Bipolar electrogram Shannon entropy at sites of rotational activation implications for ablation of atrial fibrillation

Anand N. Ganesan, Pawel Kuklik, Dennis H. Lau, Anthony G. Brooks, Mathias Baumert, Wei Wen Lim, Shivshankar Thanigaimani, Sachin Nayyar, Rajiv Mahajan, Jonathan M. Kalman, Kurt C. Roberts-Thomson, Prashanthan Sanders

Research output: Contribution to journalArticle

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Abstract

Background - The pivot is critical to rotors postulated to maintain atrial fibrillation (AF). We reasoned that wavefronts circling the pivot should broaden the amplitude distribution of bipolar electrograms because of directional information encoded in these signals. We aimed to determine whether Shannon entropy (ShEn), a measure of signal amplitude distribution, could differentiate the pivot from surrounding peripheral regions and thereby assist clinical rotor mapping. Methods and Results - Bipolar electrogram recordings were studied in 4 systems: (1) computer simulations of rotors in a 2-dimensional atrial sheet; (2) isolated rat atria recorded with a multi-electrode array (n=12); (3) epicardial plaque recordings of induced AF in hypertensive sheep (n=11); and (4) persistent AF patients (n=10). In the model systems, rotation episodes were identified, and ShEn calculated as an index of amplitude distribution. In humans, ShEn distribution was analyzed at AF termination sites and with respect to complex fractionated electrogram mean. We analyzed rotation episodes in simulations (4 cycles) and animals (rats: 14 rotors, duration 80±81 cycles; sheep: 13 rotors, 4.2±1.5 cycles). The maximum ShEn bipole was consistently colocated with the pivot zone. ShEn was negatively associated with distance from the pivot zone in simulated spiral waves, rats, and sheep. ShEn was modestly inversely associated with complex fractionated electrogram; however, there was no relationship at the sites of highest ShEn. Conclusions - ShEn is a mechanistically based tool that may assist AF rotor mapping.

Original languageEnglish
Pages (from-to)48-57
Number of pages10
JournalCirculation: Arrhythmia and Electrophysiology
Volume6
Issue number1
DOIs
Publication statusPublished - 1 Feb 2013

Keywords

  • Arrhythmia
  • Atrial fibrillation
  • Electrophysiology
  • Mapping

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Physiology (medical)

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