209-03: Noninvasive Phase Mapping of Atrial Fibrillation in Humans: Comparison with Invasive Mapping by PentaRay Nav Catheters

Introduction: A novel non-invasive endo- and epicardial mapping system (NEEES) for identification of focal activity and rotors in patients with atrial fibrillation (AF) was recently introduced. Comparisons of NEEES data to results from invasive endocardial rotor mapping is still lacking. Methods: 6 patients with persistent AF (6 male, age 59.2 ± 11.1) underwent pre-procedural magnetic resonance imaging of the heart and torso followed by cardiac mapping using NEEES. Data processing consisted in merging radiographic data with the data obtained from the NEEES. In all patients an endocardial electroanatomical map of the atria using the CARTO 3 system was created and the PentaRay Nav catheter (Biosense Webster, Inc., Diamond Bar, CA, USA) was positioned at the true anatomic location of the rotor, according to the NEEES three-dimensional heart model. Signals acquired with the PentaRay were processed together with CARTO 3 model of the atria by customized software using the same phase mapping algorithm as for the non-invasive data. Results: In all patients electrical rotors lasting between 1 to 5 rotation cycles were observed after phase mapping was applied to both, NEEES and PentaRay data. In two patients the focal-type excitation from pulmonary veins was observed. The majority of stable rotors (72.5%) were located in the left atrium, most of these rotors were aggregating in multiple clusters. In 5/6 (83%) patients 2 aggregation clusters could be identified, 1/6 (17%) patient showed 3 clusters. Rotors occurrence rate, mean cycle length and score of full rotations demonstrated statistically significant correlation for NEEES and PentaRay Nav imaged rotors.