Left and Right Atrial Contribution to the P-wave in Realistic Computational Models

Loewe, Axel; Krueger, Martin W.; Platonov, Pyotr G.; Holmqvist, Fredrik; Dössel, Olaf; Seemann, Gunnar

doi:10.1007/978-3-319-20309-6_50

Cited by 23 publications

(34 citation statements)

References 29 publications

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“…Reapplying this operation added one more voxel layer and so forth. Myocyte orientation in the atria and anatomical structures allowing for heterogenous electrophysiology [7] were annotated in the dilated models using previously described methods [8,9]. The same holds for the discrete interatrial connections at the coronary sinus, Bachmann's bundle and posteriorly.…”

Section: Methodsmentioning

confidence: 99%

Left Atrial Hypertrophy Increases P:Wave Terminal Force Through Amplitude but not Duration

Loewe

Andlauer

Platonov

et al. 2016

2016 Computing in Cardiology Conference (CinC)

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P-wave morphology correlates with the risk for atrial fibrillation (AF). Left atrial (LA) enlargement could explain both the higher risk for AF and higher P-wave terminal force (PTF) in ECG lead V 1 . However, PTF-V 1 has been shown to correlate poorly with LA size. We hypothesize that LA hypertrophy, i.e. a thickening of the myocardial wall, also contributes to increased PTF-V 1 and is part of the reason for the rather low specificity of increased PTF-V 1 regarding LA enlargement. To show this, atrial excitation propagation was simulated in a cohort of four anatomically individualized models including rule-based myocyte orientation and spatial electrophysiological heterogeneity using the monodomain approach. The LA wall was thickened symmetrically in steps of 0.66 mm by up to 3.96 mm. Interatrial conduction was possible via discrete connections at the coronary sinus, Bachmann's bundle and posteriorly. Body surface ECGs were computed using realistic, heterogeneous torso models. During the early P-wave stemming from sources in the RA, no changes were observed. Once the LA got activated, the voltage in V 1 tended to lower values for higher degrees of hypertrophy. Thus, the amplitude of the late positive Pwave decreased while the amplitude of the subsequent negative terminal phase increased. PTF-V 1 and LA wall thickening showed a correlation of 0.95. The P-wave duration was almost unaffected by LA wall thickening (∆ ≤2 ms). Our results show that PTF-V 1 is a sensitive marker for LA wall thickening and elucidate why it is superior to P-wave area. The interplay of LA hypertrophy and dilation might cause the poor empirical correlation of LA size and PTF-V 1 . IntroductionThe P-wave in the body surface ECG has long been used to gain insight into anatomy, function and dysfunction of the atria [1]. As a 12-lead ECG is routinely acquired non-invasively as part of a large number of examinations, ECG-derived measures represent ideal risk markers due to their availability and low associated costs [2]. These properties render ECG-based markers more attractive than alternatives like ultrasound, magnetic resonance imaging, electroanatomical mapping, or ECG imaging. Therefore, clinicians aim to stratify arrhythmia risk based on P-wave markers [3]. The assessment of morphological features of the P-wave is recommended in current guidelines for ECG interpretation [4] regarding the diagnosis of atrial abnormalities such as left or right atrial enlargement. The anatomy of the left atrium (LA) is of particular interest regarding the risk to develop atrial fibrillation (AF) as larger atria are more vulnerable to reentry in general. Therefore, left atrial enlargement (LAE) could explain both the higher risk to develop AF and higher P-wave terminal force (PTF) in ECG lead V 1 defined as the product of the duration and the amplitude of the terminal negative part of the P-wave. However, the criterion PTF-V 1 > 4 mVms correlates rather poorly with LA size in empirical studies. Truong et al. reported an accuracy of 51% using compute...

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Section: Methodsmentioning

confidence: 99%

Left Atrial Hypertrophy Increases P:Wave Terminal Force Through Amplitude but not Duration

Loewe

Andlauer

Platonov

et al. 2016

2016 Computing in Cardiology Conference (CinC)

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“…MRI data of four healthy male subjects were acquired as described in [10,11]. The atria and thoraces were manually segmented and combined to a voxel format, which was furthermore converted to a tetrahedral mesh for the calculation of electric potentials.…”

Section: Anatomical Modelsmentioning

confidence: 99%

“…These anatomical parts along with the corresponding fiber orientation were annotated using the rule-based algorithms described in [12]. Left-toright atrial conducting pathways included BB, 2 posterior interatrial connections and the coronary sinus [10,11].…”

Section: Anatomical Modelsmentioning

confidence: 99%

“…The ratios between conductivities in the longitudinal and transversal directions for atrial tissue, Crista Terminalis, pectinate muscles and BB were set to 3.75, 6.56, 10.52 and 9, respectively. The monodomain solver acCELLerate was employed for computation of excitation propagation [10]. For each geometrical model, 20 ectopic sequences originating from the left atrium (LA) were simulated.…”

Section: Electrophysiological Modelsmentioning

confidence: 99%

“…Afterwards, the correlation is computed between the BSPMs corresponding to the input and output P waves. In [10,11], the contribution of the right atrium (RA) to the P wave was shown to be dominant over those from the LA. As a uniform CV was assumed for all atrial nodes in the inverse model, we conjectured that the difference in timings of crossing a conduction bridge from the LA to the RA between the true and test activation sequences might have a great impact on the resulting correlation map.…”

Section: Fastest Route Algorithmmentioning

confidence: 99%

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ECG Imaging of Focal Atrial Excitation: Evaluation in a Realistic Simulation Setup

Potyagaylo

Loewe

Dam

et al. 2016

2016 Computing in Cardiology Conference (CinC)

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One promising application of electrocardiographic (ECG) imaging is noninvasive reconstruction of atrial activities. However, despite numerous clinical studies, which are mostly concerned with complex irregular excitation patterns, there are relatively few in silico investigations on the imaging of ectopic activation. In the present work, we explore the localization accuracy of ECG imaging regarding atrial focal sites. For the forward calculations, we used four realistic geometrical models with complex anatomical structure and a rule-based fiber orientation embedded into the atrial model. Excitation propagation was simulated with the monodomain model. For each geometrical model, 20 activation sequences originating from the posterior wall of the left atrium were simulated. Based on the bidomain theory, the body surface potential maps resulting from these focal events were computed. For the inverse reconstructions, we employed a full-search procedure based on the fastest route algorithm assuming uniform excitation propagation. Localization errors were revealed to be dependent on the model-specific atrial geometry. We also performed similarity analysis for the first halves of the P wave duration, which improved the results in three models.

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Simulated Excitation Patterns in the Atria and Their Corresponding Electrograms

Steyer

Díaz

Unger

et al. 2023

Lecture Notes in Computer Science

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Left and Right Atrial Contribution to the P-wave in Realistic Computational Models

Cited by 23 publications

References 29 publications

Left Atrial Hypertrophy Increases P:Wave Terminal Force Through Amplitude but not Duration

Left Atrial Hypertrophy Increases P:Wave Terminal Force Through Amplitude but not Duration

ECG Imaging of Focal Atrial Excitation: Evaluation in a Realistic Simulation Setup

Simulated Excitation Patterns in the Atria and Their Corresponding Electrograms

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