Towards the optimization of mapping catheter design for atrial fibrillation trigger detection

Atrial fibrillation (AF) is the most common cardiac arrhythmia encountered in clinical practice, representing one of the major causes of stroke, heart failure, sudden death and cardiovascular morbidity in the world. In the AF condition, cardiac electrical activation occurs in a totally chaotic and fragmentary manner at different points within the atrial myocardium, especially near the ostia of the pulmonary veins (PVs). Over the last years, several theories have been proposed to identify the mechanisms underlying AF. One of the most debated is the “Rotor Theory”, which assumes the presence of stable electrical rotors capable of sustaining AF, whose removal may improve the outcome of ablation procedures. Radiofrequency catheter ablation has been recently recommended as a first therapy for AF termination since it has been demonstrated to be more effective than medications. Nowadays, thanks to the introduction of new technologies, such as electroanatomic mapping systems, is possible to record intracardiac electrical activation in relation to anatomic location through a 3D real-time reconstruction of the cardiac chamber of interest. In this way, these systems support the physician during the ablation procedure to understand which patient-specific mechanisms are responsible of the abnormal electrical propagation, leading to the identification of points of origin and conduction as ablation targets. However, due to some limitations of the multi-electrode system, e.g. different catheter configurations, low spatial resolution, and poor contact of the electrodes with the tissue, clinical AF mapping approaches give contradictory success rates. The aim of this thesis is to investigate how factors such as catheter inter-electrode spacing, catheter coverage, and catheter-to-wall distance, influence the precision of mapping catheters in locating the rotor, by developing a workflow to test different catheters configurations in different conditions.