A novel intra-operative, high-resolution atrial mapping approach.
OBJECTIVE
A new technique is demonstrated for extensive high-resolution intra-operative atrial mapping that will facilitate the localization of atrial fibrillation (AF) sources and identification of the substrate perpetuating AF.


METHODS
Prior to the start of extra-corporal circulation, a 8 × 24-electrode array (2-mm inter-electrode distance) is placed subsequently on all the right and left epicardial atrial sites, including Bachmann's bundle, for recording of unipolar electrograms during sinus rhythm and (induced) AF. AF is induced by high-frequency pacing at the right atrial free wall. A pacemaker wire stitched to the right atrium serves as a reference signal. The indifferent pole is connected to a steal wire fixed to subcutaneous tissue. Electrograms are recorded by a computerized mapping system and, after amplification (gain 1000), filtering (bandwidth 0.5-400 Hz), sampling (1 kHz) and analogue to digital conversion (16 bits), automatically stored on hard disk. During the mapping procedure, real-time visualization secures electrogram quality. Analysis will be performed offline.


RESULTS
This technique was performed in 168 patients of 18 years and older, with coronary and/or structural heart disease, with or without AF, electively scheduled for cardiac surgery and a ventricular ejection fraction above 40 %. The mean duration of the entire mapping procedure including preparation time was 9 ± 2 min. Complications related to the mapping procedure during or after cardiac surgery were not observed.


CONCLUSIONS
We introduce the first epicardial atrial mapping approach with a high resolution of ≥1728 recording sites which can be performed in a procedure time of only 9±2 mins. This mapping technique can potentially identify areas responsible for initiation and persistence of AF and hopefully can individualize both diagnosis and therapy of AF.
Department of Cardiology, Erasmus Medical Center, PO Box 2040, 's Gravendijkwal 230, 3000 CA, Rotterdam, The Netherlands.
Ameeta
A
Yaksh
Department of Cardiology, Erasmus Medical Center, PO Box 2040, 's Gravendijkwal 230, 3000 CA, Rotterdam, The Netherlands.
Lisette J M E
LJ
van der Does
Department of Cardiothoracic Surgery, Erasmus Medical Center, Rotterdam, The Netherlands.
Charles
C
Kik
Department of Cardiology, Erasmus Medical Center, PO Box 2040, 's Gravendijkwal 230, 3000 CA, Rotterdam, The Netherlands.
Paul
P
Knops
Department of Cardiothoracic Surgery, Erasmus Medical Center, Rotterdam, The Netherlands.
Frans B S
FB
Oei
Department of Cardiothoracic Surgery, Erasmus Medical Center, Rotterdam, The Netherlands.
Pieter C
PC
van de Woestijne
Department of Cardiothoracic Surgery, Erasmus Medical Center, Rotterdam, The Netherlands.
Jos A
JA
Bekkers
Department of Cardiothoracic Surgery, Erasmus Medical Center, Rotterdam, The Netherlands.
Ad J J C
AJ
Bogers
Department of Physiology, Cardiovascular Research Institute Maastricht, Maastricht, The Netherlands.
Maurits A
MA
Allessie
Department of Cardiology, Erasmus Medical Center, PO Box 2040, 's Gravendijkwal 230, 3000 CA, Rotterdam, The Netherlands. nmsdegroot@yahoo.com.
Natasja M S
NM
de Groot
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001281:Atrial Fibrillation / Q000175:diagnosis* / Q000601:surgery*; D018780:Body Surface Potential Mapping / Q000295:instrumentation*; D004567:Electrodes, Implanted; D004867:Equipment Design; D019544:Equipment Failure Analysis; D005260:Female; D006325:Heart Atria; D006801:Humans; D007089:Image Enhancement / Q000295:instrumentation*; D007090:Image Interpretation, Computer-Assisted / Q000295:instrumentation / Q000379:methods; D008297:Male; D046228:Microarray Analysis / Q000295:instrumentation; D008875:Middle Aged; D016343:Monitoring, Intraoperative / Q000295:instrumentation*; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D025321:Surgery, Computer-Assisted / Q000295:instrumentation*; D055815:Young Adult
Atrial fibrillation; Electrophysiology; Epicardial mapping technique; Technical report