Noninvasive phase mapping of persistent atrial fibrillation in humans: Comparison with invasive catheter mapping

Figures

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  Figure 1. Typical reentrant excitation patterns during atrial fibrillation (AF) visualized by noninvasive phase mapping. Unclosed phase front (the border between red and purple colors) is seen. The phase singularities, marked by white and black points are located at the front ends. The phase front is rotating around phase singularities forming a pair of rotors with opposite chiralities, rotating clockwise and counterclockwise. At the same time, the phase singularities (rotor cores) meander along the atrial surfaces (near the left atrial appendage [LAA] and at the lateral wall of the right atrium [RA])

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  Figure 2. Spatial distribution of rotor cores and focal sources (novel noninvasive epicardial and endocardial electrophysiology system [NEEES]). Most rotors aggregated in few discrete clusters. In five patients two clusters were observed, in one patient three clusters. In two patients (N3 and N6) the focal‐type activation patterns originating from the pulmonary veins were imaged

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  Figure 3. Noninvasively and invasively imaged rotors during atrial fibrillation (AF). The phase maps obtained by novel noninvasive epicardial and endocardial electrophysiology system (NEEES) (left‐hand panels) and catheter mapping (middle and right‐hand panels) demonstrated a rotor in a similar atrial location rotating in the same clockwise direction

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  Figure 4. Rotor occurrence rates mapped noninvasively and invasively in atrial segments investigated by both mapping methods

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  Figure 5. Statistical evaluation of rotor occurrence rate measurement. (a) Correlation of rotor occurrence rates as measured by the two techniques. LA, left atrium; LSPV, left superior pulmonary vein; RA, right atrium; RSPV, right superior pulmonary vein. (b) Bland–Altman plot of agreement between measurements of rotor occurrence rate by the two techniques. Mean difference (novel noninvasive epicardial and endocardial electrophysiology system [NEEES] – catheter) is 0.04 per second, with the zone of agreement ranging from −0.117 to 0.197 per second