial fibrillation: a multicenter experience.
        Heart Rhythm. 2016; 13: 636-641
        • Steinberg J.S.
        • Shah Y.
        • Bhatt A.
        • et al.
        Focal impulse and rotor modulation: acute procedural observations and extended clinical follow-up.
        Heart Rhythm. 2017; 14: 192-197
        • Allessie M.
        • de Groot N.
        CrossTalk opposing view: rotors have not been demonstrated to be the drivers of atrial fibrillation.
        J Physiol. 2014; 592: 3167-3170
        • Pathik B.
        • Kalman J.M.
        • Walters T.
        • Kuklik P.
        • Zhao J.
        • Madry A.
        • Prabhu S.
        • Nalliah C.
        • Kistler P.M.
        • Lee G.
        Transient rotor activity during prolonged three dimensional phase mapping in human persistent atrial fibrillation.
        Heart Rhythm. 2017; 14: S209
        • Kumar S.
        • Sutherland F.
        • Rosso R.
        • et al.
        Effects of chronic omega-3 polyunsaturated fatty acid supplementation on human atrial electrophysiology.
        Heart Rhythm. 2011; 8: 562-568
        • Benharash P.
        • Buch E.
        • Frank P.
        • et al.
        Quantitative analysis of localized sources identified by focal impulse and rotor modulation mapping in atrial fibrillation.
        Circ Arrhythm Electrophysiol. 2015; 8: 554-561
        • Bieging E.
        • Morris A.
        • Cates J.
        • Marrouche N.
        Regional left atrial wall fibrosis and recurrence after atrial fibrillation ablation.
        J Cardiovasc Magn Reson. 2016; 18: P200
        • Orwant J.
        • Hietaniemi J.
        • Macdonald J.
        Mastering Algorithms With Perl.
        O'Reilly Media, California1999
        • Kuklik P.
        • Zeemering S.
        • Maesen B.
        • Maessen J.
        • Crijns H.J.
        • Verheule S.
        • Ganesan A.N.
        • Schotten U.
        Reconstruction of instantaneous phase of unipolar atrial contact electrogram using a concept of sinusoidal recomposition and Hilbert transform.
        IEEE Trans Biomed Eng. 2015; 62: 296-302
        • Wang K.
        A study of the cubic spline interpolation.
        Rivier Acad J. 2013; 9: 1-15
        • Shepard D.
        A two-dimensional interpolation function for irregularly-spaced data.
        in: Proceedings of the 1968 23rd ACM National Conference. Association for Computing Machinery, New York1968: 517-524
        • Walters T.
        • Lee G.
        • Morris G.
        • et al.
        Temporal stability of rotors and atrial activation patterns in persistent human atrial fibrillation: a high density epicardial mapping study of prolonged recordings.
        J Am Coll Cardiol EP. 2015; 1-2: 14-24
        • Alhusseini M.
        • Vidmar D.
        • Meckler G.L.
        • et al.
        Two independent mapping techniques identify rotational activity patterns at sites of local termination during persistent atrial fibrillation.
        J Cardiovasc Electrophysiol. 2017; 28: 615-622

      Linked Article

      • To the Editor— On the deformation and interpolation of phase maps
        Heart RhythmVol. 15Issue 2
        • Preview
          A recent article by Pathik et al1 analyzes electrograms from patients using a basket catheter and constructs 2-dimensional (2D) phase maps that were projected onto the 3D atrial surface. They report transient rotors in the 2D maps that were absent in the corresponding 3D maps. This discrepancy in observed activation patterns is surprising since rotational activity on a 2D grid will be preserved when that grid is projected onto a curved 3D surface unless the relative position of electrodes is changed.
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