Stanford Cardiovascular Institute, Stanford University School of Medicine, Stanford, California, United States of America.
Universitat Politècnica de València, Valencia, Spain.
PLoS One. 2021 Apr 9;16(4):e0249873. doi: 10.1371/journal.pone.0249873. eCollection 2021.
The rotational activation created by spiral waves may be a mechanism for atrial fibrillation (AF), yet it is unclear how activation patterns obtained from endocardial baskets are influenced by the 3D geometric curvature of the atrium or 'unfolding' into 2D maps. We develop algorithms that can visualize spiral waves and their tip locations on curved atrial geometries. We use these algorithms to quantify differences in AF maps and spiral tip locations between 3D basket reconstructions, projection onto 3D anatomical shells and unfolded 2D surfaces.
We tested our algorithms in N = 20 patients in whom AF was recorded from 64-pole baskets (Abbott, CA). Phase maps were generated by non-proprietary software to identify the tips of spiral waves, indicated by phase singularities. The number and density of spiral tips were compared in patient-specific 3D shells constructed from the basket, as well as 3D maps from clinical electroanatomic mapping systems and 2D maps.
Patients (59.4±12.7 yrs, 60% M) showed 1.7±0.8 phase singularities/patient, in whom ablation terminated AF in 11/20 patients (55%). There was no difference in the location of phase singularities, between 3D curved surfaces and 2D unfolded surfaces, with a median correlation coefficient between phase singularity density maps of 0.985 (0.978-0.990). No significant impact was noted by phase singularities location in more curved regions or relative to the basket location (p>0.1).
AF maps and phase singularities mapped by endocardial baskets are qualitatively and quantitatively similar whether calculated by 3D phase maps on patient-specific curved atrial geometries or in 2D. Phase maps on patient-specific geometries may be easier to interpret relative to critical structures for ablation planning.
螺旋波的旋转激活可能是心房颤动（AF）的一种机制，但尚不清楚从心内膜篮获得的激活模式如何受到心房的 3D 几何曲率或“展开”到 2D 图谱的影响。我们开发了可以在弯曲心房几何形状上可视化螺旋波及其尖端位置的算法。我们使用这些算法来量化 3D 篮重建、投影到 3D 解剖壳和展开的 2D 表面之间的 AF 图谱和螺旋尖端位置的差异。
我们在 N = 20 名接受 64 极篮（雅培，加利福尼亚州）记录 AF 的患者中测试了我们的算法。相位图谱通过非专有软件生成，以识别螺旋波的尖端，由相位奇点表示。在从篮构建的患者特定 3D 壳以及来自临床电生理图谱系统和 2D 图谱的 3D 图谱中比较了螺旋尖端的数量和密度。
患者（59.4±12.7 岁，60%为男性）显示 1.7±0.8 个相位奇点/患者，其中 11/20 名患者（55%）消融终止了 AF。在 3D 曲面和 2D 展开曲面之间，相位奇点的位置没有差异，相位奇点密度图谱之间的中位数相关系数为 0.985（0.978-0.990）。在更弯曲的区域或相对于篮位置，相位奇点位置没有明显影响（p>0.1）。
通过心内膜篮映射的 AF 图谱和相位奇点，无论是通过患者特定的心房弯曲几何形状上的 3D 相位图谱计算，还是通过 2D 计算，在定性和定量上都是相似的。相对于消融计划的关键结构，患者特定几何形状上的相位图谱可能更容易解释。
