Body surface potential propagation maps during macroreentrant atrial arrhythmias. A simulation study

Atrial flutter (AFL) is a supraventricular arrhythmia perpetuated by a macroreentrant circuit around an obstacle. Typical AFL is caused by a rotation around the tricuspid annulus (TA) and atypical AFL by a rotation around any other structure. The identification of the circuit in atypical AFL is complicated both by using the standard electrocardiogram and by the use of intracardiac recordings. In this work, we present mathematical simulations describing several macroreentrant behaviors in an atrial structure and its reflection on the torso. Specifically, we will discuss in detail a clockwise typical flutter and two atypical flutters dependent on inferior and superior vena cava respectively. We will also describe the detection and tracking of phase singularities and phase maps as a tool to summarize BSPM recordings. This work presents the simulation of arrhythmic behaviors on realistic multicellular models and calculation of its reflection on the surface of the torso as a promising tool for verifying diagnosis techniques based on BSPM.