Bartolucci Chiara, Fabbri Claudio, Tomasi Corrado, Sabbatani Paolo, Severi Stefano, Corsi Cristiana
Computational Physiopathology Unit, Department of Electrical, Electronic and Information Engineering "Guglielmo Marconi", University of Bologna, Bologna, Italy.
Electrophysiology Laboratory, Cardiology Unit, Ravenna and Cesena Hospitals, Azienda Unità Sanitaria Locale della Romagna, Ravenna, Italy.
Front Physiol. 2021 Dec 9;12:732161. doi: 10.3389/fphys.2021.732161. eCollection 2021.
Atrial fibrillation (AF) is the most common cardiac arrhythmia and catheter mapping has been proved to be an effective approach for detecting AF drivers to be targeted by ablation. Among drivers, the so-called rotors have gained the most attention: their identification and spatial location could help to understand which patient-specific mechanisms are acting, and thus to guide the ablation execution. Since rotor detection by multi-electrode catheters may be influenced by several structural parameters including inter-electrode spacing, catheter coverage, and endocardium-catheter distance, in this study we proposed a tool for testing the ability of different catheter shapes to detect rotors in different conditions. An approach based on the solution of the monodomain equations coupled with a modified Courtemanche ionic atrial model, that considers an electrical remodeling, was applied to simulate spiral wave dynamics on a 2D model for 7.75 s. The developed framework allowed the acquisition of unipolar signals at 2 KHz. Two high-density multipolar catheters were simulated (Advisor™ HD Grid and PentaRay) and placed in a 2D region in which the simulated spiral wave persists longer. The configuration of the catheters was then modified by changing the number of electrodes, inter-electrodes distance, position, and atrial-wall distance for assessing how they would affect the rotor detection. In contact with the wall and at 1 mm distance from it, all the configurations detected the rotor correctly, irrespective of geometry, coverage, and inter-electrode distance. In the HDGrid-like geometry, the increase of the inter-electrode distance from 3 to 6 mm caused rotor detection failure at 2 mm distance from the LA wall. In the PentaRay-like configuration, regardless of inter-electrode distance, rotor detection failed at 3 mm endocardium-catheter distance. The asymmetry of this catheter resulted in rotation-dependent rotor detection. To conclude, the computational framework we developed is based on realistic catheter shapes designed with parameter configurations which resemble clinical settings. Results showed it is well suited to investigate how mapping catheter geometry and location affect AF driver detection, therefore it is a reliable tool to design and test new mapping catheters.
心房颤动（AF）是最常见的心律失常，导管标测已被证明是检测房颤驱动因素以进行消融治疗的有效方法。在驱动因素中，所谓的转子受到了最多关注：它们的识别和空间定位有助于了解哪些特定于患者的机制在起作用，从而指导消融操作的实施。由于多电极导管检测转子可能会受到包括电极间距、导管覆盖范围和心内膜 - 导管距离等多个结构参数的影响，在本研究中，我们提出了一种工具，用于测试不同导管形状在不同条件下检测转子的能力。一种基于单域方程解并结合考虑电重构的修正考特曼什离子心房模型的方法，被应用于在二维模型上模拟7.75秒的螺旋波动力学。所开发的框架允许以2千赫兹的频率采集单极信号。模拟了两种高密度多极导管（Advisor™ HD Grid和PentaRay），并将它们放置在二维区域中，在该区域模拟的螺旋波持续时间更长。然后通过改变电极数量、电极间距离、位置和心房壁距离来修改导管的配置，以评估它们将如何影响转子检测。在与壁接触以及距离壁1毫米的情况下，所有配置都能正确检测到转子，而与几何形状、覆盖范围和电极间距离无关。在类似HDGrid的几何形状中，电极间距离从3毫米增加到6毫米会导致在距离左心房壁2毫米处检测转子失败。在类似PentaRay的配置中，无论电极间距离如何，在心内膜 - 导管距离为3毫米时检测转子失败。这种导管的不对称性导致了与旋转相关的转子检测。总之，我们开发的计算框架基于设计的类似于临床设置的参数配置的真实导管形状。结果表明，它非常适合研究标测导管的几何形状和位置如何影响房颤驱动因素的检测，因此它是设计和测试新型标测导管的可靠工具。
