6A novel mapping system for panoramic mapping of the left atrium: validation and application to detect and characterise localised sources maintaining AF

Honarbakhsh, Shohreh; Schilling, RJ; Dhillon, Gurpreet; Ullah, Waqas; Keating, Emily; Providência, Rui; Chow, Anthony W.; Earley, MJ; Hunter, RJ

doi:10.1093/europace/eux283.146

Cited by 35 publications

(111 citation statements)

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“…The definition used for localized drivers in AF continues to be debated with alternative definitions used in different studies . There are data emerging from centers using different mapping technologies suggesting that AF may be sustained by focal and rotational sources that are spatially stable but with temporal periodicity . However, it remains unclear how best to map and ablate these potential drivers.…”

Section: Discussionmentioning

confidence: 99%

“…Focal drivers have recently been demonstrated through sequential mapping using a “region of interest” algorithm within the CARTOFINDER mapping system . As the focus of that study was to map focal drivers it remains unclear whether sequential mapping would identify rotational drivers which may be less stable than focal drivers . As the STAR mapping method relies on identifying sites of early or leading activity rather than whether the driver site is focal or rotational, the differences in these mechanisms may not be important with this vector mapping approach.…”

Section: Discussionmentioning

confidence: 99%

“…Ablation was stopped if: (a) 5 minutes of ablation had been performed, (b) no signal remained at the ablation site, or (c) a study‐defined ablation response had been achieved. Ablation responses were defined as the termination of AF (into AT or sinus rhythm), or CL slowing of ≥30 ms. Our group has previously applied this definition . AF CL was measured over 30 beats from the PentaRay catheter positioned in the LA appendage.…”

Section: Methodsmentioning

confidence: 99%

“…Global atrial mapping to identify localized drivers in persistent atrial fibrillation (AF) has formed the foundation for several mapping systems, which utilize either basket catheters or noninvasive surface electrocardiogram recordings. When dealing with the constantly changing cycle length (CL) of AF there is a clear advantage in achieving simultaneous atrial mapping.…”

Section: Introductionmentioning

confidence: 99%

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STAR mapping method to identify driving sites in persistent atrial fibrillation: Application through sequential mapping

Honarbakhsh

Schilling

Finlay

et al. 2019

Cardiovasc electrophysiol

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Introduction The optimal way to map localized drivers in persistent atrial fibrillation (AF) remains unclear. The objective of the study was to apply a novel vector mapping approach called Stochastic Trajectory Analysis of Ranked signals (STAR) in AF. Methods and Results Patients having persistent AF ablation were included. Early sites of activation (ESA) identified on global STAR maps created with basket catheters were used to guide AF ablation post‐pulmonary vein isolation (PVI). All patients also had sequential STAR maps created with ≥10 PentaRay recordings of 30 seconds. These were validated offline in their ability to identify the ESA targeted with a study‐defined ablation response (AF termination or cycle length [CL] slowing of ≥30 ms). Thirty‐two patients were included in whom 92 ESA were identified on the global STAR maps, with 73 of 83 targeted sites demonstrating an ablation response (24 AF termination and 49 CL slowing). Sixty‐one out of 73 (83.6%) ESA were also identified on the sequential STAR maps. These showed greater consistency (P < .001), were seen pre‐ and post‐PVI (P < .001) and were more likely to be associated with AF termination on ablation (P = .007). The sensitivity and specificity of sequential mapping for the detection of ESA with an ablation response was 84.9% (95% confidence interval [CI] = 74.6‐92.2) and 90.0% (95% CI = 55.5‐99.8), respectively. During a follow‐up of 19.4 ± 3.7 months, 28 (80%) patients were free from AF/atrial tachycardia. Conclusions STAR mapping consistently identified ESA in all patients and the ablation response was compatible with ESA being driver sites. Mechanistically important ESA were successfully identified using sequential recordings.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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STAR mapping method to identify driving sites in persistent atrial fibrillation: Application through sequential mapping

Honarbakhsh

Schilling

Finlay

et al. 2019

Cardiovasc electrophysiol

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“…CARTO has recently produced CARTOFINDER (Biosense Webster) which times electrograms relative to each other in a 250 ms window which then moves through a continuous recording to show wavefront movement over time. This has enjoyed some success demonstrating focal and rotational activations in AF and an automated approach to their detection has been developed . The Topera and ECGi mapping systems rely on phase mapping to identify drivers.…”

Section: Discussionmentioning

confidence: 99%

Development, in vitro validation and human application of a novel method to identify arrhythmia mechanisms: The stochastic trajectory analysis of ranked signals mapping method

Honarbakhsh

Hunter

Finlay

et al. 2019

Cardiovasc electrophysiol

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Introduction Stochastic trajectory analysis of ranked signals (STAR) is a novel method for mapping arrhythmia. The aim was to describe its development and validation as a mapping tool. Methods and Results The method ranks electrodes in terms of the proportion of the time they lead relative to neighboring electrodes and ascribes a predominant direction of activation between electrodes. This was conceived with the aim of mapping atrial fibrillation (AF) drivers. Validation of this approach was performed in stages. First, in vitro simultaneous multi‐electrode array and optical mapping were performed on spontaneously fibrillating HL1 cell cultures, to determine if such a method would be able to determine early sites of activation (ESA). A clinical study acquiring unipolar electrograms using a 64‐pole basket for the purposes of STAR mapping in patients undergoing atrial tachycardia (AT) ablation. STAR maps were analyzed by physicians to see if arrhythmia mechanisms could be correctly determined. Mapping was then repeated during atrial pacing. STAR mapping of in vitro activation sequences accurately correlated to the optical maps of planar and rotational activation. Thirty‐two ATs were mapped in 25 patients. The ESA accurately identified focal/micro‐reentrant ATs and the mechanism of macro‐reentrant ATs was effectively demonstrated. STAR method accurately identified four pacing sites in all patients. Conclusions This novel STAR method correlated well with the gold standard of optical mapping in vitro and was able to accurately identify AT mechanisms. Further analysis is needed to determine whether the method might be of use mapping AF.

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Atrial fibrillation driver identification through regional mutual information networks: a modeling perspective

Sha¹,

Elliott²,

Zhang³

et al. 2022

J Interv Card Electrophysiol

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Purpose Effective identification of electrical drivers within remodeled tissue is a key for improving ablation treatment for atrial fibrillation. We have developed a mutual information, graph-based approach to identify and propose fault tolerance metric of local efficiency as a distinguishing feature of rotational activation and remodeled atrial tissue. Methods Voltage data were extracted from atrial tissue simulations (2D Karma, 3D physiological, and the Multiscale Cardiac Simulation Framework (MSCSF)) using multi-spline open and parallel regional mapping catheter geometries. Graphs were generated based on varied mutual information thresholds between electrode pairs and the local efficiency for each graph was calculated. Results High-resolution mapping catheter geometries can distinguish between rotational and irregular activation patterns using the derivative of local efficiency as a function of increasing mutual information threshold. The derivative is decreased for rotational activation patterns comparing to irregular activations in both a simplified 2D model (0.0017 ± 1 × 10−4 vs. 0.0032 ± 1 × 10−4, p < 0.01) and a more realistic 3D model (0.00092 ± 5 × 10−5 vs. 0.0014 ± 4 × 10−5, p < 0.01). Average local efficiency derivative can also distinguish between degrees of remodeling. Simulations using the MSCSF model, with 10 vs. 90% remodeling, display distinct derivatives in the grid design parallel spline catheter configuration (0.0015 ± 5 × 10−5 vs. 0.0019 ± 6 × 10−5, p < 0.01) and the flower shaped open spline configuration (0.0011 ± 5 × 10−5 vs. 0.0016 ± 4 × 10−5, p < 0.01). Conclusion A decreased derivative of local efficiency characterizes rotational activation and varies with atrial remodeling. This suggests a distinct communication pattern in cardiac rotational activation detectable via high-resolution regional mapping and could enable identification of electrical drivers for targeted ablation.

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6A novel mapping system for panoramic mapping of the left atrium: validation and application to detect and characterise localised sources maintaining AF

Cited by 35 publications

References 0 publications

STAR mapping method to identify driving sites in persistent atrial fibrillation: Application through sequential mapping

STAR mapping method to identify driving sites in persistent atrial fibrillation: Application through sequential mapping

Development, in vitro validation and human application of a novel method to identify arrhythmia mechanisms: The stochastic trajectory analysis of ranked signals mapping method

Atrial fibrillation driver identification through regional mutual information networks: a modeling perspective

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