Key result
Simulated electrogram fractionation was more strongly linked to atrial substrate characteristics, including tissue geometry and fiber orientation, than to the electrical activation pattern.
Why the study?
Does the electrical activation pattern or atrial substrate characteristic determine electrogram fractionation in computational atrial tissue models?
Does the electrical activation pattern or atrial substrate characteristic determine electrogram fractionation in computational atrial tissue models?
This computational study suggests that complex fractionated atrial electrograms (CFAEs) are primarily driven by structural substrate characteristics rather than the electrical activation pattern, potentially explaining controversial clinical ablation outcomes based on CFAEs.
May support substrate-focused views of CFAE in AF models; leaves open whether CFAE ablation improves clinical outcomes.
Complex fractionated atrial electrograms (CFAEs) are often used as a clinical marker for re-entrant drivers of atrial fibrillation. However, outcomes of clinical ablation procedures based on CFAEs are controversial and the mechanistic links between fractionation, re-entrant activity and the characteristics of the atrial substrate are not completely understood. We explore such links by simulating electrograms arising from both normal and re-entrant electrical activity in atrial tissue models. 2D and 3D tissue geometries with a range of conditions for intracellular coupling and myofiber orientation fields were studied. Electrograms were fractionated in the presence of complex atrial fiber fields and in 3D irregular geometries, due to far-field excitations. The complexity of the local electrical activity was not a strong determinant of the degree of fractionation. These results suggest that electrogram fractionation is more strongly linked to atrial substrate characteristics (including tissue geometry, fiber orientation and degree of intercelullar coupling) than to the electrical activation pattern sustaining atrial fibrillation.
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Varela et al. (2014) studied Atrial fibrillation. Simulated electrograms in 2D and 3D tissue geometries vs. Normal vs re-entrant electrical activity was evaluated on Degree of electrogram fractionation. Simulated electrogram fractionation was more strongly linked to atrial substrate characteristics, including tissue geometry and fiber orientation, than to the electrical activation pattern.
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