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Novel Radiofrequency Ablation Strategies for Terminating Atrial Fibrillation in the Left Atrium: A Simulation Study
- Source :
- Frontiers in Physiology, Frontiers in Physiology, Frontiers, 2016, 7, pp.108. ⟨10.3389/fphys.2016.00108⟩, Frontiers in Physiology, Vol 7 (2016), Frontiers in Physiology, 2016, 7, pp.108. ⟨10.3389/fphys.2016.00108⟩, Bayer, J D, Roney, C H, Pashaei, A, Jaïs, P & Vigmond, E J 2016, ' Novel Radiofrequency Ablation Strategies for Terminating Atrial Fibrillation in the Left Atrium : A Simulation Study ', Frontiers in Physiology, vol. 7, pp. 108 . https://doi.org/10.3389/fphys.2016.00108
- Publication Year :
- 2016
- Publisher :
- Frontiers Media SA, 2016.
-
Abstract
- International audience; Pulmonary vein isolation (PVI) with radiofrequency ablation (RFA) is the cornerstone of atrial fibrillation (AF) therapy, but few strategies exist for when it fails. To guide RFA, phase singularity (PS) mapping locates reentrant electrical waves (rotors) that perpetuate AF. The goal of this study was to test existing and develop new RFA strategies for terminating rotors identified with PS mapping. It is unsafe to test experimental RFA strategies in patients, so they were evaluated in silico using a bilayer computer model of the human atria with persistent AF (pAF) electrical (ionic) and structural (fibrosis) remodeling. pAF was initiated by rapidly pacing the right (RSPV) and left (LSPV) superior pulmonary veins during sinus rhythm, and rotor dynamics quantified by PS analysis. Three RFA strategies were studied: (i) PVI, roof, and mitral lines; (ii) circles, perforated circles, lines, and crosses 0.5-1.5 cm in diameter/length administered near rotor locations/pathways identified by PS mapping; and (iii) 4-8 lines streamlining the sequence of electrical activation during sinus rhythm. As in pAF patients, 2 ± 1 rotors with cycle length 185 ± 4 ms and short PS duration 452 ± 401 ms perpetuated simulated pAF. Spatially, PS density had weak to moderate positive correlations with fibrosis density (RSPV: r = 0.38, p = 0.35, LSPV: r = 0.77, p = 0.02). RFA PVI, mitral, and roof lines failed to terminate pAF, but RFA perforated circles and lines 1.5 cm in diameter/length terminated meandering rotors from RSPV pacing when placed at locations with high PS density. Similarly, RFA circles, perforated circles, and crosses 1.5 cm in diameter/length terminated stationary rotors from LSPV pacing. The most effective strategy for terminating pAF was to streamline the sequence of activation during sinus rhythm with >4 RFA lines. These results demonstrate that co-localizing 1.5 cm RFA lesions with locations of high PS density is a promising strategy for terminating pAF rotors. For patients immune to PVI, roof, mitral, and PS guided RFA strategies, streamlining patient-specific activation sequences during sinus rhythm is a robust but challenging alternative.
- Subjects :
- 0301 basic medicine
medicine.medical_specialty
Physiology
Radiofrequency ablation
medicine.medical_treatment
Left atrium
phase singularity mapping
Phase singularity
Ablation
030204 cardiovascular system & hematology
ablation
lcsh:Physiology
law.invention
Pulmonary vein
03 medical and health sciences
0302 clinical medicine
[SDV.MHEP.CSC]Life Sciences [q-bio]/Human health and pathology/Cardiology and cardiovascular system
law
Physiology (medical)
Internal medicine
medicine
Sinus rhythm
Cycle length
computer modeling
Original Research
lcsh:QP1-981
Phase singularity mapping
business.industry
fibrosis
Atrial fibrillation
medicine.disease
Fibrosis
persistent atrial fibrillation
Surgery
surgical procedures, operative
030104 developmental biology
medicine.anatomical_structure
Cardiology
[SDV.IB]Life Sciences [q-bio]/Bioengineering
Persistent atrial fibrillation
business
Subjects
Details
- ISSN :
- 1664042X
- Volume :
- 7
- Database :
- OpenAIRE
- Journal :
- Frontiers in Physiology
- Accession number :
- edsair.doi.dedup.....6f3db2b96a21e418a81d5416465282d3