136-23: Noninvasive and invasive phase mapping of atrial flutter

Purpose: This study assessed phase mapping approach for noninvasive mapping of atrial flutter (AFl) applying a novel noninvasive epicardial and endocardial electrophysiology system (NEEES) as compared to invasive elepctroanatomical mapping.

Method: Patients with persistent AFl underwent cardiac computed tomography or magnetic resonance imaging followed by NEEES (EP Solutions SA, Switzerland) analysis. The phase of noninvasively reconstructed unipolar electrograms (EG) was compared with electroanatomical mapping data obtained with the CARTO 3 navigation system and HALO XP catheter (Biosense Webster, US) placed around tricuspid annulus. Both unipolar EG from HALO XP catheter and the noninvasively reconstructed EG were processed using the same Hilbert transform phase mapping algorithm.

Results: Four patients with AFl (4 males, 48–56 y.o.) were analysed. In all cases the CARTO 3 activation map (Figure A) and noninvasively obtained phase map (Figure B) demonstrated the similar activation pattern. Counterclockwise direction of the phase front around the tricuspid annulus in 3 cases and clockwise direction in 1 case were correctly reconstructed by noninvasive phase mapping. The correlation between activation times determined by HALO XP unipolar EG and the phase of noninvasively reconstructed unipolar EG was high in all cases (r = 0.95 ± 0.02; p < 0.01).

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Conclusion: The phase mapping approach demonstrated the high correlation between the noninvasively and invasively identified activation sequence in patients with typical AFl.