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Simulation of intracardiac electrograms around acute ablation lesions

机译:急性消融灶周围心内电图的模拟

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Radiofrequency ablation (RFA) is a widely used clinical treatment for many types of cardiac arrhythmias. However, nontransmural lesions and gaps between linear lesions often lead to recurrence of the arrhythmia. Intracardiac electrograms (IEGMs) provide real-time information regarding the state of the cardiac tissue surrounding the catheter tip. Nevertheless, the formation and interpretation of IEGMs during the RFA procedure is complex and yet not fully understood. In this in-silico study, we propose a computational model for acute ablation lesions. Our model consists of a necrotic scar core and a border zone, describing irreversible and reversible temperature induced electrophysiological phenomena. These phenomena are modeled by varying the intra- and extracellular conductivity of the tissue as well as a regulating zone factor. The computational model is evaluated regarding its feasibility and validity. Therefore, this model was compared to an existing one and to clinical measurements of five patients undergoing RFA. The results show that the model can indeed be used to recreate IEGMs. We computed IEGMs arising from complex ablation scars, such as scars with gaps or two overlapping ellipsoid scars. For orthogonal catheter orientation, the presence of a second necrotic core in the near-field of a punctiform acute ablation lesion had minor impact on the resulting signal morphology. The presented model can serve as a base for further research on the formation and interpretation of IEGMs.
机译:射频消融(RFA)是一种适用于多种类型的心律不齐的临床治疗方法。但是,非透壁病变和线性病变之间的间隙通常会导致心律失常的复发。心内电描记图(IEGM)提供有关导管尖端周围心脏组织状态的实时信息。然而,在RFA程序中IEGM的形成和解释是复杂的,但尚未完全了解。在此计算机模拟研究中,我们提出了一种用于急性消融病变的计算模型。我们的模型由坏死疤痕核心和边界区域组成,描述了不可逆和可逆的温度诱发的电生理现象。通过改变组织的细胞内和细胞外电导率以及调节区因子来模拟这些现象。评估该计算模型的可行性和有效性。因此,将该模型与现有模型和5名接受RFA的患者的临床测量结果进行了比较。结果表明,该模型确实可以用于重新创建IEGM。我们计算了由复杂的消融疤痕引起的IEGM,这些疤痕包括有间隙的疤痕或两个重叠的椭圆形疤痕。对于正交的导管方向,点状急性消融病变的近场中第二个坏死芯的存在对所产生的信号形态影响很小。提出的模型可以作为进一步研究IEGMs的基础。

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