Catheter Configuration for Mapping Micro-Anatomic Reentries Sustaining Atrial Fibrillation

Persistent atrial fibrillation ablation treatment may benefit from multi-electrode mapping (MEM) of extrapulmonary vein sources, including intramural microanatomic reentries.Optimal MEM configurations to identify micro-reentrant tracks needs to be explored.Human microanatomic reentrant driver was reproduced in a 3D model (150m 3 resolution) of atrial tissue with sub-endocardial laterally-insulated myobundle.Unipolar and bipolar electrograms were simulated and local activation time maps were calculated in 876 MEM configurations with variable inter-electrode distances, polarities, orientations, and surface distances.Action potential simulation of microanatomic reentry showed that the conduction through common reentrant path could be only identifiable by electrodes located < 3 mm from the track.The reentrant track was identifiable in LAT maps from dense unipolar MEM (1 to 6mm spacing) with close surface contact (0.25mm) and for bipolar catheter configurations only when bipoles were aligned to the reentrant path.The reentry was observable >33% on unipolar LAT maps (spacing 6mm) and on bipolar electrodes with correct orientation ( 3mm spacing).The 3D human AF driver simulation suggested 3mm inter-electrode and wall contact (<1mm) would be required to map microanatomic reentrant drivers.