Mechanism and magnitude of bipolar electrogram directional sensitivity: Characterizing underlying determinants of bipolar amplitude.
Mechanism and magnitude of bipolar electrogram directional sensitivity: Characterizing underlying determinants of bipolar amplitude.
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DOI：
10.1016/j.hrthm.2019.12.010
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发表时间：
2020-05
期刊：
影响因子：
5.5
通讯作者：
Henriquez C
中科院分区：
文献类型：
--
作者：
Gaeta S;Bahnson TD;Henriquez C
双极电信号(EGM)的幅度是方向性敏感的，当测量从倾斜的电极对到传播的波前时，幅度会减小。使用计算模型和临床数据来确定方向敏感性的机制和大小。模拟的EGM是使用计算模型创建的，其中电极对相对于通过的波前旋转。记录了10例心房颤动患者起搏时左心房18,740个不同电极间距和方向的EGM的临床数据库。对于每个EGM，使用局部传导速度(CV)标测来测量电极与波前之间的入射角。建立了一个理论模型，描述了改变入射角、电极间距和CV对电极之间的局部激活时间(LAT)差的影响。模型预测使用模拟和临床EGM进行了验证。由电极对测量的双极幅度在入射角处减小(方向敏感)，导致LAT差异比单极下降持续时间短。电极间距越小，循环伏安速度越快，单极EGM持续时间越长，方向灵敏度越高。对于窄间距电极对(<；5 mm)，预测在所有方向上都是如此。方向敏感性的产生是因为当组件单极EGM重叠时，双极幅度降低，因此两个电极都不是“无关紧要的”。在临床导管的电极间距处，这种情况预计会发生而与导管方向无关。这表明双极方向敏感性可以降低，但不能通过最近引入的附加旋转电极对的导管来克服。
The amplitude of bipolar electrograms (EGMs) is directionally sensitive, decreasing when measured from electrode pairs oriented oblique to a propagating wavefront. Use computational modeling and clinical data to establish the mechanism and magnitude of directional sensitivity. Simulated EGMs were created using a computational model with electrode pairs rotated relative to a passing wavefront. A clinical database of 18,740 EGMs with varying electrode separation and orientations was recorded from the left atrium of 10 atrial fibrillation patients during pacing. For each EGM, the angle of incidence between the electrodes and the wavefront was measured using local conduction velocity (CV) mapping. A theoretical model was derived describing the effect of changing angle of incidence, electrode spacing, and CV on the local activation time (LAT) difference between a pair of electrodes. Model predictions were validated using simulated and clinical EGMs. Bipolar amplitude measured by an electrode pair is decreased (directionally sensitive) at angles of incidence resulting in LAT differences shorter than unipolar downstroke duration. Directional sensitivity increases with closer electrode spacing, faster CV, and longer unipolar EGM duration. For narrowly spaced electrode pairs (<5mm) it is predicted at all orientations. Directional sensitivity occurs because bipolar amplitude is reduced when component unipolar EGMs overlap, such that neither electrode is “indifferent.” At the electrode spacing of clinical catheters, this is predicted to occur regardless of catheter orientation. This suggests that bipolar directional sensitivity can be lessened but not overcome by recently introduced catheters with additional, rotated electrode pairs.
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DOI：
10.1161/circep.116.004107
发表时间：
2016-07
期刊：
Circulation. Arrhythmia and electrophysiology
影响因子：
--
作者：
Massé S;Magtibay K;Jackson N;Asta J;Kusha M;Zhang B;Balachandran R;Radisic M;Deno DC;Nanthakumar K
通讯作者：
Nanthakumar K
DOI：
10.1016/j.jacep.2016.12.016
发表时间：
2017-03-01
期刊：
JACC. Clinical electrophysiology
影响因子：
--
作者：
Leshem, Eran;Tschabrunn, Cory M;Anter, Elad
通讯作者：
Anter, Elad
影响因子：
8.4
作者：
Haldar, Shouvik K.;Magtibay, Karl;Nanthakumar, Kumaraswamy
通讯作者：
Nanthakumar, Kumaraswamy
影响因子：
24
作者：
Di Biase, Luigi;Burkhardt, J. David;Natale, Andrea
通讯作者：
Natale, Andrea
影响因子：
5.5
作者：
Takigawa, Masateru;Relan, Jatin;Jais, Pierre
通讯作者：
Jais, Pierre