Key result
Phase maps and phase singularities mapped by endocardial baskets are quantitatively similar whether calculated by 3D phase maps on patient-specific curved atrial geometries or in 2D.
Why the study?
It is unclear how AF activation patterns from endocardial baskets are influenced by 3D geometric atrial curvature or unfolding into 2D maps.
Does 3D phase mapping on curved atrial geometries alter the identified location of atrial fibrillation phase singularities compared to 2D unfolded maps in patients with AF?
Observational (n=20)
No
Does 3D phase mapping on curved atrial geometries alter the identified location of atrial fibrillation phase singularities compared to 2D unfolded maps in patients with AF?
Answers are grounded in this paper and cite their sources.
Atrial fibrillation phase maps and singularity locations derived from endocardial baskets are highly conserved whether analyzed in 3D patient-specific geometries or 2D unfolded maps.
BACKGROUND: The rotational activation created by spiral waves may be a mechanism for atrial fibrillation (AF), yet it is unclear how activation patterns obtained from endocardial baskets are influenced by the 3D geometric curvature of the atrium or 'unfolding' into 2D maps. We develop algorithms that can visualize spiral waves and their tip locations on curved atrial geometries. We use these algorithms to quantify differences in AF maps and spiral tip locations between 3D basket reconstructions, projection onto 3D anatomical shells and unfolded 2D surfaces. METHODS: We tested our algorithms in N = 20 patients in whom AF was recorded from 64-pole baskets (Abbott, CA). Phase maps were generated by non-proprietary software to identify the tips of spiral waves, indicated by phase singularities. The number and density of spiral tips were compared in patient-specific 3D shells constructed from the basket, as well as 3D maps from clinical electroanatomic mapping systems and 2D maps. RESULTS: Patients (59.4±12.7 yrs, 60% M) showed 1.7±0.8 phase singularities/patient, in whom ablation terminated AF in 11/20 patients (55%). There was no difference in the location of phase singularities, between 3D curved surfaces and 2D unfolded surfaces, with a median correlation coefficient between phase singularity density maps of 0.985 (0.978-0.990). No significant impact was noted by phase singularities location in more curved regions or relative to the basket location (p>0.1). CONCLUSIONS: AF maps and phase singularities mapped by endocardial baskets are qualitatively and quantitatively similar whether calculated by 3D phase maps on patient-specific curved atrial geometries or in 2D. Phase maps on patient-specific geometries may be easier to interpret relative to critical structures for ablation planning.
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Abad et al. (2021) conducted an observational in Atrial Fibrillation (n=20). 3D phase mapping on patient-specific curved atrial geometries vs. 2D unfolded surface phase mapping was evaluated on Correlation coefficient between phase singularity density maps of 3D curved surfaces and 2D unfolded surfaces (Median correlation coefficient 0.985, 95% CI 0.978-0.990). Phase maps and phase singularities mapped by endocardial baskets are quantitatively similar whether calculated by 3D phase maps on patient-specific curved atrial geometries or in 2D.
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