Influence of three-dimensional fibrotic patterns on simulated intracardiac electrogram morphology

Complex fractionated atrial electrograms (CFAE) are a target for catheter ablation as they coincide with areas of slow conduction. In this study we simulated different volume fractions of diffuse and patchy fibrosis up to 50 %. Catheter signals for different electrode spacings were calculated and characteristic features were compared to a clinical database of CFAE-signals. A linear slowing of global conduction velocities was found independent of the type of fibrosis. For patchy fibrosis, electrograms displayed fractionation, which was not seen for diffuse fibrosis of the same degree. In comparison to clinical data, simulated electrograms showed up to 10 zero crossings per electrogram, which was also seen for clinical EGMs with medium fractionation (class 2 of 3). For both, clinical (84 %) and simulated (88 %) signals, a significant difference in amplitude is present between fractionated and non-fractionated signals.