Novel Aggregated Multi-Position Non-Contact Mapping of Atrial Tachycardia in Humans: From Computational Modelling to Clinical Validation.

Abstract

BACKGROUND\nA novel aggregated multi-position non-contact mapping (AMP-NCM) algorithm is proposed to diagnose cardiac arrhythmias.\n\n\nOBJECTIVE\nTo computationally determine an accuracy threshold then compare the accuracy and clinical utility of AMP-NCM to gold-standard contact mapping.\n\n\nMETHODS\nIn a cellular automata model, the number of catheter positions and chamber coverage was varied to establish accuracy requirements for clinically relevant AMP-NCM. This guided the clinical study protocol. In a prospective cohort of patients with atrial tachycardia (AT), NCM recordings from a single position (SP) and multiple positions were compared to contact mapping with a high-density multipolar catheter using morphology and timing differences of reconstructed signals. Identification of AT mechanisms and ablation targets using both AMP-NCM and contact mapping were randomly evaluated by 5 blinded reviewers.\n\n\nRESULTS\nAMP-NCM accuracy was asymptotic at 60 catheter positions in computational modelling. Twenty patients (65 ± 12 years, 19 males) with 26 ATs (5 focal AT, 21 reentrant AT) were studied. Morphological correlation of signals derived from AMP-NCM was significantly better than those from SP-NCM compared to contact signals (median: 0.93 vs. 0.76, p < 0.001). AMP-NCM generated maps more rapidly than contact mapping; 3 ± 1 min vs. 13 ± 6 min, p < 0.001; and correctly diagnosed AT mechanisms in 25 of 26 (96%) maps. Overall, 80% of arrhythmia mechanisms were correctly identified using AMP-NCM by blinded reviewers.\n\n\nCONCLUSION\nOnce 60 catheter positions were achieved, AMP-NCM successfully diagnosed mechanisms of AT and identified treatment sites equal to gold-standard contact mapping in 3 minutes of procedure-time.