Surface Wavefront Propagation Maps: Non-invasive characterization of atrial flutter circuit

Atrial flutter (AFL) is a supraventricular arrhythmia maintained by a macroreentrant circuit. The circuit responsible of AFL maintenance is difficult to be determined in cases of atypical circuits. In this work, we made use of wavefront propagation maps (WPMs) obtained from 64-lead body surface potential mapping (BSPM) recordings in order to characterize the rotation circuit non- invasively. BSPM recordings were obtained for 8 patients with AFL (5 typical, 3 atypical). AFL waves with a length equal to the dominant atrial cycle length (DACL) were isolated from TQ segments free from ventricular activity. WPMs were constructed for all patients summarizing the electrical activity during AFL and the direction of rotation was determined. In all typical AFL patients directions were consistent with either clockwise or counterclockwise rotations while in atypical AFL patients different directions were found. WPMs appear as a promising tool for the non-invasive determination of the circuit maintaining AFL in each patient non-invasively and thus may help in planning ablation procedures.