Spatiotemporal mapping for detection of anatomic locations of drivers of atrial fibrillation in swine

Figures

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  Figure 1. Overview and workflow of the current study. AFib = atrial fibrillation; iEGM = intracardiac electrogram; PVI = pulmonary vein isolation.

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  Figure 2. Visualization and analysis of the unique catheter positions #2 from swine #1 during pre-PVI AFib. A: 3-dimensional reconstruction of LA geometry (gray), with the electrode positions from the PentaRay catheter (blue dots). The yellow shaded area illustrates the potential mapping coverage, whereas the red circle highlights a specific electrode position. Adjacent are the bipolar iEGMs and calculated values for analytical metrics including DF, MSF, SE, MSE, MI, and Kt from this electrode. B: Normalized value maps for each analytical technique across this catheter position. AFib = atrial fibrillation; DF = dominant frequency; iEGM = intracardiac electrogram; Kt = kurtosis; LA = left atrium; MSE = multiscale entropy; MSF = multiscale frequency; MI = mutual information; PVI = pulmonary vein isolation; SE = Shannon entropy.

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  Figure 3. AFib driver identification on the pre-PVI AFib in swine #1. A: Categorization of CPunique by similarity scores. Among 54 catheter positions, #8, #9, #17, #18, #19, #23, #26, #37, and #41 (red arrows) exhibited high correlations across more than 13 paired techniques, thus identified as AFib drivers. B: Location of these 9 identified AFib drivers (red stars) plotted for the 3-dimensional geometry of the atria. AFib = atrial fibrillation; PVI = pulmonary vein isolation.

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  Figure 4. Correlation of AFib drivers identified using similarity score with anatomic hallmarks in swine #3 (A) and swine #4 (B) during pre-PVI AFib. The color bar represents the distribution of identified AFib drivers across each anatomic hallmark, with a percentage scale from blue at 0% to yellow at 100%. AFib = atrial fibrillation; LIPV = left inferior pulmonary vein; LSPV = left superior pulmonary vein; PVI = pulmonary vein isolation; RIPV = right inferior pulmonary vein; RSPV = right superior pulmonary vein.

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  Figure 5. Segmentation of 9 anatomic hallmarks of the LA and spatial distribution of all PentaRay electrode positions (blue dots) during pre-PVI AFib in swine #2 from (A) anterior and (B) posterior views. The hallmarks include 4 pulmonary veins—LSPV, LIPV, RSPV, and RIPV—and 5 non-PVs regions: posterior wall, septal wall, appendage, anterior wall, and roof. Regions are color coded to visualize anatomic boundaries. AFib = atrial fibrillation; LA = left atrium; LIPV = left inferior pulmonary vein; LSPV = left superior pulmonary vein; PVI = pulmonary vein isolation; RIPV = right inferior pulmonary vein; RSPV = right superior pulmonary vein.

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  Figure 6. Spatial anatomic locations of AFib drivers from (A) pre-PVI AFib to (B) post-PVI AFib in swine #2. The color bar represents the distribution of identified AFib drivers across each anatomic hallmark, with a percentage scale that transitions from blue at 0% to yellow at 100%. AFib = atrial fibrillation; LIPV = left inferior pulmonary vein; LSPV = left superior pulmonary vein; PVI = pulmonary vein isolation; RIPV = right inferior pulmonary vein; RSPV = right superior pulmonary vein.

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  Figure 7. Visualization of AFib drivers identified using the similarity-score method with respect to anatomic hallmarks in swine #2. Panels A and B show AFib driver distribution during (A) pre-PVI AFib and (B) post-PVI AFib, from both anterior and posterior views. Anatomic regions of the left atrium are color coded by hallmark segmentation, whereas red stars indicate the center of AFib drivers. AFib = atrial fibrillation; LIPV = left inferior pulmonary vein; LSPV = left superior pulmonary vein; PVI = pulmonary vein isolation; RIPV = right inferior pulmonary vein; RSPV = right superior pulmonary vein.