Analyse et détection des électrogrammes complexes fractionnés en vue de soigner la fibrillation auriculaire à l'aide de techniques d'ablation par radiofréquence

Abstract : This manuscript presents research on the analysis and the detection of Complex Fractionated Atrial Electrograms (CFAE). In the first part, following a presentation over Atrial Fibrillation (AF) mechanisms and bioelectrical signals, the most commonly used tools for analyzing CFAE are presented. Linear tools are initially applied to signals from AF ablation procedures, then nonlinear tools are shown and integrated intoa CFAE detection algorithm. This one is based on the quantification of electrogram recurrence properties. In the second part, the cell and cardiac muscle tissue are described and simulated using mathematical models. Models such as FitzHugh Nagumo, Aliev Panfilov and Courtemanche Ramirez Nattel are implemented to reproduce the mechanisms of AF mentioned in the presentation of this disease. The acquisition of fields of potential is also reproduced using a numerical model of catheter as the one used during ablation process. Time signals thus generated are used to match the spatiotemporal activations at the substrate level with the patterns to be observed in CFAE. An experimental model completes the analysis. Cell cultures of newborn rats on MEA (Micro ElectrodeArray) can recreate fibrillation conditions and acquire extracellular potentials. Again, electrogramsare compared with signals from computer simulations and the clinical database signals. The analysisof pattern sequence via the three types of models can attach the observed patterns in electrograms with the mechanisms occurring at the cardiac tissue level during AF. Real-time analysis would allow the practitioner to receive critical information during ablation about the nature and the location of arrhythmia sources
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Nicolas Navoret. Analyse et détection des électrogrammes complexes fractionnés en vue de soigner la fibrillation auriculaire à l'aide de techniques d'ablation par radiofréquence. Médecine humaine et pathologie. Université de Bourgogne, 2013. Français. ⟨NNT : 2013DIJOS011⟩. ⟨tel-00926703⟩

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