Paul Knops, BSc, Charles Kik, MD, Ad J. J. C

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Presentation transcript:

Simultaneous endocardial and epicardial high-resolution mapping of the human right atrial wall Paul Knops, BSc, Charles Kik, MD, Ad J.J.C. Bogers, MD, PhD, Natasja M.S. de Groot, MD, PhD The Journal of Thoracic and Cardiovascular Surgery Volume 152, Issue 3, Pages 929-931 (September 2016) DOI: 10.1016/j.jtcvs.2016.05.026 Copyright © 2016 The American Association for Thoracic Surgery Terms and Conditions

Figure 1 Schematic view of simultaneous endocardial and epicardial high-resolution mapping during sinus rhythm (SR) and atrial fibrillation (AR). Simultaneous endocardial and epicardial mapping is required to directly demonstrate synchronous activation between endocardium and epicardium. The Journal of Thoracic and Cardiovascular Surgery 2016 152, 929-931DOI: (10.1016/j.jtcvs.2016.05.026) Copyright © 2016 The American Association for Thoracic Surgery Terms and Conditions

Figure 2 Mapping electrode array and endocardial/epicardial mapping clamp. Top left: Close up of 2 aligned 128 pole mapping arrays assembled on 2 thin, rounded, and bendable stainless-steel spatulas (perspective view); details are explained in the text. Bottom left: Diagram showing the mapping positions on the right atrial free wall that can be attained. Right: Intrathoracic view during insertion of the assembled mapping clamp. RV, Right ventricle; AO, aorta; RAA, right atrial appendage; VCS, vena cava superior; RA, right atrium; VCI, vena cava inferior. The Journal of Thoracic and Cardiovascular Surgery 2016 152, 929-931DOI: (10.1016/j.jtcvs.2016.05.026) Copyright © 2016 The American Association for Thoracic Surgery Terms and Conditions

Figure 3 Examples of color-coded local activation time (LAT) maps during sinus rhythm (SR) and AF. These simultaneous endocardial and epicardial mapping data were achieved from a patient with a history of persistent AF during elective coronary artery bypass surgery. The electrode arrays are represented by 2 rectangular rastered areas in which each electrode is represented by a single raster box. A blue raster line visualizes a time delay of more than 7 ms between 2 contiguous electrodes, whereas a time delay of more than 11 ms is depicted as a thick red raster line. (The LAT numbers are removed from the maps for better visualization.) Thin black lines represent isochrones of LAT, drawn at 5 ms intervals. Thick black and white arrows indicate the main activation trajectories (black = peripheral wave: entering from outside of the mapping area, white = focal wave: arising from within the mapping area). Electrograms of an associated endocardial and epicardial electrode pair are shown in the rhythm strips above the maps (time frame 2 seconds; the epicardial electrogram is on top). The far-field ventricular activations are marked in green. The local atrial activations are automatically marked by the vertical red lines (For AF, the ventricular activation signal is subtracted from the signal before automatic marking of the atrial activation.) Left: Endocardial and epicardial LAT maps during SR. During SR, the endocardium and epicardium are almost simultaneously activated. The maps demonstrate accurate perpendicular alignment of both mapping electrode arrays. The endocardial and epicardial mapping area is activated within a time span of maximal 39 ms. Right: Endocardial and epicardial LAT maps derived during AF. Both endocardial and epicardial mapping areas show significantly more complex and dissociated activation patterns. The total time required to activate the complete area of both mapping electrode arrays is approximately 3 times longer than during SR (106 ms). The 2 sites marked with white stars indicate the earliest activation within the mapped area, which is suggestive for transmural wave propagation (white arrows). NA, Not available. The Journal of Thoracic and Cardiovascular Surgery 2016 152, 929-931DOI: (10.1016/j.jtcvs.2016.05.026) Copyright © 2016 The American Association for Thoracic Surgery Terms and Conditions

Schematic view of simultaneous endocardial and epicardial high-resolution mapping during sinus rhythm and AF. The Journal of Thoracic and Cardiovascular Surgery 2016 152, 929-931DOI: (10.1016/j.jtcvs.2016.05.026) Copyright © 2016 The American Association for Thoracic Surgery Terms and Conditions