Body surface localization of left and right atrial high-frequency rotors in atrial fibrillation patients: a clinical-computational study.
BACKGROUND
Ablation is an effective therapy in patients with atrial fibrillation (AF) in which an electrical driver can be identified.


OBJECTIVE
The aim of this study was to present and discuss a novel and strictly noninvasive approach to map and identify atrial regions responsible for AF perpetuation.


METHODS
Surface potential recordings of 14 patients with AF were recorded using a 67-lead recording system. Singularity points (SPs) were identified in surface phase maps after band-pass filtering at the highest dominant frequency (HDF). Mathematical models of combined atria and torso were constructed and used to investigate the ability of surface phase maps to estimate rotor activity in the atrial wall.


RESULTS
The simulations show that surface SPs originate at atrial SPs, but not all atrial SPs are reflected at the surface. Stable SPs were found in AF signals during 8.3% ± 5.7% vs. 73.1% ± 16.8% of the time in unfiltered vs. HDF-filtered patient data, respectively (P < .01). The average duration of each rotational pattern was also lower in unfiltered than in HDF-filtered AF signals (160 ± 43 ms vs. 342 ± 138 ms; P < .01), resulting in 2.8 ± 0.7 rotations per rotor. Band-pass filtering reduced the apparent meandering of surface HDF rotors by reducing the effect of the atrial electrical activity occurring at different frequencies. Torso surface SPs representing HDF rotors during AF were reflected at specific areas corresponding to the fastest atrial location.


CONCLUSIONS
Phase analysis of surface potential signals after HDF filtering during AF shows reentrant drivers localized to either the left atrium or the right atrium, helping in localizing ablation targets.
Bio-ITACA, Universitat Politécnica de Valencia, Valencia, Spain.
Miguel
M
Rodrigo
Bio-ITACA, Universitat Politécnica de Valencia, Valencia, Spain. Electronic address: mguisan@eln.upv.es.
María S
MS
Guillem
Cardiology Department, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain.
Andreu M
AM
Climent
Bio-ITACA, Universitat Politécnica de Valencia, Valencia, Spain.
Jorge
J
Pedrón-Torrecilla
Bio-ITACA, Universitat Politécnica de Valencia, Valencia, Spain.
Alejandro
A
Liberos
Bio-ITACA, Universitat Politécnica de Valencia, Valencia, Spain.
José
J
Millet
Cardiology Department, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain.
Francisco
F
Fernández-Avilés
Cardiology Department, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain. Electronic address: fatienza@secardiologia.es.
Felipe
F
Atienza
Center for Arrhythmia Research, University of Michigan, Ann Arbor, Michigan.
Omer
O
Berenfeld
D000328:Adult; D000368:Aged; D001281:Atrial Fibrillation / Q000503:physiopathology / Q000601:surgery*; D018780:Body Surface Potential Mapping / Q000379:methods*; D017115:Catheter Ablation / Q000295:instrumentation*; D004867:Equipment Design; D005260:Female; D005500:Follow-Up Studies; D006325:Heart Atria / Q000503:physiopathology / Q000601:surgery*; D006329:Heart Conduction System / Q000503:physiopathology / Q000601:surgery*; D006801:Humans; D008297:Male; D016896:Treatment Outcome
Atrial fibrillation; Atrial rotor; Body surface potential mapping; Electrocardiography; Mapping