Introduction:
Multi-site, high-resolution mapping can be used to identify either the trigger or substrate perpetuating atrial fibrillation (AF). The goal of this study was to assess the feasibility and safety of a new high-resolution epicardial mapping approach.
Hypothesis:
Epicardial atrial mapping of the entire atria can be safely performed as a routine procedure during cardiac surgery.
Methods:
Epicardial mapping of the entire right atrium, left atrium and Bachmann’s Bundle was performed in 291 patients (218 male, age:66±11yrs) undergoing elective surgery during sinus rhythm (SR) and (induced) AF using high-resolution mapping arrays with inter-electrode distances of 1-2mm. Electrophysiological parameters were quantified and designated to anatomical quadrants of 1cm2.
Results:
AF was non-inducible in 36 patients. Hemodynamic parameters (mean arterial pressure, right atrial pressure, BIS score, ST-T segment alterations) before and during SR mapping were comparable (P<0.22). During AF, only mean arterial pressure (71±11 versus 67±10mmHg (P<0.004)) and right atrial pressure (10±4 versus 11±4mmHg (P<0.0001)) decreased. Total mapping time during SR or AF was respectively 3±1min. and 4±2min. Beat-to-beat variation of SR cycle length and peak-to-peak amplitude of unipolar potentials were respectively 0.04±14.42ms and -0.01±0.53mV, reflecting stability of the mapping array. Complications were not observed.
Conclusions:
Our novel intra-operative epicardial atrial mapping approach can be safely applied during both SR and AF. This mapping approach is the first technique allowing quantification of the arrhythmogenic substrate in the individual patient thereby taking the first step towards personalizing treatment of AF.
189-04: Automated ultra-high resolution mapping of reentrant scar-related atrial arrhythmias: finding the critical isthmus based on electrophysiological properties