J Korean Med Sci.  2014 Mar;29(3):370-377. 10.3346/jkms.2014.29.3.370.

The Relationship among Complex Fractionated Electrograms, Wavebreak, Phase Singularity, and Local Dominant Frequency in Fibrillation Wave-Dynamics: a Modeling Comparison Study

• Yun Y
• Hwang M
• Park JH
• Shin H
• Shim EB
• Pak HN

• KMID: 1734924
• DOI: http://doi.org/10.3346/jkms.2014.29.3.370

Abstract

Although complex fractionated electrogram (CFE) is known to be a target for catheter ablation of fibrillation, its physiological meaning in fibrillation wave-dynamics remains to be clarified. We evaluated the spatiotemporal relationships among the parameters of fibrillation wave-dynamics by simulation modeling. We generated maps of CFE-cycle length (CFE-CL), local dominant frequency (LDF), wave break (WB), and phase singularity (PS) of fibrillation in 2-dimensional homogeneous bidomain cardiac modeling (1,000 x 1,000 cells ten Tusscher model). We compared spatiotemporal correlations by dichotomizing each maps into 10 x 10 lattice zones. In spatial distribution, WB and PS showed excellent correlation (R = 0.963, P < 0.001). CFE-CL had weak correlations with WB (R = 0.288, P < 0.001), PS (R = 0.313, P < 0.001), and LDF (R = -0.411, P < 0.001). However, LDF did not show correlation with PS or WB. PSs were mostly distributed at the periphery of low CFE-CL area. Virtual ablation (5% of critical mass) of CFE-CL < 100 ms terminated fibrillation at 14.3 sec, and high LDF ablation (5% of critical mass) changed fibrillation to organized tachycardia, respectively. In homogeneous 2D fibrillation modeling, CFE-CL was weakly correlated with WB, PS, and LDF, spatiotemporally. PSs are mostly positioned at the periphery of low CFE-CL areas, and virtual ablation targeting low CFE-CL regions terminated fibrillation successfully.

Keyword

Fibrillation; Complex Fractionated Electrogram; Simulation Modeling

MeSH Terms

Algorithms
Atrial Fibrillation/*physiopathology
Body Surface Potential Mapping
Catheter Ablation
*Electrocardiography
Electrodes
Heart Atria/physiopathology
Humans
*Models, Biological

Figure

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  Fig. 1 Voltage map and complex fractionated electrogram (CFE) acquisition using virtual bipolar electrodes. (A) Voltage map with pacing cycle length (PCL) 600 ms and its action potential. (B) Recording of bipolar electrogram and CFE from virtual catheter. (C) Recording of action potential at each cell and activation pattern. (D) Virtual bipolar egm showing CFEs. (E) Local dominant frequencies generated from the locations of distal and proximal electrodes by Fourier analyses. Ds, Distal electrode; Px, Proximal electrode.

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  Fig. 2 Spatiotemporal distributions of wavebreak (WB), phase singularity (PS), local dominant frequency (LDF), and complex fractionated electrogram-cycle length (CFE-CL) in multiple time intervals. WB and PS maps display cumulative points during the corresponding periods of fibrillation. Maps of CFE-CL and LDF are color-coded according to the color scale bars.

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  Fig. 3 Overlap of complex fractionated electrogram-cycle length (CFE-CL) and phase singularity (PS). (A-C) Overlaying of CFE-CL maps and cumulative PS maps of 6 sec durations of fibrillation. PS are mostly positioned at the periphery of areas with short CFE-CL. (D) Calculating methods for standard deviation of CFE-CL around the cell of interest. Standard deviation of CFE-CL at the cells around PS were compared with that around non-PS. "a-1, b-1, a+1, and b+1" indicate coordinates of cells.

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  Fig. 4 Spatiotemporal correlations among wavebreak (WB), phase singularity (PS), local dominant frequency (LDF) and complex fractionated electrogram-cycle length (CFE-CL) (n=300).

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  Fig. 5 Complex fractionated electrogram (CFE)-guided ablation. (A) virtual action potential curves during fibrillation/tachycardia in control, after local dominant frequency (LDF) ablation, and after CFE ablation, respectively. (B) Spatiotemporal changes of voltage maps of control fibrillation. Time duration after induction is marked on left upper part of each voltage map. (C) After virtual ablation of LDF (5% of critical mass; far right panel), fibrillation changed to sustaining organized tachycardia. (D) After virtual CFE ablation (5% of critical mass; far right panel), fibrillation terminated spontaneously in 14.3 sec.

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