Entropy mapping approach for functional reentry detection in atrial fibrillation: An in-silico study

Catheter ablation of critical electrical propagation sites is a promising tool for reducing the recurrence of atrial fibrillation (AF). The spatial identification of the arrhythmogenic mechanisms sustaining AF requires the evaluation of electrograms (EGMs) recorded over the atrial surface. This work aims to characterize functional reentries using measures of entropy to track and detect a reentry core. To this end, different AF episodes are simulated using a 2D model of atrial tissue. Modified Courtemanche human action potential and Fenton-Karma models are implemented. Action potential propagation is modeled by a fractional diffusion equation, and virtual unipolar EGM are calculated. Episodes with stable and meandering rotors, figure-of-eight reentry, and disorganized propagation with multiple reentries are generated. Shannon entropy (ShEn), approximate entropy (ApEn), and sample entropy (SampEn) are computed from the virtual EGM, and entropy maps are built. Phase singularity maps are implemented as references. The results show that ApEn and SampEn maps are able to detect and track the reentry core of rotors and figure-of-eight reentry, while the ShEn results are not satisfactory. Moreover, ApEn and SampEn consistently highlight a reentry core by high entropy values for all of the studied cases, while the ability of ShEn to characterize the reentry core depends on the propagation dynamics. Such features make the ApEn and SampEn maps attractive tools for the study of AF reentries that persist for a period of time that is similar to the length of the observation window, and reentries could be interpreted as AF-sustaining mechanisms. Further research is needed to determine and fully understand the relation of these entropy measures with fibrillation mechanisms other than reentries.