Key result
Double ring grid linked to ~99% fewer false positive rotor detections vs 2x2 ring.
Why the study?
Does a double ring electrode configuration improve the accuracy of phase singularity detection during atrial fibrillation mapping compared to a single 2x2 ring?
Observational (n=20)
Does a double ring electrode configuration improve the accuracy of phase singularity detection during atrial fibrillation mapping compared to a single 2x2 ring?
Absolute Event Rate: 3.91% vs 0.88%
p-value: p=<0.001
Robust rotor detection during AF mapping requires at least an 8-electrode double ring configuration to minimize false positive phase singularities.
Hypothesis-generating for double-ring grids in AF rotor mapping; leaves open prospective validation before clinical use.
OBJECTIVE: To explore technical challenges of phase singularity (PS) mapping during atrial fibrillation (AF) using direct contact electrograms. METHODS: AF mapping was performed in high-density epicardial recordings of human paroxysmal (PAF) or persistent (PersAF) (N = 20 pts) AF with an array of 16 × 16 electrodes placed on atrial epicardium. PS points were detected using subsets of electrodes forming rings of varying sizes. RESULTS: PS detection using a 2 × 2 electrode ring identified 0.88 ± 1.00 PS/s in PAF group and 3.91 ± 2.51 per s in PersAF group (p < 0.001) in 2.4 × 2.4 cm mapping area. All detected PS had a short lifespan with the longest being 1100 ms (6.8 rotations). Exploration of the PS detection in a numerical model demonstrated that at least eight electrodes are required to avoid frequent false positive PS detection due to chance. Application of a detection grid consisting a double ring of electrodes (2 × 2 and 4 × 4 rings) decreased the number of false positive detections. The double ring was more resilient to electrode swapping (with just three instances of false positives versus 4380 false positives using 2 × 2 ring). CONCLUSIONS: The number of detected rotors critically depends upon the parameters of the detection algorithm, especially the number of electrodes used to detect PS. Based on our results, we recommend double ring comprised of 2 × 2 and 4 × 4 grid of electrodes for robust rotor detection. SIGNIFICANCE: Great methodological care has to be taken before equating detected PS with rotating waves and using PS detection algorithms to guide catheter ablation of AF.
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Kuklik et al. (2016) conducted an observational in Atrial fibrillation (paroxysmal or persistent) (n=20). Persistent atrial fibrillation (PersAF) vs. Paroxysmal atrial fibrillation (PAF) was evaluated on Phase singularity detection rate (PS/s) (p=<0.001). Phase singularity detection using a double ring grid (2 × 2 and 4 × 4) reduced false positive rotor detections compared to a 2 × 2 ring (3 vs 4380 false positives).
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