Purpose

Multi-polar diagnostic catheters are used to construct the 3D electro-anatomic mapping of the atrium during atrial fibrillation (AF) ablation procedures; however, it remains unclear how to use the electrograms recorded by these catheters to locate AF-driving sites known as focal and rotor source types. The purpose of this study is to present the first algorithm to iteratively navigate a circular multi-polar catheter to locate AF focal and rotor sources without the need to map the entire atria.

Methods

Starting from an initial location, the algorithm, which was blinded to the location and type of the AF source, iteratively advanced a Lasso catheter based on its electrogram characteristics. The algorithm stopped the catheter when it located of an AF source and identified the type. The efficiency of the algorithm is validated using a set of simulated focal and rotor-driven arrhythmias in fibrotic human 2D and 3D atrial tissue.

Results

Our study shows the feasibility of locating AF sources with a success rate of greater than 95.25% within average 7.56 ± 2.28 placements independently of the initial position of the catheter and the source type.

Conclusions

The algorithm could play a critical role in clinical electrophysiology laboratories for mapping patient-specific ablation of AF sources located outside the pulmonary veins and improving the procedure success.

中文翻译：

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使用多极诊断导管的迭代导航定位心房颤动的转子和焦点源。

目的

多极诊断导管用于在房颤（AF）消融过程中构建心房的3D电解剖图。然而，目前尚不清楚如何使用这些导管记录的电描记图来定位称为焦点和转子源类型的AF驱动部位。这项研究的目的是提出第一个算法来迭代导航圆形多极导管以定位AF焦点和转子源，而无需绘制整个心房。

方法

从初始位置开始，对AF源的位置和类型不了解的算法根据其电描记图特征迭代地推进了Lasso导管。该算法在找到AF源并确定其类型时停止了导管。使用一组模拟的纤维化人类2D和3D心房组织中的局灶性和转子驱动性心律失常来验证算法的效率。

结果

我们的研究表明，在平均7.56±2.28放置范围内，成功定位率大于95.25％的AF源的可行性与导管的初始位置和源类型无关。

结论

该算法可能在临床电生理实验室中发挥重要作用，用于绘制位于肺静脉外部的AF源的患者特定消融图，并提高手术成功率。