High-resolution Catheters for Arrhythmic Driver Detection: Preliminary Results in Atrial Fibrillation

Alice Andalò1, Giuseppe Calamia1, Claudio Fabbri2, Paolo Sabbatani3, MIchele Monaci1, Stefano Severi2, Cristiana Corsi2
1DEI, University of Bologna, 2University of Bologna, 3Bufalini Hospital, AUSL della Romagna


Mechanisms that sustain atrial fibrillation (AF) are not yet clearly identified. Recently, there has been an increasing interest in detecting spiral waves and rotors and in understanding how these potential drivers sustaining AF might be therapeutic targets for catheter-based ablation. The aim of this study was to understand if arrhythmic drivers may be detected using electrograms (EGMs) acquired with a new high-resolution catheter. EGMs were acquired using the Advisor™ HD Grid (Abbott) mapping cathe-ter. Spatiotemporal organization of atrial fibrillation was studied applying a previously developed and validated algorithm based on phase analysis for local activation timings (LATs) detection and on the persistence of phase singularities for meandering and stable rotor identification on the left atrium (LA) wall. The rotor identification approach was tested on synthetic data showing ex-cellent results (100% of correct classifications). On in vivo data, we analysed 28 segments of ten second duration in three patients. Six stable rotors were identified; two rotors had a persistence of 10 seconds; the remaining 4 rotors were shorter (mean persistence in time: 291 ± 284 ms). Results show the proposed analysis is feasible and processing of EGMs ac-quired with high-resolution catheters allows detection of stable rotors. Proba-bly due to low spatial coverage of the catheter, meandering rotors were not tracked. These results need confirmation on a larger dataset and hold promise for a comprehensive arrhythmic driver detection with different mapping catheters.