Although bipolar electrograms (Bi-egms) are commonly used for catheter mapping and ablation of cardiac arrhythmias, the accuracy and reproducibility of Bi-egms have not been evaluated. We aimed to clarify the influence of the catheter orientation (CO), catheter contact angle (CA), local conduction velocity (CV), scar size, and catheter type on the Bi-egm morphology using an in silico 3-dimensional realistic model of atrial fibrillation. We constructed a 3-dimensional, realistic, in silico left atrial model with activation wave propagation including bipolar catheter models. Bi-egms were obtained by computing the extracellular potentials from the distal and proximal electrodes. The amplitude and width were measured on virtual Bi-egms obtained under different conditions created by changing the CO according to the wave direction, catheter-atrial wall CA, local CV, size of the non-conductive area, and catheter type. Bipolar voltages were also compared between virtual and clinically acquired Bi-egms. Bi-egm amplitudes were lower for a perpendicular than parallel CO relative to the wave direction (p<0.001), lower for a 90 than 0 CA (p<0.001), and lower for a CV of 0.13m/s than 0.48m/s (p<0.001). Larger sized non-conductive areas were associated with a decreased bipolar amplitude (p<0.001) and increased bipolar width (p<0.001). Among three commercially available catheters (Orion, Pentaray, and Thermocool), those with more narrowly spaced and smaller electrodes produced higher voltages on the virtual Bi-egms (p<0.001). Multiple factors including the CO, CA, CV, and catheter design significantly influence the Bi-egm morphology. Universal voltage cut-off values may not be appropriate for bipolar voltage-guided substrate mapping.
Bibliographical noteFunding Information:
This research was supported by grants [HI18C0070 to HNP] from the Korea Health 21 R&D Project, the Ministry of Health and Welfare (https://www.htdream.kr/), [NRF-2017R1A2B4003983 to HNP] from the Basic Science Research Program run by the National Research Foundation of Korea (NRF; http://www. nrf.re.kr/nrf_eng_cms/) funded by the Ministry of Science, ICT & Future Planning(MSIP), and Basic Science Research Program through the National Research Foundation of Korea (NRF) funded by the Ministry of Education [2017R1D1A1B03030495 to MH] (http://www.nrf.re.kr/nrf_eng_cms/). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. The authors thank MID (Medical Illustration & Design), a part of the Medical Research Support Services of Yonsei University College of Medicine, for their artistic support. We also thank Mr. John Martin for his linguistic assistance.
© 2019 Hwang et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
All Science Journal Classification (ASJC) codes
- Ecology, Evolution, Behavior and Systematics
- Modelling and Simulation
- Molecular Biology
- Cellular and Molecular Neuroscience
- Computational Theory and Mathematics