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Rossi S, Abdala L, Woodward A, Vavalle JP, Henriquez CS, Griffith BE. Rule-based definition of muscle bundles in patient-specific models of the left atrium. Front Physiol 2022; 13:912947. [PMID: 36311246 PMCID: PMC9597256 DOI: 10.3389/fphys.2022.912947] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Accepted: 06/29/2022] [Indexed: 11/13/2022] Open
Abstract
Atrial fibrillation (AF) is the most common arrhythmia encountered clinically, and as the population ages, its prevalence is increasing. Although the CHA2DS2- VASc score is the most used risk-stratification system for stroke risk in AF, it lacks personalization. Patient-specific computer models of the atria can facilitate personalized risk assessment and treatment planning. However, a challenge faced in creating such models is the complexity of the atrial muscle arrangement and its influence on the atrial fiber architecture. This work proposes a semi-automated rule-based algorithm to generate the local fiber orientation in the left atrium (LA). We use the solutions of several harmonic equations to decompose the LA anatomy into subregions. Solution gradients define a two-layer fiber field in each subregion. The robustness of our approach is demonstrated by recreating the fiber orientation on nine models of the LA obtained from AF patients who underwent WATCHMAN device implantation. This cohort of patients encompasses a variety of morphology variants of the left atrium, both in terms of the left atrial appendages (LAAs) and the number of pulmonary veins (PVs). We test the fiber construction algorithm by performing electrophysiology (EP) simulations. Furthermore, this study is the first to compare its results with other rule-based algorithms for the LA fiber architecture definition available in the literature. This analysis suggests that a multi-layer fiber architecture is important to capture complex electrical activation patterns. A notable advantage of our approach is the ability to reconstruct the main LA fiber bundles in a variety of morphologies while solving for a small number of harmonic fields, leading to a comparatively straightforward and reproducible approach.
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Affiliation(s)
- Simone Rossi
- Department of Mathematics, UNC Chapel Hill, Chapel Hill, NC, United States
| | - Laryssa Abdala
- Department of Mathematics, UNC Chapel Hill, Chapel Hill, NC, United States
| | - Andrew Woodward
- Advanced Medical Imaging Lab, UNC Chapel Hill, Chapel Hill, NC, United States
| | - John P. Vavalle
- Department of Medicine, UNC Chapel Hill, Chapel Hill, NC, United States
| | - Craig S. Henriquez
- Department of Biomedical Engineering, Duke University, Durham, NC, United States
| | - Boyce E. Griffith
- Department of Mathematics, UNC Chapel Hill, Chapel Hill, NC, United States
- Department of Biomedical Engineering, UNC Chapel Hill, Chapel Hill, NC, United States
- McAllister Heart Institute, UNC Chapel Hill, Chapel Hill, NC, United States
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Bonczar M, Piątek-Koziej K, Wolska J, Tomala O, Stitou EA, Pękala J, Pękala P, Walocha J, Hołda M, Koziej M. Variations in human pulmonary vein ostia morphology: A systematic review with meta-analysis. Clin Anat 2022; 35:906-926. [PMID: 35460116 DOI: 10.1002/ca.23896] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Revised: 04/21/2022] [Accepted: 04/21/2022] [Indexed: 11/09/2022]
Abstract
This study aimed to establish the most accurate and up-to-date anatomical knowledge of pulmonary veins (PV), ostia variations, diameters and ostial area, to provide physicians, especially heart and thoracic surgeons with exact knowledge concerning this area. The main online medical databases, such as PubMed, Embase, Scopus, Web of Science, and Google Scholar, were searched to gather all studies in which the variations, maximal diameter, and ostial area of the PVs were investigated. During the study, the preferred reporting items for systematic reviews and meta-analyses (PRISMA) guidelines were followed. Additionally, the critical appraisal tool for anatomical meta-analysis (CATAM) was used to provide the highest quality findings. The most common ostia variation is the classical one, which contains the left superior pulmonary vein (LSPV), left inferior pulmonary vein (LIPV), right superior pulmonary vein (RSPV) and right inferior pulmonary vein (RIPV). The mean diameter and ostial area of each pulmonary vein were established in the general population and in multiple variations considering the method of collecting the data and geographical location. Significant variability in PV ostia is observed. Left-sided PVs have smaller ostia than the corresponding right-sided PVs, and the inferior PVs ostia are smaller than the superior. The LCPV ostium size is the largest among all veins analyzed, while the RMPV ostium is the smallest. The results of this meta-analysis are hoped to help clinicians in planning and performing procedures that involve the pulmonary and cardiac areas, especially catheter ablation for atrial fibrillation.
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Affiliation(s)
- Michał Bonczar
- Department of Anatomy, Jagiellonian University Medical College, Kraków, Poland
| | | | - Joanna Wolska
- Edinburgh Medical School, University of Edinburgh, Edinburgh, UK
| | - Olaf Tomala
- Edinburgh Medical School, University of Edinburgh, Edinburgh, UK
| | - El-Ayachi Stitou
- Department of Anatomy, Jagiellonian University Medical College, Kraków, Poland
| | - Jakub Pękala
- Department of Anatomy, Jagiellonian University Medical College, Kraków, Poland
| | - Przemysław Pękala
- Department of Anatomy, Jagiellonian University Medical College, Kraków, Poland
| | - Jerzy Walocha
- Department of Anatomy, Jagiellonian University Medical College, Kraków, Poland
| | - Mateusz Hołda
- HEART - Heart Embryology and Anatomy Research Team, Department of Anatomy, Jagiellonian University Medical College, Cracow, Poland.,Division of Cardiovascular Sciences, The University of Manchester, UK
| | - Mateusz Koziej
- Department of Anatomy, Jagiellonian University Medical College, Kraków, Poland.,HEART - Heart Embryology and Anatomy Research Team, Department of Anatomy, Jagiellonian University Medical College, Cracow, Poland
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Martinez Urabayen U, Caballeros M, Soriano I, Ramos P, García Bolao I, Bastarrika G. Anatomic characteristics of the left atrium in subjects undergoing radiofrequency ablation for atrial fibrillation. RADIOLOGIA 2021; 63:391-399. [PMID: 34625194 DOI: 10.1016/j.rxeng.2020.03.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2019] [Accepted: 03/04/2020] [Indexed: 10/20/2022]
Abstract
OBJECTIVE To analyze the anatomic characteristics of the left atrium and pulmonary veins in individuals undergoing ablation for atrial fibrillation and to identify possible anatomic factors related with recurrence. MATERIAL AND METHODS We retrospectively reviewed the CT angiography studies done to plan radiofrequency ablation for atrial fibrillation in 95 patients (57 men; mean age, 65 ± 10 y). We reviewed the anatomy of the pulmonary veins and recorded the diameters of their ostia as well as the diameter and volume of the left atrium. We analyzed these parameters according to the type of arrhythmia and the response to treatment. RESULTS In 71 (74.7%) patients, the anatomy of the pulmonary veins was normal (i.e., two right pulmonary veins and two left pulmonary veins). Compared to patients with paroxysmal atrial fibrillation, patients with persistent atrial fibrillation had slightly larger diameter of the left pulmonary veins (left superior pulmonary vein 17.9 ± 2.6 mm vs. 16.7 ± 2.2 mm, p = 0.04; left inferior pulmonary vein 15.3 ± 2 mm vs. 13.8 ± 2.2 mm, p = 0.009) and larger left atrial volume (91.9 ± 24.9 cm3 vs. 70.7 ± 20.3 mm3, p = 0.001). After 22.1 ± 12.1 months' mean follow-up, 41 patients had sinus rhythm. Compared to patients in whom the sinus rhythm was restored, patients with recurrence had greater left atrial volume (81.4 ± 23.0 mm3 vs. 71.1 ± 23.2 mm3, p = 0.03). No significant differences in pulmonary vein diameters or clinical parameters were observed between patients with recurrence and those without. CONCLUSION The volume of the left atrium is greater in patients with persistent atrial fibrillation and in those who do not respond to ablation.
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Affiliation(s)
- U Martinez Urabayen
- Sección de imagen cardiotorácica, Servicio de Radiología, Clínica Universidad de Navarra, Pamplona, Navarra, Spain
| | - M Caballeros
- Sección de imagen cardiotorácica, Servicio de Radiología, Clínica Universidad de Navarra, Madrid, Spain
| | - I Soriano
- Sección de imagen cardiotorácica, Servicio de Radiología, Clínica Universidad de Navarra, Pamplona, Navarra, Spain
| | - P Ramos
- Departamento de Cardiología, Clínica Universidad de Navarra, Pamplona, Navarra, Spain
| | - I García Bolao
- Departamento de Cardiología, Clínica Universidad de Navarra, Pamplona, Navarra, Spain
| | - G Bastarrika
- Sección de imagen cardiotorácica, Servicio de Radiología, Clínica Universidad de Navarra, Pamplona, Navarra, Spain.
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Martínez Urabayen U, Caballeros M, Soriano I, Ramos P, García Bolao I, Bastarrika G. Características anatómicas de la aurícula izquierda en sujetos sometidos a ablación por radiofrecuencia de fibrilación auricular. RADIOLOGIA 2021. [DOI: 10.1016/j.rx.2020.03.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
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Bajraktari G, Bytyçi I, Henein MY. Left atrial structure and function predictors of recurrent fibrillation after catheter ablation: a systematic review and meta-analysis. Clin Physiol Funct Imaging 2020; 40:1-13. [PMID: 31556215 DOI: 10.1111/cpf.12595] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2019] [Accepted: 09/17/2019] [Indexed: 02/05/2023]
Abstract
BACKGROUND Catheter ablation (CA) has become a conventional treatment for atrial fibrillation (AF), but remains with high recurrence rate. The aim of this meta-analysis was to determine left atrial (LA) structure and function indices that predict recurrence of AF. METHODS We systematically searched PubMed-Medline, EMBASE, Scopus, Google Scholar and the Cochrane Central Registry, up to September 2017 in order to select clinical trials and observational studies which reported echocardiographic predictors of AF recurrence after CA. Eighty-five articles with a total of 16 126 patients were finally included. RESULTS The pooled analysis showed that after a follow-up period of 21 ± 12 months, patients with AF recurrence had larger LA diameter with weighted mean difference (WMD: 2·99 ([95% CI 2·50-3·47], P<0·001), larger LA volume index (LAVI) maximal and LAVI minimal (P<0·0001 for both), larger LA area (P<0·0001), lower LA strain (P<0·0001) and lower LA total emptying fraction (LA EF) (P<0·0001) compared with those without AF recurrence. The most powerful LA predictors (in accuracy order) of AF recurrence were as follows: LA strain <19% (OR: 3·1[95% CI, -1.3-10·4], P<0·0001), followed by LA diameter ≥50 mm (OR: 2·75, [95% CI 1·66-4·56,] P<0·0001), and LAVmax >150 ml (OR: 2·25, [95% CI, 1.1-5·6], P = 0·0002). CONCLUSIONS Based on this meta-analysis results, a dilated left atrium with diameter more than 50 mm and volume above 150 ml or myocardial strain below 19% reflect an unstable LA that is unlikely to hold sinus rhythm after catheter ablation for atrial fibrillation.
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Affiliation(s)
- Gani Bajraktari
- Institute of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
- Clinic of Cardiology, University Clinical Centre of Kosova, Prishtina, Kosovo
- Medical Faculty, University of Prishtina, Prishtina, Kosovo
| | - Ibadete Bytyçi
- Institute of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
- Clinic of Cardiology, University Clinical Centre of Kosova, Prishtina, Kosovo
| | - Michael Y Henein
- Institute of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
- Molecular & Clinical Sciences Research Institute, St George University, London, UK
- Brunel University, London, UK
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Xu B, Xing Y, Xu C, Peng F, Sun Y, Wang S, Guo H. A left common pulmonary vein: Anatomical variant predicting good outcomes of repeat catheter ablation for atrial fibrillation. J Cardiovasc Electrophysiol 2019; 30:717-726. [DOI: 10.1111/jce.13876] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2018] [Revised: 01/29/2019] [Accepted: 02/06/2019] [Indexed: 12/31/2022]
Affiliation(s)
- Buyun Xu
- Department of Cardiology, Shaoxing People's HospitalZhejiang University School of MedicineShaoxing China
| | - Yangbo Xing
- Department of Cardiology, Shaoxing People's HospitalZhejiang University School of MedicineShaoxing China
| | - Chao Xu
- Department of Cardiology, Shaoxing People's HospitalZhejiang University School of MedicineShaoxing China
| | - Fang Peng
- Department of Cardiology, Shaoxing People's HospitalZhejiang University School of MedicineShaoxing China
| | - Yong Sun
- Department of Cardiology, Shaoxing People's HospitalZhejiang University School of MedicineShaoxing China
| | - Shengkai Wang
- Department of Cardiology, Shaoxing People's HospitalZhejiang University School of MedicineShaoxing China
| | - Hangyuan Guo
- Department of Cardiology, Shaoxing People's HospitalZhejiang University School of MedicineShaoxing China
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Matta M, Anselmino M, Ferraris F, Scaglione M, Gaita F. Cryoballoon vs. radiofrequency contact force ablation for paroxysmal atrial fibrillation. J Cardiovasc Med (Hagerstown) 2018; 19:141-147. [DOI: 10.2459/jcm.0000000000000633] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Desai Y, Levy MR, Iravanian S, Clermont EC, Kelli HM, Eisner RL, El-Chami MF, Leon AR, Delurgio DB, Merchant FM. Clinical and anatomic predictors of need for repeat atrial fibrillation ablation. World J Cardiol 2017; 9:742-748. [PMID: 29081907 PMCID: PMC5633538 DOI: 10.4330/wjc.v9.i9.742] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2017] [Revised: 03/14/2017] [Accepted: 07/17/2017] [Indexed: 02/06/2023] Open
Abstract
AIM To identify predictors of need for repeat procedures after initial atrial fibrillation (AF) ablation.
METHODS We identified a cohort undergoing first time AF ablation at our institution from January 2004 to February 2014 who had cardiac magnetic resonance (CMR) imaging performed prior to ablation. Clinical variables and anatomic characteristics (determined from CMR) were assessed as predictors of need for repeat ablation. The decision regarding need for and timing of repeat ablation was at the discretion of the treating physician.
RESULTS From a cohort of 331 patients, 142 patients (43%) underwent repeat ablation at a mean of 13.6 ± 18.4 mo after the index procedure. Both male gender (81% vs 71%, P = 0.05) and lower ejection fraction (57.4% ± 10.3% vs 59.8% ± 9.4%, P = 0.04) were associated with need for repeat ablation. On pre-ablation CMR, mean pulmonary vein (PV) diameters were significantly larger in all four PVs among patients requiring repeat procedures. In multivariate analysis, increased right superior PV diameter significantly predicted need for repeat ablation (odds ratio 1.08 per millimeter increase in diameter, 95%CI: 1.00-1.16, P = 0.05). There were also trends toward significance for increased left and right inferior PV sizes among those requiring repeat procedures.
CONCLUSION Increased PV size predicts the need for repeat AF ablation, with each millimeter increase in PV diameter associated with an approximately 5%-10% increased risk of requiring repeat procedures.
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Affiliation(s)
- Yaanik Desai
- Emory University School of Medicine, Atlanta, GA 30322, United States
| | - Mathew R Levy
- Cardiology Division, Department of Medicine, Emory University School of Medicine, Atlanta, GA 30322, United States
| | - Shahriar Iravanian
- Emory University School of Medicine, Atlanta, GA 30322, United States
- Cardiology Division, Department of Medicine, Emory University School of Medicine, Atlanta, GA 30322, United States
| | - Edward C Clermont
- Division of Cardiology, Department of Medicine, University of Pennsylvania, Philadelphia, PA 19104, United States
| | - Heval M Kelli
- Emory University School of Medicine, Atlanta, GA 30322, United States
- Cardiology Division, Department of Medicine, Emory University School of Medicine, Atlanta, GA 30322, United States
| | - Robert L Eisner
- Emory University School of Medicine, Atlanta, GA 30322, United States
- Department of Radiology, Emory University School of Medicine, Atlanta, GA 30322, United States
| | - Mikhael F El-Chami
- Emory University School of Medicine, Atlanta, GA 30322, United States
- Cardiology Division, Department of Medicine, Emory University School of Medicine, Atlanta, GA 30322, United States
| | - Angel R Leon
- Emory University School of Medicine, Atlanta, GA 30322, United States
- Cardiology Division, Department of Medicine, Emory University School of Medicine, Atlanta, GA 30322, United States
| | - David B Delurgio
- Emory University School of Medicine, Atlanta, GA 30322, United States
- Cardiology Division, Department of Medicine, Emory University School of Medicine, Atlanta, GA 30322, United States
| | - Faisal M Merchant
- Emory University School of Medicine, Atlanta, GA 30322, United States
- Cardiology Division, Department of Medicine, Emory University School of Medicine, Atlanta, GA 30322, United States
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