Spatial reproducibility of complex fractionated atrial electrogram depending on the direction and configuration of bipolar electrodes: an in-silico modeling study.
Although 3D-complex fractionated atrial electrogram (CFAE) mapping is useful in radiofrequency catheter ablation for persistent atrial fibrillation (AF), the directions and configuration of the bipolar electrodes may affect the electrogram. This study aimed to compare the spatial reproducibility of CFAE by changing the catheter orientations and electrode distance in an in-silico left atrium (LA). We conducted this study by importing the heart CT image of a patient with AF into a 3D-homogeneous human LA model. Electrogram morphology, CFAE-cycle lengths (CLs) were compared for 16 different orientations of a virtual bipolar conventional catheter (conv-cath: size 3.5 mm, inter-electrode distance 4.75 mm). Additionally, the spatial correlations of CFAE-CLs and the percentage of consistent sites with CFAE-CL<120 ms were analyzed. The results from the conv-cath were compared with that obtained using a mini catheter (mini-cath: size 1 mm, inter-electrode distance 2.5 mm). Depending on the catheter orientation, the electrogram morphology and CFAE-CLs varied (conv-cath: 11.5±0.7% variation, mini-cath: 7.1±1.2% variation), however the mini-cath produced less variation of CFAE-CL than conv-cath (p<0.001). There were moderate spatial correlations among CFAE-CL measured at 16 orientations (conv-cath: r=0.3055±0.2194 vs. mini-cath: 0.6074±0.0733, p<0.001). Additionally, the ratio of consistent CFAE sites was higher for mini catheter than conventional one (38.3±4.6% vs. 22.3±1.4%, p<0.05). Electrograms and CFAE distribution are affected by catheter orientation and electrode configuration in the in-silico LA model. However, there was moderate spatial consistency of CFAE areas, and narrowly spaced bipolar catheters were less influenced by catheter direction than conventional catheters.
Division of Cardiology, Yonsei University Health System, Seoul 03722, Korea.
Jun-Seop
JS
Song
Division of Cardiology, Yonsei University Health System, Seoul 03722, Korea.
Young-Seon
YS
Lee
Division of Cardiology, Yonsei University Health System, Seoul 03722, Korea.
Minki
M
Hwang
Division of Cardiology, Yonsei University Health System, Seoul 03722, Korea.
Jung-Kee
JK
Lee
Division of Cardiology, Yonsei University Health System, Seoul 03722, Korea.
Changyong
C
Li
Division of Cardiology, Yonsei University Health System, Seoul 03722, Korea.
Boyoung
B
Joung
Division of Cardiology, Yonsei University Health System, Seoul 03722, Korea.
Moon-Hyoung
MH
Lee
Department of Mechanical and Biomedical Engineering, Kangwon National University, Chuncheon 24341, Korea.
Eun Bo
EB
Shim
Division of Cardiology, Yonsei University Health System, Seoul 03722, Korea.
Hui-Nam
HN
Pak
Atrial fibrillation; Bipolar electrogram; Complex fractionated atrial electrogram; Computational modeling