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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 
 PLOS COMPUTATIONAL BIOLOGY, Vol.15(4) : e1006765, 2019 
Journal Title
Issue Date
Atrial Fibrillation/physiopathology* ; Atrial Fibrillation/surgery* ; Catheter Ablation/instrumentation* ; Catheter Ablation/statistics & numerical data ; Computational Biology ; Computer Simulation ; Electrodes ; Electrophysiologic Techniques, Cardiac/instrumentation* ; Electrophysiologic Techniques, Cardiac/statistics & numerical data ; Electrophysiological Phenomena ; Heart Conduction System/physiopathology ; Heart Conduction System/surgery ; Humans ; Models, Cardiovascular ; Reproducibility of Results ; User-Computer Interface
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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1. College of Medicine (의과대학) > BioMedical Science Institute (의생명과학부) > 1. Journal Papers
1. College of Medicine (의과대학) > Dept. of Internal Medicine (내과학교실) > 1. Journal Papers
Yonsei Authors
Pak, Hui Nam(박희남) ORCID logo https://orcid.org/0000-0002-3256-3620
Lim, Byounghyun(임병현)
Joung, Bo Young(정보영) ORCID logo https://orcid.org/0000-0001-9036-7225
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