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International Journal of Cardiology Jul 2019Atrial fibrillation is the most common arrhythmia in humans and is associated with high morbidity, mortality and health-related expenses. Computational approaches have... (Review)
Review
Atrial fibrillation is the most common arrhythmia in humans and is associated with high morbidity, mortality and health-related expenses. Computational approaches have been increasingly utilized in atrial electrophysiology. In this review we summarize the recent advancements in atrial fibrillation modeling at the organ scale. Multi-scale atrial models now incorporate high level detail of atrial anatomy, tissue ultrastructure and fibrosis distribution. We provide the state-of-the art methodologies in developing personalized atrial fibrillation models with realistic geometry and tissue properties. We then focus on the use of multi-scale atrial models to gain mechanistic insights in AF. Simulations using atrial models have provided important insight in the mechanisms underlying AF, showing the importance of the atrial fibrotic substrate and altered atrial electrophysiology in initiation and maintenance of AF. Last, we summarize the translational evidence that supports incorporation of computational modeling in clinical practice for development of personalized treatment strategies for patients with AF. In early-stages clinical studies, AF models successfully identify patients where pulmonary vein isolation alone is not adequate for treatment of AF and suggest novel targets for ablation. We conclude with a summary of the future developments envisioned for the field of atrial computational electrophysiology.
Topics: Atrial Fibrillation; Catheter Ablation; Computer Simulation; Heart Atria; Humans; Imaging, Three-Dimensional; Magnetic Resonance Imaging, Cine; Models, Cardiovascular; Tomography, X-Ray Computed
PubMed: 30755334
DOI: 10.1016/j.ijcard.2019.01.096 -
The International Journal of... Dec 2022To assess transthoracic echocardiographic (TTE) left atrial (LA) strain parameters and their association with atrial fibrillation (AF) recurrence after thoracoscopic... (Randomized Controlled Trial)
Randomized Controlled Trial
To assess transthoracic echocardiographic (TTE) left atrial (LA) strain parameters and their association with atrial fibrillation (AF) recurrence after thoracoscopic surgical ablation (SA) in patients in sinus rhythm (SR) or in AF at baseline. Patients participating in the Atrial Fibrillation Ablation and Autonomic Modulation via Thoracoscopic Surgery trial were included. All patients underwent thoracoscopic pulmonary vein isolation with LA appendage exclusion and were randomized to ganglion plexus (GP) or no GP ablation. In TTEs performed before surgery, LA strain and mechanical dispersion (MD) of the LA reservoir and conduit phase in all patients, and of the contraction phase in patients in SR were obtained. Recurrence of AF was defined as any documented atrial tachyarrhythmia lasting > 30 s during one year of follow-up. Two hundred and four patients (58.6 ± 7.8 years, 73% male, 57% persistent AF) were included. At baseline TTE 121 (59%) were in SR and 83 (41%) had AF. Patients with AF recurrence had lower LA strain of the reservoir phase (13.0% vs. 16.6%; p = < 0.001) and a less decrease in strain of the conduit phase (-9.0% vs. -11.8%; p = 0.006), regardless of rhythm. MD of the conduit phase was larger in patients with AF recurrence (79.4 vs. 43.5 ms; p = 0.012). Multivariate cox regression analysis demonstrated solely an association between LA strain of the reservoir phase and AF recurrence in patients in SR (HR 0.95, p = 0.046) or with AF (HR 0.90, p = 0.038). A reduction in LA strain of the reservoir phase prior to SA predicts recurrence of AF in both patients with SR or AF. Left atrial strain assessment may therefore add to a better patient selection for SA.
Topics: Humans; Male; Female; Atrial Fibrillation; Predictive Value of Tests; Atrial Appendage; Heart Atria; Pulmonary Veins
PubMed: 36445663
DOI: 10.1007/s10554-022-02645-5 -
Europace : European Pacing,... Aug 2023The relationship between local unipolar voltage (UV) in the pulmonary vein (PV)-ostia and left atrial wall thickness (LAWT) and the utility of these parameters as...
AIMS
The relationship between local unipolar voltage (UV) in the pulmonary vein (PV)-ostia and left atrial wall thickness (LAWT) and the utility of these parameters as indices of outcome after atrial fibrillation (AF) ablation remain unclear.
METHODS AND RESULTS
Two-hundred seventy-two AF patients who underwent AF ablation were enrolled. Unipolar voltage of PV-ostia was measured using a CARTO system, and LAWT was measured using computed tomography. The primary endpoint was atrial tachyarrhythmia (ATA) recurrence including AF. The ATA recurrence was documented in 74 patients (ATA-Rec group). The UV and LAWT of the bilateral superior PV roof to posterior and around the right-inferior PV in the ATA-Rec group were significantly greater than in patients without ATA recurrence (ATA-Free group) (P < 0.001). The UV had a strong positive correlation with LAWT (R2 = 0.446, P < 0.001). The UV 2.7 mV and the corresponding LAWT 1.6 mm were determined as the cut-off values for ATA recurrence (P < 0.001, respectively). Multisite LA high UV (HUV, ≥4 areas of >2.7 mV) or multisite LA wall thickening (≥5 areas of >1.6 mm), defined as LA hypertrophy (LAH), was related to higher ATA recurrence. Among 92 LAH patients, 66 had HUV (LAH-HUV) and the remaining 26 had low UV (LAH-LUV), characterized by history of non-paroxysmal AF and heart failure, reduced LV ejection fraction, or enlarged LA. In addition, LAH-LUV showed the worst ablation outcome, followed by LAH-HUV and No LAH (log-rank P < 0.001).
CONCLUSION
Combining UV and LAWT enables us to stratify recurrence risk and suggest a tailored ablation strategy according to LA tissue properties.
Topics: Humans; Atrial Fibrillation; Heart Atria; Atrial Appendage; Tachycardia; Tomography, X-Ray Computed; Catheter Ablation; Pulmonary Veins; Recurrence; Treatment Outcome
PubMed: 37539865
DOI: 10.1093/europace/euad240 -
JACC. Clinical Electrophysiology Feb 2020The goal of this study was to find effective parameters that can be used in real-time that result in chronic scar verified by left atrial (LA) late gadolinium...
OBJECTIVES
The goal of this study was to find effective parameters that can be used in real-time that result in chronic scar verified by left atrial (LA) late gadolinium enhancement cardiac magnetic resonance (LGE-CMR).
BACKGROUND
Automated annotation can be a useful tool while ablating in tagging areas that will result in scar, but the effective settings that best predict chronic scar are still unknown.
METHODS
Patients underwent pulmonary vein isolation using a CARTO3 mapping system with a VISITAG Module and 3-month post-ablation LGE-CMR. The electroanatomical map (EAM) was used to retrospectively tag ablated areas with 5 different parameters: catheter stability; stability duration; force over time; minimum contact force; and impedance drop. The ablation tags in EAM were projected to the 3-month post-ablation LGE-CMR. Tags were divided into 2 groups depending on if they correlated with CMR-based scar tags (STAGs) or nonscar tags (NTAGs); the effective parameters were estimated for the 2 groups at different power levels.
RESULTS
This study assessed 70 consecutive patients and 28,939 ablation tags. Ablation time and force time integral (FTI) were significantly larger in the STAG group. Mean contact force, change of catheter tip temperature, and impedance were not significantly different between STAGs and NTAGs. The minimum ablation time and FTI to make durable scar lesions were 17.6, 13.6, and 11.0 s and 226.1, 187.4, and 161.4 g at 25, 35, and 50 W, respectively.
CONCLUSIONS
Minimum ablation time and FTI values are critical parameters that determine durable atrial scar creation and their minimum values vary with the ablation power setting.
Topics: Aged; Atrial Fibrillation; Cardiac Imaging Techniques; Catheter Ablation; Cicatrix; Female; Heart Atria; Humans; Magnetic Resonance Imaging; Male; Middle Aged; Pulmonary Veins; Retrospective Studies; Treatment Outcome
PubMed: 32081215
DOI: 10.1016/j.jacep.2019.10.001 -
JACC. Clinical Electrophysiology Mar 2021
Topics: Atrial Fibrillation; Catheter Ablation; Cicatrix; Embolic Stroke; Heart Atria; Humans
PubMed: 33736752
DOI: 10.1016/j.jacep.2020.12.002 -
JACC. Clinical Electrophysiology Feb 2020
Topics: Atrial Appendage; Atrial Fibrillation; Catheter Ablation; Cicatrix; Heart Atria; Humans
PubMed: 32081216
DOI: 10.1016/j.jacep.2019.12.006 -
Current Cardiology Reviews 2015Macroreentrant atrial tachycardia is a common complication following surgery for congenital heart disease (CHD), and is often highly symptomatic with potentially... (Review)
Review
Macroreentrant atrial tachycardia is a common complication following surgery for congenital heart disease (CHD), and is often highly symptomatic with potentially significant hamodynamic consequences. Medical management is often unsuccessful, requiring the use of invasive procedures. Cavotricuspid isthmus dependent flutter is the most common circuit but atypical circuits also exist, involving sites of surgical intervention or areas of scar related to abnormal hemodynamics. Ablation can be technically challenging, due to complex anatomy, and difficulty with catheter stability. A thorough assessment of the patients status and pre-catheter ablation planning is critical to successfully managing these patients.
Topics: Catheter Ablation; Heart Atria; Heart Defects, Congenital; Humans; Pacemaker, Artificial; Treatment Outcome
PubMed: 25308809
DOI: 10.2174/1573403x10666141013122231 -
Minerva Cardioangiologica Apr 2004Ablation to eliminate atrial fibrillation (AF) is a therapy in evolution. Approaches to the ablation appear to be currently divided into 2 major strategies anatomic... (Review)
Review
Ablation to eliminate atrial fibrillation (AF) is a therapy in evolution. Approaches to the ablation appear to be currently divided into 2 major strategies anatomic versus electrically guided. In addition in using an electrically guided techniques debate remains whether a targeted approach should be used, whether exit block should be documented, and whether all non pulmonary vein triggers should be targeted. This review highlights the different ablation strategies and identifies a systematic approach to ablation of pulmonary and non pulmonary vein triggers that we have adapted at our institution. The role of intracardiac echo, trigger provocation and localization and the use of 3-D mapping systems in AF ablation are defined.
Topics: Adrenergic beta-Agonists; Atrial Fibrillation; Catheter Ablation; Electrocardiography; Heart Atria; Heart Conduction System; Humans; Imaging, Three-Dimensional; Isoproterenol; Magnetic Resonance Angiography; Membrane Potentials; Pulmonary Veins; Treatment Outcome; Ultrasonography, Interventional
PubMed: 15194992
DOI: No ID Found -
Cardiology Journal 2020Catheter ablation (CA) is a well-known treatment option for patients with symptomatic drug-resistant atrial fibrillation (AF). Multiple factors have been identified to... (Review)
Review
BACKGROUND
Catheter ablation (CA) is a well-known treatment option for patients with symptomatic drug-resistant atrial fibrillation (AF). Multiple factors have been identified to determine AF recurrence after CA, however their predictive value is rather small. Identification of novel predictors of CA outcome is therefore of primary importance to reduce health costs and improve long-term results of intervention. The recurrence of AF following CA is related to severity of left ventricular (LV) dysfunction, extent of atrial dilatation and fibrosis. The aim of this paper was to present and discuss the latest studies on the utility of echocardiographic parameters in terms of CA effectiveness in patients with paroxysmal and persistent AF.
METHODS
PubMed, Google Scholar, EBSCO databases were searched for studies reporting echocardiographic preprocedural predictors of AF recurrence after CA. LV systolic and diastolic function, as well as atrial size, strain and dyssynchrony were taken into consideration.
RESULTS
Twenty one full-text articles were analyzed, including three meta-analyses. Several echocardiographic parameters have been reported to determine a risk of AF recurrence after CA. There are conventional methods that measure left atrial size and volume, LV ejection fraction, parameters assessing LV diastolic dysfunction, and methods using more innovative technologies based on speckle tracking echocardiography to determine left atrial synchrony and strain. Each of these parameters has its own predictive value.
CONCLUSIONS
Regarding CA effectiveness, every patient has to be evaluated individually to estimate the risk of AF recurrence, optimally using a combination of several echocardiographic parameters.
Topics: Atrial Fibrillation; Catheter Ablation; Echocardiography; Heart Atria; Humans; Predictive Value of Tests; Recurrence; Treatment Outcome
PubMed: 29924375
DOI: 10.5603/CJ.a2018.0067 -
JACC. Cardiovascular Imaging Nov 2021
Topics: Atrial Fibrillation; Atrial Remodeling; Heart Atria; Humans; Predictive Value of Tests
PubMed: 34274271
DOI: 10.1016/j.jcmg.2021.05.021