Noninvasive Phase Mapping of Atrial Flutter in Humans – Comparison with Invasive Mapping

Abstract

Introduction: The present study compared invasive activation and phase mapping to noninvasive phase mapping in patients with cavotricuspid isthmus (CTI)-dependent atrial flutter (AFl) using a novel noninvasive epicardial and endocardial electrophysiology system (NEEES). Methods: Four patients with CTI-dependent AFl underwent simultaneous invasive and noninvasive mapping using an electroanatomical mapping system and the NEEES. A mapping catheter aligned along the tricuspid valve region provided data on local activation times analysing unipolar and bipolar electrograms (EGs). Invasive and noninvasive EGs were processed using the same phase mapping algorithm. Results: Activation times obtained invasively and noninvasively from phase-processed unipolar EGs demonstrated close correlation with activation times obtained from invasive bipolar EGs. Noninvasively reconstructed phase maps accurately delineated the activation sequence of CTI-dependent AFl. Conclusion: Noninvasive phase mapping can accurately delineate the activation pattern of CTIdependent AFl and may be useful in other types of macro-reentrant tachycardias.