High-Density and High-Coverage Composite Atrial Activation Maps: An In-Silico Validation Study

• Published in: IEEE transactions on biomedical engineering 2025-01, Vol.72 (1), p.79-89
• Main Authors: Ozgul, Ozan, Marques, Victor G., Hermans, Ben JM, van Hunnik, Arne, Verheule, Sander, Gharaviri, Ali, Pezzuto, Simone, Auricchio, Angelo, Schotten, Ulrich, Bonizzi, Pietro, Zeemering, Stef
• Format: Article
• Language: English
• Subjects: Ablation; Algorithms; Arrhythmia; Atrial arrhythmias; Biomedical engineering; catheter ablation; Catheters; Conduction; conduction patterns; Density; Electrodes; Errors; high-density atrial mapping; Image reconstruction; Localization; Mapping; Recording; recurrence plots; repetitive activation patterns; sequential mapping; Stitching; Tachycardia; Visualization
• ISSN: 0018-9294; 1558-2531; 1558-2531
• DOI: 10.1109/TBME.2024.3439502

Objective: Repetitive atrial activation patterns (RAAPs) during complex atrial tachycardia could be associated with localized mechanisms that can be targeted. Clinically available electroanatomical mapping systems are limited by either the spatial coverage or electrode density of the mapping catheters, preventing the adequate visualization of transiently occurring RAAPs. This work proposes a technique to overcome this shortcoming by stitching spatially overlapping conduction patterns together to a larger image- called a composite map. Methods: Simulated stable mechanisms and meandering reentries are sequentially mapped (4 × 4 grid, 3 mm spacing) and then reconstructed back to the original sizes with the proposed recurrence plot-based algorithm. Results: The reconstruction of single linear waves presents minimal errors (local activation time (LAT) difference: 3.2 [1.6-4.9] ms, conduction direction difference: 5.2 [2.3-8.0] degrees). Errors significantly increase (p