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Compass Mapping, Double Potentials, Activation Patterns can Identify and Track Rotational Activity Sites in the Left Atrium of Humans with Persistent Atrial Fibrillation.

BACKGROUND: Rotational circuits that occur between bipolar electrodes exhibit double potentials (DPs). It had been previously surmised that rotors could not be electrically tracked directly. PURPOSE: Our purpose was two fold; first, to show that through the use of compass mapping, one can regionally identify rotational activity; and second, to show that by combining simultaneous compass map recordings, standard narrow-adjacent bipolar, and unipolar recordings, that specific signature recording patterns emerge that allow one to identify the accurate time, location, and path of a rotational mechanism. METHODS: This was an observational study in 20 patients with persistent atrial fibrillation in which the electrode configuration of a circular mapping catheter was changed to wide cross-circle electrode pairing (compass mapping). DPs were recorded and analyzed from 12 left atrial (LA) sites and identified electrical wavefront patterns and direction. A substudy analyzed transitions patterns with simultaneous narrow-adjacent bipolar and unipolar recordings. RESULTS: Four wavefront patterns were identified: DPs, peripheral waves (PWs), distal peripheral waves and fibrillatory activity. DP wavefront patterns exhibited significantly shorter cycle lengths than PWs in 8 of 12 LA sites. Patients had 2.9± 2.1 regions that exhibited DPs. DPs of varying duration were found, few (25%) were of stable duration and location. Detailed electrical examination at the transition between a PW to a DP identified a highly consistent pattern of simultaneous Doppler compression and expansion of cycle lengths at adjacent electrodes, reversal of activation sequence, and a ½ cycle drop-off of activation signals in the line of electrodes. CONCLUSIONS: DP recordings in compass mode can provide a regional assessment for the existence of rotational activity. Simultaneous DP recordings in compass mode, narrow-adjacent bipolar, and unipolar recording provide an accurate assessment of the time, location, and path that a rotational mechanism breaches a perimeter of electrodes. Accurate time, location and path of perimeter breaches can be used to electrically track rotational mechanisms during atrial fibrillation.

Credits: Donald S. Rubenstein, M.D., Ph.D., Hang Yin Ph.D. CEPS, and Sana A. Azami B.S

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