Panoramic atrial mapping with basket catheters: A quantitative analysis to optimize practice, patient selection, and catheter choice

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Identification of the mechanisms sustaining persistent atrial fibrillation (AF) is an ongoing challenge. “Panoramic mapping” of the left atrium (LA) using whole‐chamber basket catheters has been fundamental to several recent approaches aiming to identify drivers in AF.1 However, such mapping can be limited by electrode position, with poor tissue contact and clustering of basket splines reducing the electrical coverage of the chamber of interest.5
To date, a majority of published studies using whole‐chamber basket catheters have used the Constellation catheter (Boston Scientific Ltd., Natick, MA, USA). This 64‐electrode catheter consists of eight evenly spaced splines, each with eight electrodes spaced 5 mm apart. The Constellation catheter is available in four sizes (35, 45, 60, and 75 mm); the 60 mm catheter has been used in a majority of studies. The flaws seen with interspline bunching resulting in loss of coverage and contact, and the lack of electrode poles proximally resulting in loss of septal coverage, have inspired the development of newer basket catheters. The FIRMap catheter (Topera, Abbott, San Diego, CA, USA) has stiffer splines intended to minimize distortion and bunching. Electrode spacing is also increased with more proximal electrodes aiming to improve LA septal coverage. However, no study has compared these catheters to date.
This study aimed to characterize optimal practice for atrial mapping with whole‐chamber basket catheters. LA coverage, electrode–tissue contact, and catheter stability were examined to allow (i) the first direct comparison of the functionality of the Constellation and FIRMap catheters, (ii) an analysis of optimal catheter position, and (iii) to study the impact of increasing atrial size and scarring thus informing patient selection.
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