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The Amplitude-Normalized Area of a Bipolar Electrogram as a Measure of Local Conduction Delay in the Heart

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The Amplitude-Normalized Area of a Bipolar Electrogram as a Measure of Local Conduction Delay in the Heart. / Mendonca Costa, Caroline; Anderson, Grace C.; Meijborg, Veronique M.F.; O’Shea, Christopher; Shattock, Michael J.; Kirchhof, Paulus; Coronel, Ruben; Niederer, Steven; Pavlovic, Davor; Dhanjal, Tarvinder; Winter, James.

In: FRONT PHYSIOL, Vol. 11, 465, 19.05.2020.

Research output: SCORING: Contribution to journal › SCORING: Journal article › Research › peer-review

Harvard

Mendonca Costa, C, Anderson, GC, Meijborg, VMF, O’Shea, C, Shattock, MJ, Kirchhof, P, Coronel, R, Niederer, S, Pavlovic, D, Dhanjal, T & Winter, J 2020, 'The Amplitude-Normalized Area of a Bipolar Electrogram as a Measure of Local Conduction Delay in the Heart', FRONT PHYSIOL, vol. 11, 465. https://doi.org/10.3389/fphys.2020.00465

APA

Mendonca Costa, C., Anderson, G. C., Meijborg, V. M. F., O’Shea, C., Shattock, M. J., Kirchhof, P., Coronel, R., Niederer, S., Pavlovic, D., Dhanjal, T., & Winter, J. (2020). The Amplitude-Normalized Area of a Bipolar Electrogram as a Measure of Local Conduction Delay in the Heart. FRONT PHYSIOL, 11, [465]. https://doi.org/10.3389/fphys.2020.00465

Vancouver

Mendonca Costa C, Anderson GC, Meijborg VMF, O’Shea C, Shattock MJ, Kirchhof P et al. The Amplitude-Normalized Area of a Bipolar Electrogram as a Measure of Local Conduction Delay in the Heart. FRONT PHYSIOL. 2020 May 19;11. 465. https://doi.org/10.3389/fphys.2020.00465

Bibtex

@article{06b537da5e1949b88d4d23f228da87a6,
title = "The Amplitude-Normalized Area of a Bipolar Electrogram as a Measure of Local Conduction Delay in the Heart",
abstract = "Background: Re-entrant ventricular tachycardia may be non-inducible or haemodynamically compromising, requiring assessment of the electrophysiological properties of the myocardium during sinus rhythm (i.e., substrate mapping). Areas of heart tissue with slow conduction can act as a critical isthmus for re-entrant electrical excitation and are a potential target for ablation therapy. Aim: To develop and validate a novel metric of local conduction delay in the heart, the amplitude-normalized electrogram area (norm_EA). Methods: A computational model of a propagating mouse action potential was used to establish the impact of altering sodium channel conductance, intracellular conductivity, fibrosis density, and electrode size/orientation on bipolar electrogram morphology. Findings were then validated in experimental studies in mouse and guinea pig hearts instrumented for the recording of bipolar electrograms from a multipolar linear mapping catheter. norm_EA was calculated by integrating the absolute area of a bipolar electrogram divided by the electrogram amplitude. Electrogram metrics were correlated with the local conduction delay during sodium channel block, gap junction inhibition, and acute ischemia. Results: In computational simulations, reducing sodium channel conductance and intracellular conductivity resulted in a decrease in signal amplitude and increase in norm_EA (reflecting a broadening of electrogram morphology). For larger electrodes (3 mm diameter/7.1 mm2 area), the change in norm_EA was essentially linear with the change in local conduction delay. Experimental studies supported this finding, showing that the magnitude of change in norm_EA induced by flecainide (1–4 μM), carbenoxolone (10–50 μM), and low-flow ischemia (25% of initial flow rate) was linearly correlated with the local conduction delay in each condition (r2 = 0.92). Qualitatively similar effects were observed in guinea pig hearts perfused with flecainide. Increasing fibrosis density in the computational model also resulted in a decrease in signal amplitude and increase in norm_EA. However, this remains to be validated using experimental/clinical data of chronic infarct. Conclusion: norm_EA is a quantitative measure of local conduction delay between the electrode pair that generates a bipolar electrogram, which may have utility in electrophysiological substrate mapping of non-inducible or haemodynamically compromising tachyarrhythmia.",
keywords = "bipolar electrogram, cardiac arrhythmia, cardiac mapping, conduction delay, electrophysiology, substrate mapping",
author = "{Mendonca Costa}, Caroline and Anderson, {Grace C.} and Meijborg, {Veronique M.F.} and Christopher O{\textquoteright}Shea and Shattock, {Michael J.} and Paulus Kirchhof and Ruben Coronel and Steven Niederer and Davor Pavlovic and Tarvinder Dhanjal and James Winter",
note = "Funding Information: JW (FS/16/35/31952) is supported by the British Heart Foundation. DP and CO{\textquoteright}S are supported by the (Sci-Phy-4-Health Center for Doctoral Training L016346) EPSRC, (109604/Z/15/Z) Wellcome Trust and (PG/17/55/33087, FS/16/35/31952, FS/19/16/34169, FS/19/12/34204) British Heart Foundation. RC, VM are supported by a Transatlantic Network of Excellence grant from the Leducq Foundation (16CVD02, RHYTHM). GA and MS are supported by the British Heart Foundation (RG/12/4/29426 and FS/15/66/32037). CM is supported by the British Heart Foundation (PG/15/91/31812). This work was further supported by European Union (grant agreement No 633196 [CATCH ME]), European Union BigData@Heart (grant agreement EU IMI 116074), British Heart Foundation (FS/13/43/30324; PG/17/30/32961, and AA/18/2/34218), and Leducq Foundation (genomic topology of AF to PK). Publisher Copyright: {\textcopyright} Copyright {\textcopyright} 2020 Mendonca Costa, Anderson, Meijborg, O{\textquoteright}Shea, Shattock, Kirchhof, Coronel, Niederer, Pavlovic, Dhanjal and Winter.",
year = "2020",
month = may,
day = "19",
doi = "10.3389/fphys.2020.00465",
language = "English",
volume = "11",
journal = "FRONT PHYSIOL",
issn = "1664-042X",
publisher = "Frontiers Research Foundation",

}

RIS

TY - JOUR

T1 - The Amplitude-Normalized Area of a Bipolar Electrogram as a Measure of Local Conduction Delay in the Heart

AU - Mendonca Costa, Caroline

AU - Anderson, Grace C.

AU - Meijborg, Veronique M.F.

AU - O’Shea, Christopher

AU - Shattock, Michael J.

AU - Kirchhof, Paulus

AU - Coronel, Ruben

AU - Niederer, Steven

AU - Pavlovic, Davor

AU - Dhanjal, Tarvinder

AU - Winter, James

N1 - Funding Information: JW (FS/16/35/31952) is supported by the British Heart Foundation. DP and CO’S are supported by the (Sci-Phy-4-Health Center for Doctoral Training L016346) EPSRC, (109604/Z/15/Z) Wellcome Trust and (PG/17/55/33087, FS/16/35/31952, FS/19/16/34169, FS/19/12/34204) British Heart Foundation. RC, VM are supported by a Transatlantic Network of Excellence grant from the Leducq Foundation (16CVD02, RHYTHM). GA and MS are supported by the British Heart Foundation (RG/12/4/29426 and FS/15/66/32037). CM is supported by the British Heart Foundation (PG/15/91/31812). This work was further supported by European Union (grant agreement No 633196 [CATCH ME]), European Union BigData@Heart (grant agreement EU IMI 116074), British Heart Foundation (FS/13/43/30324; PG/17/30/32961, and AA/18/2/34218), and Leducq Foundation (genomic topology of AF to PK). Publisher Copyright: © Copyright © 2020 Mendonca Costa, Anderson, Meijborg, O’Shea, Shattock, Kirchhof, Coronel, Niederer, Pavlovic, Dhanjal and Winter.

PY - 2020/5/19

Y1 - 2020/5/19

N2 - Background: Re-entrant ventricular tachycardia may be non-inducible or haemodynamically compromising, requiring assessment of the electrophysiological properties of the myocardium during sinus rhythm (i.e., substrate mapping). Areas of heart tissue with slow conduction can act as a critical isthmus for re-entrant electrical excitation and are a potential target for ablation therapy. Aim: To develop and validate a novel metric of local conduction delay in the heart, the amplitude-normalized electrogram area (norm_EA). Methods: A computational model of a propagating mouse action potential was used to establish the impact of altering sodium channel conductance, intracellular conductivity, fibrosis density, and electrode size/orientation on bipolar electrogram morphology. Findings were then validated in experimental studies in mouse and guinea pig hearts instrumented for the recording of bipolar electrograms from a multipolar linear mapping catheter. norm_EA was calculated by integrating the absolute area of a bipolar electrogram divided by the electrogram amplitude. Electrogram metrics were correlated with the local conduction delay during sodium channel block, gap junction inhibition, and acute ischemia. Results: In computational simulations, reducing sodium channel conductance and intracellular conductivity resulted in a decrease in signal amplitude and increase in norm_EA (reflecting a broadening of electrogram morphology). For larger electrodes (3 mm diameter/7.1 mm2 area), the change in norm_EA was essentially linear with the change in local conduction delay. Experimental studies supported this finding, showing that the magnitude of change in norm_EA induced by flecainide (1–4 μM), carbenoxolone (10–50 μM), and low-flow ischemia (25% of initial flow rate) was linearly correlated with the local conduction delay in each condition (r2 = 0.92). Qualitatively similar effects were observed in guinea pig hearts perfused with flecainide. Increasing fibrosis density in the computational model also resulted in a decrease in signal amplitude and increase in norm_EA. However, this remains to be validated using experimental/clinical data of chronic infarct. Conclusion: norm_EA is a quantitative measure of local conduction delay between the electrode pair that generates a bipolar electrogram, which may have utility in electrophysiological substrate mapping of non-inducible or haemodynamically compromising tachyarrhythmia.

AB - Background: Re-entrant ventricular tachycardia may be non-inducible or haemodynamically compromising, requiring assessment of the electrophysiological properties of the myocardium during sinus rhythm (i.e., substrate mapping). Areas of heart tissue with slow conduction can act as a critical isthmus for re-entrant electrical excitation and are a potential target for ablation therapy. Aim: To develop and validate a novel metric of local conduction delay in the heart, the amplitude-normalized electrogram area (norm_EA). Methods: A computational model of a propagating mouse action potential was used to establish the impact of altering sodium channel conductance, intracellular conductivity, fibrosis density, and electrode size/orientation on bipolar electrogram morphology. Findings were then validated in experimental studies in mouse and guinea pig hearts instrumented for the recording of bipolar electrograms from a multipolar linear mapping catheter. norm_EA was calculated by integrating the absolute area of a bipolar electrogram divided by the electrogram amplitude. Electrogram metrics were correlated with the local conduction delay during sodium channel block, gap junction inhibition, and acute ischemia. Results: In computational simulations, reducing sodium channel conductance and intracellular conductivity resulted in a decrease in signal amplitude and increase in norm_EA (reflecting a broadening of electrogram morphology). For larger electrodes (3 mm diameter/7.1 mm2 area), the change in norm_EA was essentially linear with the change in local conduction delay. Experimental studies supported this finding, showing that the magnitude of change in norm_EA induced by flecainide (1–4 μM), carbenoxolone (10–50 μM), and low-flow ischemia (25% of initial flow rate) was linearly correlated with the local conduction delay in each condition (r2 = 0.92). Qualitatively similar effects were observed in guinea pig hearts perfused with flecainide. Increasing fibrosis density in the computational model also resulted in a decrease in signal amplitude and increase in norm_EA. However, this remains to be validated using experimental/clinical data of chronic infarct. Conclusion: norm_EA is a quantitative measure of local conduction delay between the electrode pair that generates a bipolar electrogram, which may have utility in electrophysiological substrate mapping of non-inducible or haemodynamically compromising tachyarrhythmia.

KW - bipolar electrogram

KW - cardiac arrhythmia

KW - cardiac mapping

KW - conduction delay

KW - electrophysiology

KW - substrate mapping

UR - http://www.scopus.com/inward/record.url?scp=85085874596&partnerID=8YFLogxK

U2 - 10.3389/fphys.2020.00465

DO - 10.3389/fphys.2020.00465

M3 - SCORING: Journal article

C2 - 32508676

AN - SCOPUS:85085874596

VL - 11

JO - FRONT PHYSIOL

JF - FRONT PHYSIOL

SN - 1664-042X

M1 - 465

ER -