Abstract
Atrial arrhythmias, and specifically atrial fibrillation (AF), induce rapid and irregular activation patterns that appear on the torso surface as abnormal P-waves in electrocardiograms and body surface potential maps (BSPM). In recent years both P-waves and the BSPM have been used to identify the mechanisms underlying AF, such as localizing ectopic foci or high-frequency rotors. However, the relationship between the activation of the different areas of the atria and the characteristics of the BSPM and P-wave signals are still far from being completely understood. In this work we developed a multi-scale framework, which combines a highly-detailed 3D atrial model and a torso model to study the relationship between atrial activation and surface signals in sinus rhythm. Using this multi scale model, it was revealed that the best places for recording P-waves are the frontal upper right and the frontal and rear left quadrants of the torso. Our results also suggest that only nine regions (of the twenty-one structures in which the atrial surface was divided) make a significant contribution to the BSPM and determine the main P-wave characteristics.
Highlights
Atrial arrhythmias, mainly atrial fibrillation (AF), are the most common sustained cardiac arrhythmias in humans and are considered major causes of morbidity and mortality [1]
We consider the major contributions of our study are: 1) a realistic and highly detailed multiscale atrial-torso model to analyse atrial activation and 2) the possibility of using this model to determine the contribution of different atrial structures to the P-wave and the body surface potential maps (BSPM) distribution in healthy subjects
This multi-scale atrial-torso model has three main characteristics: 1) electrophysiological heterogeneity due to eight different cellular models with long-term stability in terms of APD90 and restitution properties that guarantee the stability of numerical computations; 2) the realistic atrial model has high spatial resolution and is divided into small structures to improve the local control of the histological fibre orientation and electrical properties; 3) a realistic torso model with the highest spatial resolution in the area surrounding the atrium, the most influential tissue conductivities on the generation of body surface and volumetric potentials, and Pwave morphologies
Summary
Mainly atrial fibrillation (AF), are the most common sustained cardiac arrhythmias in humans and are considered major causes of morbidity and mortality [1]. In recent decades this has led to the in-depth study of the human atrial anatomy and electrophysiology from cellular to tissue scale, which has provided a large amount of information on the atrial structure and function. Collecting all this multi-scale heterogeneous information in order to understand pathological mechanisms is somewhat complex. Number: TIN2012-37546-C03-01 (Recipient: Ana Ferrer); the "Programa Estatal de Investigación, Desarrollo e Innovación Orientado a los Retos de la Sociedad" from the Ministerio de Economía y Competitividad and the European Commission (European Regional Development Funds - ERDF FEDER), Award Number: TIN2014-59932-JIN (Recipient: Rafael Sebastián); and the "Programa Prometeo" from the Generalitat Valenciana, Award Number: 2012/030 (Recipient: Laura Martínez)
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