DGM-TOP: automatic identification of the critical boundaries in atrial tachycardia

Figures

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  FIGURE 1. Overview of preprocessing of a clinical anatomical map for CARTO- and RHYTHMIA-recorded maps.

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  FIGURE 2. Overview of preprocessing of a clinical anatomical map. (A): extraction of the points at the boundaries. (B) Boundary is expanded up to the first order neighbors. (C) Points are divided into sections. (D) Each section is directed along the conduction vector.

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  FIGURE 3. Illustration of index calculation for three different activation patterns. The boundaries were divided into 12 sections, and the ΔLATi for each section was recorded in the histogram below. The index was calculated by summing the values of all bars in the histogram. (A) Complete rotation pattern yielded an index of +1, characteristic of a CB. (B) Near-complete rotation pattern resulted in an index of −1, also indicative of a CB. (C) Parallel activation pattern produced an index of 0, characteristic of an NCB.

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  FIGURE 4. Example of index calculation on a 2B simulation with a TCL of 243 ms from 2 different viewpoints (one for each boundary). Boundary (A) has an index of +1, while boundary (B) has an index of −1. Therefore, the sum of all TC totals 0. The ablation line between boundary (A,B) terminated the AT.

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  FIGURE 5. Example of index calculation on a 3B simulation with a TCL of 201 ms from 3 different viewpoints (one for each boundary). Boundary (A) has an index of −1, boundary (B) has an index of +1, and the boundary (C) has an index of 0. Therefore the sum of all TC totals 0. The ablation line between boundary (A,B) terminated the AT.

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  FIGURE 6. Example of index calculation on a 4B simulation with a TCL of 221 ms from 4 different viewpoints (one for each boundary). Boundary (A) has an index of 0, boundary (B) has an index of −1, the boundary (C) has an index of 0, and boundary (D) has an index of +1. The sum of all TC is 0. The ablation line between boundary (B,D) terminated the AT.

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  FIGURE 7. (A) Electroanatomical map of AT1 in anterior-posterior (AP) view. The cyclical colors on the figure represent the LAT of the map. The boundaries are colored in white. (B) Conduction around the MV. The index was determined to be −1 (C) Conduction around the RPV. The index was calculated to be +1 (D) Conduction around the LPV. The index was determined to be 0. This AT was clinically ablated with a line from the LPV to the RPV, resulting in a second AT with reentry around the MV.

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  FIGURE 8. (A) Electroanatomical map of AT2 in anterior-posterior (AP) view. The cyclical colors on the figure represent the LAT of the map. The boundaries are colored in white. (B) Conduction around the LPV. The index was determined to be −1 (C) Conduction around the MV. The index was determined to be +1 (D) Conduction around the RPV. The index was determined to be 0. This AT was clinically ablated with a line from the LPV to the RPV, resulting in a second AT with reentry around the MV.

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  FIGURE 9. (A) Electroanatomical map of AT3 in anterior-posterior (AP) view. The cyclical colors on the figure represent the LAT of the map. The boundaries are colored in white. (B) Conduction around the MV. The index was determined to be −1 (C) Conduction around the RPV. The index was determined to be 0 (D) Conduction around the LPV. The index was determined to be 0 (E) Conduction around the anterior scar. The index was calculated to be +1. This AT was clinically ablated with a line from the scar to the MV, resulting in termination.

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  FIGURE 10. Correlation of the maximal BCL of a boundary to the maximal TCL after ablation for all 3B and 4B simulations (N = 378).