PMID- 30951529
OWN - NLM
STAT- MEDLINE
DCOM- 20190528
LR  - 20200225
IS  - 1553-7358 (Electronic)
IS  - 1553-734X (Print)
IS  - 1553-734X (Linking)
VI  - 15
IP  - 4
DP  - 2019 Apr
TI  - Multiple factors influence the morphology of the bipolar electrogram: An in 
      silico modeling study.
PG  - e1006765
LID - 10.1371/journal.pcbi.1006765 [doi]
LID - e1006765
AB  - 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 degrees  than 0 degrees  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.
FAU - Hwang, Minki
AU  - Hwang M
AD  - Division of Cardiology, Yonsei University Health System, Seoul, Republic of 
      Korea.
FAU - Kim, Jaehyuk
AU  - Kim J
AD  - Division of Cardiology, Yonsei University Health System, Seoul, Republic of 
      Korea.
FAU - Lim, Byounghyun
AU  - Lim B
AD  - Division of Cardiology, Yonsei University Health System, Seoul, Republic of 
      Korea.
FAU - Song, Jun-Seop
AU  - Song JS
AD  - Division of Cardiology, Yonsei University Health System, Seoul, Republic of 
      Korea.
FAU - Joung, Boyoung
AU  - Joung B
AD  - Division of Cardiology, Yonsei University Health System, Seoul, Republic of 
      Korea.
FAU - Shim, Eun Bo
AU  - Shim EB
AD  - Department of Mechanical and Biomedical Engineering, Kangwon National University, 
      Chuncheon, Kangwon-do, Republic of Korea.
FAU - Pak, Hui-Nam
AU  - Pak HN
AUID- ORCID: 0000-0002-3256-3620
AD  - Division of Cardiology, Yonsei University Health System, Seoul, Republic of 
      Korea.
LA  - eng
PT  - Journal Article
PT  - Research Support, Non-U.S. Gov't
DEP - 20190405
PL  - United States
TA  - PLoS Comput Biol
JT  - PLoS computational biology
JID - 101238922
SB  - IM
MH  - Atrial Fibrillation/*physiopathology/*surgery
MH  - Catheter Ablation/*instrumentation/statistics & numerical data
MH  - Computational Biology
MH  - Computer Simulation
MH  - Electrodes
MH  - Electrophysiologic Techniques, Cardiac/*instrumentation/statistics & numerical 
      data
MH  - Electrophysiological Phenomena
MH  - Heart Conduction System/physiopathology/surgery
MH  - Humans
MH  - Models, Cardiovascular
MH  - Reproducibility of Results
MH  - User-Computer Interface
PMC - PMC6469793
COIS- The authors have declared that no competing interests exist.
EDAT- 2019/04/06 06:00
MHDA- 2019/05/29 06:00
PMCR- 2019/04/05
CRDT- 2019/04/06 06:00
PHST- 2018/09/09 00:00 [received]
PHST- 2019/01/07 00:00 [accepted]
PHST- 2019/04/17 00:00 [revised]
PHST- 2019/04/06 06:00 [pubmed]
PHST- 2019/05/29 06:00 [medline]
PHST- 2019/04/06 06:00 [entrez]
PHST- 2019/04/05 00:00 [pmc-release]
AID - PCOMPBIOL-D-18-01558 [pii]
AID - 10.1371/journal.pcbi.1006765 [doi]
PST - epublish
SO  - PLoS Comput Biol. 2019 Apr 5;15(4):e1006765. doi: 10.1371/journal.pcbi.1006765. 
      eCollection 2019 Apr.