Optimization of a Novel Activation-Repolarization Metric to Identify Targets for Catheter Ablation

Fernando Campos, Michele Orini, Ben Hanson, Peter Taggart, Pier Lambiase, Bradley Porter, Christopher Aldo Rinaldi, Jaswinder Gill, Martin Bishop
2018 2018 Computing in Cardiology Conference (CinC)  
Identification of targets for catheter ablation of arrhythmias remains a significant challenge. We have recently developed a novel substrate mapping procedure, termed the Reentry Vulnerability Index (RVI), which incorporates both activation (AT) and repolarization (RT) times to identify ablation targets. Despite showing promise in a series of experiments, the approach requires further development to enable its incorporation into a clinical protocol. The goal of this study was to use computer
more » ... ulations to optimize the RVI procedure for its future usage within the clinic. A 2D sheet model was employed to investigate the behavior of the RVI algorithm under mapping catheters recordings resembling clinical conditions. Conduction block following premature stimulation was induced and mapped in a cardiac tissue model including repolarization heterogeneity. RVI maps were computed based on the difference between RTs and ATs between successive pairs of electrodes within a given search radius. A color map was then constructed to highlight small RVI values which identify vulnerable sites for reentry. Within 2D sheet models we show that RVI maps computed on sparse recording sites randomly placed on the tissue surface were in good agreement with high resolution maps. Moreover, RVI maps computed on recording sites resembling a decapolar electrode placed linearly as well as on a fan-like arrangement also captured regions of small RVIs. The RVI algorithm performed well under a wide range of clinicallyrelevant mapping conditions. The RVI metric was capable of identifying pro-arrhythmic regions which may be used to guide ablation.
doi:10.22489/cinc.2018.208 dblp:conf/cinc/CamposOHTLPRGB18 fatcat:g6bhyw3xczhurcs6oud6byb7ka