Introduction:
Computational analysis of 64-electrode basket catheter (BC) recordings of atrial fibrillation (AF) have been used to generate visually-identified electrical rotors and focal sources that are then targeted for radiofrequency ablation (RFA).
Hypothesis:
The purpose of this study was to assess BC maps of right (RA) and left (LA) atria during AF in humans using a novel software, CartoFinder™ (CF) (Biosense Webster, CA, USA), which was developed to identify rapid activation patterns (RAP) and incorporate them into a 3D mapping system, CARTO.
Methods:
20 patients who were undergoing RFA AF utilizing CARTO mapping and who consented were enrolled. 1 minute BC maps of the RA and LA were obtained after creation of a 3D virtual anatomic shell prior to and after RFA around the pulmonary veins (PV). There were no complications. BC maps were analyzed by CF post procedure. CF annotates the leading edge of RAP with red color (see figure).
Results:
Of these 20 patients, CF recordings were complete in 14 pts (mean age 59; 12 persistent AF). There were 2.8 RAP / pt. The RA RAP were located septum (n = 9), anterolateral (n=5), and posterior (n = 3) walls. The LA RAP were located anterior (n = 8), roof (n=7), and posterior (n = 7) walls. RFA was delivered on top of (n=10), within 5mm (n = 4), or distant (n=10) from any RAP. Post PV isolation, there was a 45% reduction in RAP vs pre-RFA; and, 11 pts converted to sinus (n=7) or transitioned to flutter (n=4).
Conclusions:
CF is a novel software algorithm incorporated into CARTO that identifies RAP in the RA and LA. RFA around the PV only results in 45% reduction of RAP, suggesting that RFA beyond traditional PV isolation is required to eliminate the bulk of RAP.
Compass Mapping, Double Potentials, Activation Patterns Can Identify and Track Rotational Activity Sites in the Left Atrium of Humans with Persistent Atrial Fibrillation.