Identification of Repetitive Activation Patterns Using Novel Computational Analysis of Multielectrode Recordings During Atrial Fibrillation and Flutter in Humans.

OBJECTIVES

The purpose of this study was to assess computational analysis of 64-electrode basket catheter (BC) recordings of atrial fibrillation (AF) and atrial flutter using novel software, CARTOFINDER (CF).

BACKGROUND

Repetitive patterns have been recorded during AF and reported to be an important mechanism of AF. CF was used to identify rotational repetitive activation patterns (RAPs) in the right (RA) and left atrium (LA).

METHODS

To assess for presence of RAPs, multiple 1-min BC maps of the RA and LA were obtained before and after radiofrequency ablation (RFA) around the pulmonary veins in 14 patients undergoing AF ablation. Validation of the CF algorithm was based on analysis of BC recordings of the cavotricuspid isthmus flutter.

RESULTS

There were 2.9 rotational RAPs per patient (1.3 RA; 1.6 LA). No RAPs were noted in 2 patients. RFA was delivered on top of (n = 10), within 5 mm (n = 5), or distant (n = 10) from any RAP. Reproducibility of the BC to identify the same RAP was 82%. Post-pulmonary vein (PV) isolation, there was a 45% reduction in RAP versus pre-RFA. CF was validated by 4 electrophysiologists blindly reviewing 32 RA CF maps. Electrophysiologists correctly categorized presence/absence of RAP in 122 of 128 maps (95%).

CONCLUSIONS

CF is novel software incorporated into CARTO that identifies rotational RAP in the RA and LA with 82% reproducibility. PV RFA results in 45% reduction of RAP, suggesting that RFA beyond PV isolation is required to eliminate the bulk of RAP. Electrophysiologists who were first-time users of CF could readily identify RAPs.