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Highest Dominant Frequency and rotor positions are stable markers for atrial driver location in non-invasive mapping of atrial fibrillation

Inverse-computed Dominant Frequency (DF) and rotor maps have been proposed as non-invasive mapping techniques to locate atrial drivers maintaining atrial fibrillation (AF). This study evaluates the robustness of both techniques to identify atrial drivers. Highest DF (HDF) regions and rotor position were compared with the same inverse-computed measurements on a population of 30 different mathematical AF simulations after addition of white noise to the ECG, linear and angular deviations in the location of the atria and also with varying blood conductivities. Inverse-computed EGMs showed individually a poor correlation with the actual EGMs even in the absence of induced error sources and worsened with the artifacts. However, inverse-computed HDF regions showed stability against artifacts: from 82±18% match for the HDF region for the best conditions, down to 60±22% for the worst case. The rotor location also presented a stable measurement: the distance from the inverse-computed rotor to the actual rotor was 0.8±1.61 cm for the best conditions, 2.4±3.6 cm for 10 dB, 4.3±3.2 cm for 4 cm displacement and 4.0±2.1 cm for 36°. Non-invasive AF driver identification based on HDF and rotor location is accurate even in the presence of noise or uncertainties in atrial location or conductivity.