Decapolar catheter

A minimum of two 5‐minute basket catheter recordings were acquired to create global STAR maps (Supporting Information Method) pre‐ and post‐pulmonary vein isolation (PVI) as described for this cohort previously.8 A minimum of 10 recordings each of 30 seconds was acquired with the PentaRay catheter to achieve adequate LA coverage. The study aim was to map the LA but right atrial (RA) mapping was allowed if the coronary sinus activation was predominantly proximal to distal or the CL at the LA septum was persistently faster than the LA appendage.
The unipolar electrograms were recorded through Bard (Labsystem Pro Electrophysiology System). A decapolar catheter (Biosense Webster) positioned in the IVC was used as the indifferent catheter and electrograms were filtered between 0.5 to 500 Hz. The unipolar recordings and anatomical location data for the basket and PentaRay catheter were imported into Matlab (Matlab 2017b; MathWorks, MA) and using a custom‐written script, the global and sequential STAR maps were created.

Mapping was performed using the CARTOFINDER system (see Supplemental Methods).⁷
LA geometry and high-density bipolar voltage map were created using a PentaRay NAV catheter with 2-6-2 mm electrode spacing (Biosense Webster) (see Supplemental Methods). Voltage zones were defined as non-LVZ (≥0.5 mV), LVZ (0.2–0.5 mV), and very LVZ (vLVZ) (0–0.2 mV).⁸ (link) Unipolar electrograms were obtained using a LabSystem Pro electrophysiological recording system (Bard Electrophysiology Division, Natick, MA) by referencing to a decapolar catheter (Biosense Webster) positioned in the inferior vena cava. Filter bandwidth was 0.05–500 Hz.
A 64-pole basket catheter (Constellation, Boston Scientific Ltd, Natick, MA; or FIRMap, Abbott, Santa Clara, CA) was used to record unipolar signals. It was positioned in the LA to achieve the best possible atrial coverage.⁹ (link)

Patients were brought to the electrophysiology laboratory in the fasting, nonsedated state. Femoral vein and artery were both punctured for all the patients, and two 8‐F vascular sheaths were placed respectively. A decapolar catheter (Biosense‐Webster Inc., Irvine, California) with 2‐mm interelectrode distance was placed after subclavian vein puncture was performed. CartoUNIVU module is an advanced image integration module developed by Biosense Webster and could integrate the fluoroscopic images into 3D electroanatomical mapping systems (EAMS). This module is composed by software component connecting the CARTO system and X‐ray system, and by registration plate (RP). Before the registration process, a fluoroscopic image must be captured first with the fluoroscopy arm placed over the RP in the anterior‐posterior orientation. This image would be delivered to the CARTO system and the table is repositioned. Then, fluoroscopy arm projecting the heart could acquire standard views, and the registration process of CartoUNIVU module was performed. Coronary angiography from different angles like RAO30°, LAO30°, CAU20°, and RAO30°, LAO30°, and CRA20° were finished immediately after the registration process. Isoproterenol infusion would be used in the case of no spontaneous PVC.