title: Basket-Type Catheters: Diagnostic Pitfalls Caused by Deformation and Limited Coverage.
abstract: Whole-chamber mapping using a 64-pole basket catheter (BC) has become a featured approach for the analysis of excitation patterns during atrial fibrillation. A flexible catheter design avoids perforation but may lead to spline bunching and influence coverage. We aim to quantify the catheter deformation and endocardial coverage in clinical situations and study the effect of catheter size and electrode arrangement using an in silico basket model. Atrial coverage and spline separation were evaluated quantitatively in an ensemble of clinical measurements. A computational model of the BC was implemented including an algorithm to adapt its shape to the atrial anatomy. Two clinically relevant mapping positions in each atrium were assessed in both clinical and simulated data. The simulation environment allowed varying both BC size and electrode arrangement. Results showed that interspline distances of more than 20 mm are common, leading to a coverage of less than 50% of the left atrial (LA) surface. In an ideal in silico scenario with variable catheter designs, a maximum coverage of 65% could be reached. As spline bunching and insufficient coverage can hardly be avoided, this has to be taken into account for interpretation of excitation patterns and development of new panoramic mapping techniques.
authors.affiliation: Institute of Biomedical Engineering, Karlsruhe Institute of Technology (KIT), 76131 Karlsruhe, Germany.
authors.forename: Tobias
authors.identifier: 0000-0002-1495-4927
authors.initials: T
authors.lastname: Oesterlein
authors.affiliation: Institute of Biomedical Engineering, Karlsruhe Institute of Technology (KIT), 76131 Karlsruhe, Germany.
authors.forename: Daniel
authors.initials: D
authors.lastname: Frisch
authors.affiliation: Institute of Biomedical Engineering, Karlsruhe Institute of Technology (KIT), 76131 Karlsruhe, Germany.
authors.forename: Axel
authors.identifier: 0000-0002-2487-4744
authors.initials: A
authors.lastname: Loewe
authors.affiliation: Institute for Experimental Cardiovascular Medicine, University Heart Center Freiburg · Bad Krozingen, Medical Center, University of Freiburg, 79106 Freiburg, Germany; Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany.
authors.forename: Gunnar
authors.initials: G
authors.lastname: Seemann
authors.affiliation: Städtisches Klinikum Karlsruhe, 76133 Karlsruhe, Germany.
authors.forename: Claus
authors.initials: C
authors.lastname: Schmitt
authors.affiliation: Institute of Biomedical Engineering, Karlsruhe Institute of Technology (KIT), 76131 Karlsruhe, Germany.
authors.forename: Olaf
authors.initials: O
authors.lastname: Dössel
authors.affiliation: Städtisches Klinikum Karlsruhe, 76133 Karlsruhe, Germany.
authors.forename: Armin
authors.initials: A
authors.lastname: Luik
mesh_terms: D000368:Aged; D001281:Atrial Fibrillation / Q000503:physiopathology; D002404:Catheterization; D057785:Catheters; D003198:Computer Simulation; D004452:Echocardiography; D004562:Electrocardiography; D004566:Electrodes; D004594:Electrophysiology; D004699:Endocardium / Q000473:pathology; D004867:Equipment Design; D005260:Female; D006325:Heart Atria / Q000503:physiopathology; D006801:Humans; D008297:Male; D008875:Middle Aged