Development History
By 2010 we were already able to recognise patterns within AF, using very limited electrograms and catheters. This resulted in a steady increase in our persistent AF patients being ablated to sinus rhythm (vs Cardioversion).
Prof Schilling and team set out to build a system that would significantly enhance what can already be done by a clinician with 20 years’ experience of high volume AF ablation and some innate talent and instinct.
The Aim of STAR Mapping™
Allow assimilation of more data (to increase accuracy)
Guide the clinician in determining where to ablate
Improve first time outcomes of AF ablation
Reduce harmful and unnecessary ablation
May allow less experienced clinicians to successfully perform the procedure
The STAR Mapping System™
Is designed to replicate the logical deductive process applied to electrical signals collected by the cardiac catheters currently used in the mapping procedure
The process is automated (AI driven) and is designed to handle far more data than a human observer is capable of
Allows collection & processing of many thousands of heart signals (electrograms) per patient, thus it may refine the accuracy and may reduce operator workload
STAR Mapping is designed to enable clinicians with limited experience to map persistent AF (the most complex variant of AF), it may also outperform the most experienced clinician in identifying relevant sites for ablation of AF
The AF catheter procedure is designed to perform as per standard clinical practice
Once catheters are placed in the heart these are used to collect data during AF from locations throughout the heart
Data is then fed into the STAR Mapping™ system and within seconds STAR Mapping™ identifies areas that are driving the AF and that may be suitable for ablation
The Cardiologist may then direct the ablation catheters to the identified, targeted sites and with a brief ablation terminates the heart arrhythmia
See Image Below
STAR Mapping™ is used to identify areas driving AF on a 3D model of the atria (marked as site 1 left frame)
This location is identified on the standard 3D mapping system and ablation performed (site 1 middle frame)
After 5 lesions were delivered at this site the AF terminated to normal rhythm as shown by a sudden slowing and regularisation of the heart electrical signals (right frame)
Ref: Honarbakhsh et al. 2019 JACC EP
Catheter Ablation Key Steps
Without STAR Mapping™
- Patient is anaesthetised and venous access established in groin
- Trans-septal puncture to access left atrium of heart
- Electrophysiology catheters placed in coronary sinus and left atrium
- Left atrial geometry created on 3D mapping system with mapping catheters
- PV isolation (PVI) is achieved using radiofrequency (RF) ablation
- Either: Cardiovert patient out of AF and finish the procedure
- Or: Make empiric ablations based on visual assessment of possible drivers of AF +/- Cardioversion out of AF
Guided Ablation using STAR Mapping™
- PVI carried out as per the standard procedure
- Collect AF data either globally with basket or sequentially with commercially available mapping catheter on any 3D mapping system
- Upload electrograms, electrode positions and geometry to STAR
- STAR Mapping will identify and prioritise target areas for ablation
- Ablate areas in order of priority at corresponding sites on 3D mapping system
- AF terminated stop procedure
- All sites ablated – cardiovert and stop
STAR Mapping™ System Validation
The star mapping system has been uniquely validated both on heart cell arrays under the microscope (the only mapping technology to have ever been validated to this level of scrutiny), and in humans during pacing and regular mappable rhythms.
Confirmed STAR Mapping ™ Accurately Maps Rhythm of Known Pattern:
25 Patients with heart rhythms that were possible to map using conventional 3D mapping system, to confirm that the system worked as intended
All the 25 pacing sites and abnormal rhythm mechanisms were correctly identified by STAR Mapping™ (operator blinded to the conventional mapping system)
In-vitro testing was also performed on 10 heart tissue cultures with AF where the mechanism could be seen directly with optical mapping. Good correlation between the visualized mechanism and STAR Mapping™
Image to the right shows STAR Mapping™ showing sites of pacing
Honarbakhsh S et al JCE 2019
STAR Mapping™ System
Images of correlation of STAR Mapping™ with mapping of a regular rhythm using a conventional mapping system.
STAR Mapping™ Correlation
Mapping correlation with optical mapping of AF in a heart cell array