Abstract
Gaining an insight into atrial excitation dynamics is crucial for a thorough understanding of the mechanisms that underlie rhythm disturbances and their appropriate treatment, e.g. via substrate-based ablation therapy guided by electroanatomical mapping. Methods based on simulations can be helpful to understand electrogram genesis and morphology caused by different excitation patterns. State-of-the art in silico approaches studied these phenomena only on simplified geometries, such as 2D patches, which neither considered the local curvature of these patches nor heterogeneity between different atrial regions. In this study, we calculate unipolar and bipolar electrograms derived from a clinically inspired multielectrode array in a realistic atrial geometry, which was obtained from magnetic resonance imaging. The array is placed on the endocardium on six different basic excitation patterns. Most of the quantitative features of clinically measured electrograms for these phenomena could be reproduced and thus mechanistically underpinned. Future studies using even finer meshes and more sophisticated methods to calculate electrograms may shed more light also on the genesis of fractionation.
This is a preview of subscription content, log in via an institution to check access.
Access this chapter
Tax calculation will be finalised at checkout
Purchases are for personal use only
Change history
10 August 2023
A correction has been published.
References
Kim, Y.-H., et al.: 2019 APHRS expert consensus statement on three-dimensional mapping systems for tachycardia developed in collaboration with HRS, EHRA, and LAHRS. J. Arrhythmia 36(2), 215–270 (2020)
Hong, K., Borges, J., Glover, B.: Catheter ablation for the management of atrial fibrillation: current technical perspectives. Open Heart 7, e001207 (2020)
Greenspoin, A.J., Hsu, S.S., Datorre, S.: Successful radiofrequency catheter ablation of sustained ventricular tachycardia postmyocardial infarction in man guided by a multielectrode “basket’’ catheter. J. Cardiovasc. Electrophysiol. 8(5), 565–570 (1997)
Sánchez, J., Loewe, A.: A review of healthy and fibrotic myocardium microstructure modeling and corresponding intracardiac electrograms. Front. Physiol. 13 (2022)
Reich, C., Oesterlein, T., Rottmann, M., Seemann, G., Dössel, O.: Classification of cardiac excitation patterns during atrial fibrillation. Curr. Direct. Biomed. Eng. 2(1), 161–166 (2016)
Pollnow, S., Greiner, J., Oesterlein, T., Wülfers, E., Loewe, A., Dössel, O.: Mini electrodes on ablation catheters: valuable addition or redundant information? Insights from a computational study. Comput. Math. Methods Med. 2017 (2017)
Hwang, M., Kim, J., Lim, B., Song, J.-S., Joung, B., Shim, E.: Multiple factors influence the morphology of the bipolar electrogram: an in silico modeling study. PLoS Comput. Biol. 15, 1–13 (2019)
Krüger, M.W., et al.: Personalization of atrial anatomy and electrophysiology as a basis for clinical modeling of radio-frequency ablation of atrial fibrillation. IEEE Trans. Med. Imaging 32, 73–84 (2013)
Wachter, A., Loewe, A., Krueger, M.W., Dössel, O., Seemann, G.: Mesh structure-independent modeling of patient-specific atrial fiber orientation. Curr. Direct. Biomed. Eng. 1, 409–412 (2015)
Loewe, A., Krueger, M.W., Platonov, P.G., Holmqvist, F., Dössel, O., Seemann, G.: Left and right atrial contribution to the p-wave in realistic computational models. In: van Assen, H., Bovendeerd, P., Delhaas, T. (eds.) FIMH 2015. LNCS, vol. 9126, pp. 439–447. Springer, Cham (2015). https://doi.org/10.1007/978-3-319-20309-6_50
Loewe, A., Krueger, M.W., Holmqvist, F., Dössel, O., Seemann, G., Platonov, P.G.: Influence of the earliest right atrial activation site and its proximity to interatrial connections on P-wave morphology. EP Eur. 18, iv35–iv43 (2016)
Plank, G., et al.: The openCARP simulation environment for cardiac electrophysiology. Comput. Methods Program. Biomed. 208, 106223 (2021)
openCARP consortium, C., et al.: OpenCARP (v12.0) (2022). https://doi.org/10.35097/874
Vigmond, E., de Francesco, G., Neic, A., Huang, Y.-L.C., Loewe, A.: meshalyzer (v4.1) (2023). https://doi.org/10.35097/881
Courtemanche, M., Ramirez, R.J., Nattel, S.: Ionic mechanisms underlying human atrial action potential properties: insights from a mathematical model. Am. J. Physiol.-Heart Circulatory Physiol. 275(1), H301–H321 (1998)
Bishop, M.J., Plank, G.: Bidomain ECG simulations using an augmented monodomain model for the cardiac source. IEEE Trans. Biomed. Eng. 58(8), 2297–2307 (2011)
Konings, K.T., Smeets, J.L., Penn, O.C., Wellens, H.J., Allessie, M.A.: Configuration of unipolar atrial electrograms during electrically induced atrial fibrillation in humans. Circulation 95(5), 1231–1241 (1997)
de Bakker, J.M.: Electrogram recording and analyzing techniques to optimize selection of target sites for ablation of cardiac arrhythmias. Pacing Clin. Electrophysiol. 42, 1503–1516 (2019)
Frontera, A., et al.: Electrogram signature of specific activation patterns: analysis of atrial tachycardias at high-density endocardial mapping. Heart Rhythm 15(1), 28–37 (2018)
Haïssaguerre, M., et al.: Spontaneous initiation of atrial fibrillation by ectopic beats originating in the pulmonary veins. N. Engl. J. Med. 339, 659–666 (1998)
Vigmond, E., Pashaei, A., Amraoui, S., Cochet, H., Hassaguerre, M.: Percolation as a mechanism to explain atrial fractionated electrograms and reentry in a fibrosis model based on imaging data. Heart Rhythm 13, 1536–1543 (2016)
de Sa, D.D.C., et al.: Electrogram fractionation. Circul. Arrhythmia Electrophysiol. 4(6), 909–916 (2011)
Tveito, A., Mardal, K., Rognes, M.: Modeling Excitable Tissue: The EMI Framework. Simula Springer Briefs on Computing, Springer, Heidelberg (2020). https://doi.org/10.1007/978-3-030-61157-6
Acknowledgements
This project has received funding from the European High-Performance Computing Joint Undertaking EuroHPC (JU) under grant agreement No 955495. The JU receives support from the European Union’s Horizon 2020 research and innovation programme and France, Italy, Germany, Austria, Norway, Switzerland.
Author information
Authors and Affiliations
Corresponding author
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 2023 The Author(s), under exclusive license to Springer Nature Switzerland AG
About this paper
Cite this paper
Steyer, J., Diaz, L.P.M., Unger, L.A., Loewe, A. (2023). Simulated Excitation Patterns in the Atria and Their Corresponding Electrograms. In: Bernard, O., Clarysse, P., Duchateau, N., Ohayon, J., Viallon, M. (eds) Functional Imaging and Modeling of the Heart. FIMH 2023. Lecture Notes in Computer Science, vol 13958. Springer, Cham. https://doi.org/10.1007/978-3-031-35302-4_21
Download citation
DOI: https://doi.org/10.1007/978-3-031-35302-4_21
Published:
Publisher Name: Springer, Cham
Print ISBN: 978-3-031-35301-7
Online ISBN: 978-3-031-35302-4
eBook Packages: Computer ScienceComputer Science (R0)