Basket-Type Catheters : Diagnostic Pitfalls Caused by Deformation and Limited Coverage

Whole-chamber mapping using a 64-pole basket catheter (BC) has become a featured approach for the analysis of excitation patterns during atrial fibrillation. A flexible catheter design avoids perforation but may lead to spline bunching and influence coverage. We aim to quantify the catheter deformation and endocardial coverage in clinical situations and study the effect of catheter size and electrode arrangement using an in silico basket model. Atrial coverage and spline separation were evaluated quantitatively in an ensemble of clinical measurements. A computational model of the BC was implemented including an algorithm to adapt its shape to the atrial anatomy. Two clinically relevant mapping positions in each atrium were assessed in both clinical and simulated data. The simulation environment allowed varying both BC size and electrode arrangement. Results showed that interspline distances of more than 20 mm are common, leading to a coverage of less than 50% of the left atrial (LA) surface. In an ideal in silico scenario with variable catheter designs, a maximum coverage of 65% could be reached. As spline bunching and insufficient coverage can hardly be avoided, this has to be taken into account for interpretation of excitation patterns and development of new panoramic mapping techniques

A staggered-in-time and non-conforming-in-space numerical framework for realistic cardiac electrophysiology outputs

Computer-based simulations of non-invasive cardiac electrical outputs, such as electrocardiograms and body surface potential maps, usually entail severe computational costs due to the need of capturing fine-scale processes and to the complexity of the heart-torso morphology. In this work, we model cardiac electrical outputs by employing a coupled model consisting of a reaction-diffusion model - either the bidomain model or the most efficient pseudo-bidomain model - on the heart, and an elliptic model in the torso. We then solve the coupled problem with a segregated and staggered in-time numerical scheme, that allows for independent and infrequent solution in the torso region. To further reduce the computational load, main novelty of this work is in introduction of an interpolation method at the interface between the heart and torso domains, enabling the use of non-conforming meshes, and the numerical framework application to realistic cardiac and torso geometries. The reliability and efficiency of the proposed scheme is tested against the corresponding state-of-the-art bidomain-torso model. Furthermore, we explore the impact of torso spatial discretization and geometrical non-conformity on the model solution and the corresponding clinical outputs. The investigation of the interface interpolation method provides insights into the influence of torso spatial discretization and of the geometrical non-conformity on the simulation results and their clinical relevance.Comment: 26 pages,11 figures, 3 table