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Purpose <p>ExTRa Mapping is a phase mapping system identifying rotational activation during atrial fibrillation (AF). The aim of the current study was to evaluate differences in rotational activation identified by the ExTRa Mapping using Reflexion HD catheter (Ref-ExTRa) and Advisor HD Grid Mapping Catheter (Grid-ExTRa).</p> Methods <p>Variation of non-passively activated ratio (%NP), representing a time percentage of meandering AF rotors, among three sequential recordings was assessed at the identical sites by both catheters at the recording time of 5&#xa0;s and 8&#xa0;s in 14 patients with persistent AF even after pulmonary vein isolation. The outcome measures included %NP at each recording, mean value of the three sequential recordings, and the instability index, which was defined as (maximum difference / mean %NP) × 100 (%).</p> Results <p>A total of 2520 recordings at 210 sites were assessed. %NP had weak correlation between Grid-ExTRa and Ref-ExTRa (Pearson`s correlation R = 0.27, <i>P</i> &lt; 0.001), and was significantly lower in Grid-ExTRa than Ref-ExTRa (10[1–21] versus 31[17–43], <i>P</i> &lt; 0.001). The maximum difference of %NP among the three sequential recordings was also lower in Grid-ExTRa, although the instability index was significantly higher in Grid-ExTRa (97.8[44.7–163.2]% versus 57.8[32.1–92.2]%, <i>P</i> &lt; 0.001). However, the instability index became significantly lower at recording time of 8&#xa0;s compared with 5&#xa0;s (63.4[35.4–111.1]% versus 81.4[37.5–143.4]%, <i>P</i> &lt; 0.001) regardless of the mapping catheter types. The prevalence of the high-reliability colors was significantly higher in Grid-ExTRa (82.2% versus 55.1%, <i>P</i> &lt; 0.001), although there was no significant correlation between reliability colors and the instability index.</p> Conclusions <p>Novel Grid-ExTRa allows for high-density assessment of rotational activation during AF rhythm, but was associated with lower %NP values and higher relative instability compared with Ref-ExTRa.</p> Graphical Abstract <p></p>

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Characteristics of rotational activation identified by the novel high-density ExTRa Mapping system

  • 期刊论文

  • 发表日期：

    2026年3月30日

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  • Tetsuma Kawaji,
  • Saki Yamano,
  • Ryuta Ishida,
  • Misaki Naka,
  • Bingyuan Bao,
  • Tomoya Kimura,
  • Shun Hojo,
  • Shintaro Matsuda,
  • Masashi Kato,
  • Takafumi Yokomatsu,
  • Shinji Miki,
  • Takashi Ashihara

摘要

Purpose

ExTRa Mapping is a phase mapping system identifying rotational activation during atrial fibrillation (AF). The aim of the current study was to evaluate differences in rotational activation identified by the ExTRa Mapping using Reflexion HD catheter (Ref-ExTRa) and Advisor HD Grid Mapping Catheter (Grid-ExTRa).

Methods

Variation of non-passively activated ratio (%NP), representing a time percentage of meandering AF rotors, among three sequential recordings was assessed at the identical sites by both catheters at the recording time of 5 s and 8 s in 14 patients with persistent AF even after pulmonary vein isolation. The outcome measures included %NP at each recording, mean value of the three sequential recordings, and the instability index, which was defined as (maximum difference / mean %NP) × 100 (%).

Results

A total of 2520 recordings at 210 sites were assessed. %NP had weak correlation between Grid-ExTRa and Ref-ExTRa (Pearson`s correlation R = 0.27, P < 0.001), and was significantly lower in Grid-ExTRa than Ref-ExTRa (10[1–21] versus 31[17–43], P < 0.001). The maximum difference of %NP among the three sequential recordings was also lower in Grid-ExTRa, although the instability index was significantly higher in Grid-ExTRa (97.8[44.7–163.2]% versus 57.8[32.1–92.2]%, P < 0.001). However, the instability index became significantly lower at recording time of 8 s compared with 5 s (63.4[35.4–111.1]% versus 81.4[37.5–143.4]%, P < 0.001) regardless of the mapping catheter types. The prevalence of the high-reliability colors was significantly higher in Grid-ExTRa (82.2% versus 55.1%, P < 0.001), although there was no significant correlation between reliability colors and the instability index.

Conclusions

Novel Grid-ExTRa allows for high-density assessment of rotational activation during AF rhythm, but was associated with lower %NP values and higher relative instability compared with Ref-ExTRa.

Graphical Abstract