Does Mapping Catheter Geometry and Location Affect AF Driver Detection? A Simulation Study

Claudio Fabbri1, Chiara Bartolucci1, Corrado Tomasi2, Paolo Sabbatani2, Stefano Severi1, Cristiana Corsi1
1University of Bologna, 2AUSL della Romagna, Italy


Ablation is the standard therapy to remove drivers triggering or sustain-ing atrial fibrillation (AF), including re-entrant waves (rotors). Therefore, the correct identification of both presence and location of rotors during the ablation procedure could support a more precise targets’ tracking. Since rotor detection by multi-electrode catheters may be influenced by several parameters including inter-electrode spacing, catheter coverage and endocardium-catheter distance, in this study we developed a tool which allows testing their capability of detecting AF drivers with differ-ent catheter shapes in different conditions. A 7.75s simulated spiral wave propagation in 2D tissue (50mm x 50mm) was obtained using a monodomain implementation and a modified Cour-temanche model that considers an electrical remodeling. Two commer-cially available high-density multipolar catheters were simulated (Advi-sor™ HD Grid and Pentaray®) and placed in a region of the grid in which the simulated spiral persists longer. The inter-electrode distance, the coverage (number of electrodes) and the endocardium-catheter distance were changed and the capability of the simulated catheters to detect the rotor was evaluated.
Our framework allowed the acquisition of the signal in unipolar mode at 2KHz. In contact with the wall and within 1mm distance from the real core all the configurations allowed a correct detection of the rotor, irre-spective of geometry, coverage and inter-electrode distance. In the HD Grid-like geometry increasing the inter-electrode distance causes the in-capability of rotor detection at a closer distance from the LA wall (inter-electrode distance 3/6mm up to 2/1mm endocardium-catheter distance). In the Pentaray-like configuration, independently from the inter-electrode distance, the rotor detection failed at 3mm endocardium-catheter distance. The asymmetry of this catheter resulted in rotation-dependence in the rotor detection.
The tool was effective in assessing how catheter geometry and specific parameters affect its capability to detect rotors. In the future, other cathe-ter morphologies and different parameters/conditions could be investi-gated.