In Silico Local Impedance Mapping Using Multielectrode Catheters

Carmen Martinez Anton1, Laura Anna Unger2, Axel Loewe3, Olaf Doessel4
1Institute of Biomedical Engineering, Karlsruhe Institute of Technology (KIT), 2Medizinische Klinik IV, Städtisches Klinikum Karlsruhe, 3Karlsruhe Institute of Technology (KIT), 4Institute of Biomedical Engineering, Karlsruhe Institute of Technology


Abstract

Mapping techniques, such as voltage maps, are currently used to estimate the location of atrial substrate potentially causing atrial fibrillation. Local impedance (LI) has recently been introduced as another modality for atrial substrate assessment as it does not rely on the dynamically changing electrical activity of the heart. However, its potential has been mainly studied using point-by-point acquisitions with ablation catheters disregarding multielectrode mapping catheters. This study explores the ability of LI to assess catheter-tissue contact and identify healthy and scar tissue using in silico experiments. Three-dimensional models of two mapping catheters with multielectrode arrangements were developed to measure LI in three tissue configurations. Combining 13 different stimulating bipolar pairs and five catheter-tissue distances, 195 simulated LI measurements were computed using forward electrical simulations at 14.5 kHz. Increasing the catheter-tissue distance yielded monotonously decreasing LI values using both catheters. The grid catheter showed a median LI value on healthy tissue of 63.91 ohms, decreasing to 56.02 ohms at 2 mm distance. Similarly, the star catheter showed median LI values of 156.18 ohms and 115.13 ohms, respectively. The decreasing effect was also seen in scar tissue (52.77 ohms to 49.80 ohms, and 130.72 ohms to 111.28 ohms with a grid and star catheter, respectively). The presence of a scar line altered the LI measurements compared to the homogeneous patches. In silico multielectrode LI measurements can be of help for identifying direct catheter-tissue contact and distinguishing between healthy myocardium or scar tissue underneath, paving the way towards its use as a surrogate for atrial substrate in clinical applications. In this work, scar tissue always yielded lower LI values than healthy scenarios for both catheters and all stimulating bipoles.