An Automated Platform to Standardize Position in the Left Atrium and Map Electrophysiological Data

Introduction Atrial mapping is essential to guide atrial fibrillation (AF) ablation, but we still lack tools for intra-patient analysis and inter-patient comparisons. We propose a platform to map electrophysiological data in a standardized atrial coordinate space. Methods Left (LA: 828±326 points) and right (RA: 612±254 points) atria were mapped in 36 persistent AF patients (28 male, 68±11 years, AF duration 8±10 months) before ablation. Voltage and fractionation as quantified by the shortest interval between consecutive complex fractionated EGMs (SCI) were assessed from 10-s bipolar electrograms (EGMs). A coordinate system was determined in each atrium by solving Laplace’s equation with appropriate Dirichlet boundary conditions. Mean distributions of SCI and voltage over a reference anatomy were compared through the Kruskal-Wallis test in the LA lateral, anterior, posterior, and septal walls, and the upper, lower and septal RA regions. Results Voltage was lower on the LA septum and the lower RA (p<0.0001). Higher fragmentation was measured by lower SCI on the LA septum and the upper RA (p<0.0001). Conclusions We developed an automated platform to display EGM data in a standardized atrial space, which improves AF mapping and provides a rigorous statistical framework.