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

초록

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 (1,000x 1,000 cells ten Tusscher model). We compared spatiotemporal correlations by dichotomizing each maps into 10x10 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.

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