Determinants of atrial bipolar voltage: Inter electrode distance and wavefront angle
Determinants of atrial bipolar voltage: Inter electrode distance and wavefront angle
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DOI：
10.1016/j.compbiomed.2018.07.011
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发表时间：
2018-11-01
影响因子：
7.7
通讯作者：
Nanthakumar, Kumaraswamy
中科院分区：
文献类型：
--
作者：
Beheshti, Mohammadali;Magtibay, Karl;Nanthakumar, Kumaraswamy
背景：局部双极电描记图（EGM）峰间电压（Vpp）目前被用于标测心肌基质。然而，在当前的多电极标测时代，电极间距离和波前入射角如何影响双极Vpp值尚不清楚。目的：阐明标测健康心房区域与患病心房区域时，组织和电极几何形状对双极Vpp测量的影响。方法：人体心房组织的双肌模型用于量化健康组织中各种电极配置对Vpp值的影响，和含有不可兴奋区域的组织。表面双极的取向角和极间间距，以及不可激芯的厚度和深度是连续变化的。从离体猪hearts.Results获得的数据进行验证结果：在健康组织中，双极Vpp值随着电极间间距的增加而增加，并在超过约4 mm的间距后达到稳定状态。健康组织中的双极Vpp值对大电极间间距的波前取向角相对不敏感。相反，在病变组织中，随着电极间间距的增加，双极Vpp值线性增加而没有平台，并且对取向角更敏感。双极Vpp值随着瘢痕厚度的增加而降低，小双极的相对降低幅度大于大双极。双极Vpp值随着固定尺寸瘢痕的壁内位置的逐渐增加而增加，并且与健康组织的区别变得更小，特别是对于较小的电极间间距。为电极间距离建立的可缩放关系有利于电场-与传统的Vpp值不同，Vpp值是电极间间距最大为4 mm的标测导管的生理相关测量工具。通过不同间距的导管进行心肌健康的通用评估。
Background: Local bipolar electrogram (EGM) peak-to-peak voltage (Vpp) is currently used to characterise mapped myocardial substrate. However, how interelectrode distance and angle of wavefront incidence affect bipolar, Vpp values, in the current era of multi-electrode mapping is unknown.Objectives: To elucidate the effects of tissue and electrode geometry on bipolar Vpp measurements, when mapping healthy versus diseased atrial regions.Methods: A bidomain model of human atrial tissue was used to quantify the influence on Vpp values of various electrode configurations in healthy tissue, and tissue containing an unexcitable region. The orientation angle and interelectrode spacing of a surface bipole, and thickness and depth of the unexcitable core were serially varied. Results were validated with data obtained from isolated porcine hearts.Results: In healthy tissue, bipolar Vpp values increased with increasing interelectrode spacing and plateaued beyond a spacing of approximately 4 mm. The bipolar Vpp values in healthy tissue were relatively less sensitive to wavefront orientation angle with large interelectrode spacing. In diseased tissue, on the contrary, with increasing interelectrode spacing, bipolar Vpp values increased linearly without a plateau and were more sensitive to orientation angle. The bipolar Vpp values decreased with increasing thickness of the scar, with larger relative decrease in small bipoles than larger ones. Bipolar Vpp values increased with a progressively intramural location of fixed-size scar and became less distinguishable from healthy tissue especially for smaller interelectrode spacings.Conclusions: The scalable relationship established for interelectrode distances favour an electric-field-based assessment as opposed to traditional Vpp values as a tool for physiologically relevant measurement for mapping catheters with interelectrode spacing up to 4 mm. This will allow for universal assessment of myocardial health across catheters with varied spacing.