Multiple factors influence the morphology of the bipolar electrogram: An in silico modeling study

Minki Hwang, Jaehyuk Kim, Byounghyun Lim, Jun Seop Song, Boyoung Joung, Eun Bo Shim, Hui Nam Pak

Research output: Contribution to journalArticle

Abstract

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.

Original languageEnglish
Article numbere1006765
JournalPLoS computational biology
Volume15
Issue number4
DOIs
Publication statusPublished - 2019 Jan 1

Fingerprint

Catheters
Contact Angle
catheters
Conduction
Computer Simulation
Voltage
wave direction
Modeling
modeling
Electrode
electrode
contact angle
Cardiac Arrhythmias
Atrial Fibrillation
Contact angle
Ablation
Reproducibility
ablation
Perpendicular
Wave Propagation

All Science Journal Classification (ASJC) codes

  • Ecology, Evolution, Behavior and Systematics
  • Modelling and Simulation
  • Ecology
  • Molecular Biology
  • Genetics
  • Cellular and Molecular Neuroscience
  • Computational Theory and Mathematics

Cite this

Hwang, Minki ; Kim, Jaehyuk ; Lim, Byounghyun ; Song, Jun Seop ; Joung, Boyoung ; Shim, Eun Bo ; Pak, Hui Nam. / Multiple factors influence the morphology of the bipolar electrogram : An in silico modeling study. In: PLoS computational biology. 2019 ; Vol. 15, No. 4.
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abstract = "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.",
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Multiple factors influence the morphology of the bipolar electrogram : An in silico modeling study. / Hwang, Minki; Kim, Jaehyuk; Lim, Byounghyun; Song, Jun Seop; Joung, Boyoung; Shim, Eun Bo; Pak, Hui Nam.

In: PLoS computational biology, Vol. 15, No. 4, e1006765, 01.01.2019.

Research output: Contribution to journalArticle

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