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Title of the item:

A Novel Tool for the Identification and Characterization of Repetitive Patterns in High-Density Contact Mapping of Atrial Fibrillation

Title :
A Novel Tool for the Identification and Characterization of Repetitive Patterns in High-Density Contact Mapping of Atrial Fibrillation
Authors :
Stef Zeemering
Arne van Hunnik
Frank van Rosmalen
Pietro Bonizzi
Billy Scaf
Tammo Delhaas
Sander Verheule
Ulrich Schotten
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Subject Terms :
atrial fibrillation
recurrence plots
repetitive conduction patterns
Source :
Frontiers in Physiology, Vol 11 (2020)
Publisher :
Frontiers Media S.A., 2020.
Publication Year :
Collection :
Document Type :
File Description :
electronic resource
Language :
Relation :;
Access URL :
Accession Number :
Academic Journal
IntroductionElectrical contact mapping provides a detailed view of conduction patterns in the atria during atrial fibrillation (AF). Identification of repetitive wave front propagation mechanisms potentially initiating or sustaining AF might provide more insights into temporal and spatial distribution of candidate AF mechanism and identify targets for catheter ablation. We developed a novel tool based on recurrence plots to automatically identify and characterize repetitive conduction patterns in high-density contact mapping of AF.Materials and MethodsRecurrence plots were constructed by first transforming atrial electrograms recorded by a multi-electrode array to activation-phase signals and then quantifying the degree of similarity between snapshots of the activation-phase in the electrode array. An AF cycle length dependent distance threshold was applied to discriminate between repetitive and non-repetitive snapshots. Intervals containing repetitive conduction patterns were detected in a recurrence plot as regions with a high recurrence rate. Intervals that contained similar repetitive patterns were then grouped into clusters. To demonstrate the ability to detect and quantify the incidence, duration and size of repetitive patterns, the tool was applied to left and right atrial recordings in a goat model of different duration of persistent AF [3 weeks AF (3 wkAF, n = 8) and 22 weeks AF (22 wkAF, n = 8)], using a 249-electrode mapping array (2.4 mm inter-electrode distance).ResultsRecurrence plots identified frequent recurrences of activation patterns in all recordings and indicated a strong correlation between recurrence plot threshold and AF cycle length. Prolonged AF duration was associated with shorter repetitive pattern duration [mean maximum duration 3 wkAF: 74 cycles, 95% confidence interval (54–94) vs. 22 wkAF: 41 cycles (21–62), p = 0.03], and smaller recurrent regions within repetitive patterns [3 wkAF 1.7 cm2 (1.0–2.3) vs. 22 wkAF 0.5 cm2 (0.0–1.2), p = 0.02]. Both breakthrough patterns and re-entry were identified as repetitive conduction patterns.ConclusionRecurrence plots provide a novel way to delineate high-density contact mapping of AF. Dominant repetitive conduction patterns were identified in a goat model of sustained AF. Application of the developed methodology using the new generation of multi-electrode catheters could identify additional targets for catheter ablation of AF.

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