Doppler-Based Algorithm for Mapping Cardiac Rotors by Induced Temperature Perturbations

Abstract

Electrogram-guided ablation for mapping of abnormal atrial activity has become increasingly popular in clinical applications. However, current methods have several limitations, and none have been shown to increase the ablation procedure success rate more than empirical ablation procedures. Here we present a new approach to identify arrhythmogenic sources as targets for ablation. Based on our previous findings that rotor drifting can be characterized by a local temperature gradient within the tissue, this article describes an innovative induced temperature technique which exploits the fact that rotor drifting produces Doppler shifts in the dominant frequency as measured at stationary locations. A mathematical algorithm is detailed to solve the inverse problem, reconstruct the drift trajectory, and predict the rotor origin location. Mathematical modeling and computer simulations demonstrate the feasibility of the new approach for rotors and focal source, two well-known arrhythmogenic sources of irregular conduction. Performance was extensively investigated for different numbers of electrodes and varied SNRs. Random conditions were also taken into account, since the electrodes array position and the initial location of the rotor pivot can impact the outcomes. By using temperature perturbation and employing the Doppler algorithm, the rotor drift trajectory and the origin region is shown to be estimated. We consider ways in which this technique can be extended to differentiate between rotors and ectopic activity. Future experimental and clinical validations should lead to potential use in ablation procedures and improve localization capabilities, thus increasing success rates and optimizing arrhythmia management.