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Jaffery OA, Melki L, Slabaugh G, Good WW, Roney CH. A Review of Personalised Cardiac Computational Modelling Using Electroanatomical Mapping Data. Arrhythm Electrophysiol Rev 2024; 13:e08. [PMID: 38807744 PMCID: PMC11131150 DOI: 10.15420/aer.2023.25] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Accepted: 12/27/2023] [Indexed: 05/30/2024] Open
Abstract
Computational models of cardiac electrophysiology have gradually matured during the past few decades and are now being personalised to provide patient-specific therapy guidance for improving suboptimal treatment outcomes. The predictive features of these personalised electrophysiology models hold the promise of providing optimal treatment planning, which is currently limited in the clinic owing to reliance on a population-based or average patient approach. The generation of a personalised electrophysiology model entails a sequence of steps for which a range of activation mapping, calibration methods and therapy simulation pipelines have been suggested. However, the optimal methods that can potentially constitute a clinically relevant in silico treatment are still being investigated and face limitations, such as uncertainty of electroanatomical data recordings, generation and calibration of models within clinical timelines and requirements to validate or benchmark the recovered tissue parameters. This paper is aimed at reporting techniques on the personalisation of cardiac computational models, with a focus on calibrating cardiac tissue conductivity based on electroanatomical mapping data.
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Affiliation(s)
- Ovais A Jaffery
- School of Engineering and Materials Science, Queen Mary University of London London, UK
| | - Lea Melki
- R&D Algorithms, Acutus Medical Carlsbad, CA, US
| | - Gregory Slabaugh
- Digital Environment Research Institute, Queen Mary University of London London, UK
| | | | - Caroline H Roney
- School of Engineering and Materials Science, Queen Mary University of London London, UK
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Lin C, Nguyen A, Ling I, Partow-Navid R, Leung S, Zadeh A, Ho I, Zaman JA. SuperMap algorithm: an efficient, safe and accurate modality for mapping and eliminating challenging cardiac arrhythmias. Future Cardiol 2024; 20:45-53. [PMID: 38530866 DOI: 10.2217/fca-2023-0123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Accepted: 01/31/2024] [Indexed: 03/28/2024] Open
Abstract
Even with the development of advanced catheter-based mapping systems, there remain several challenges in the electrophysiological evaluation and elimination of atrial arrhythmias. For instance, atrial tachycardias with irregular rates cannot be reliably mapped by systems that require stability in order to sequentially gather data points to be organized thereafter. Separately, these arrhythmias often arise following initial ablation for atrial fibrillation, posing logistic challenges. Here, we present the available literature summarizing the use of a non-contact mapping catheter, the AcQMap catheter, in conjunction with SuperMap, an algorithm that compiles a large number of non-contact data points from multiple catheter positions within the atria. These studies demonstrate the efficiency, safety and accuracy of this technology.
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Affiliation(s)
- Charlie Lin
- Keck School of Medicine, University of Southern California, CA 90033, USA
| | - Andrew Nguyen
- Keck School of Medicine, University of Southern California, CA 90033, USA
| | - Ian Ling
- Keck School of Medicine, University of Southern California, CA 90033, USA
| | - Rod Partow-Navid
- Keck School of Medicine, University of Southern California, CA 90033, USA
| | - Steven Leung
- Keck School of Medicine, University of Southern California, CA 90033, USA
| | - Andrew Zadeh
- Keck School of Medicine, University of Southern California, CA 90033, USA
| | - Ivan Ho
- Keck School of Medicine, University of Southern California, CA 90033, USA
| | - Junaid Ab Zaman
- Keck School of Medicine, University of Southern California, CA 90033, USA
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Munoz FDC, Futyma P. Integration of new mapping tools into remote navigation systems: every journey begins with a single step. J Interv Card Electrophysiol 2023; 66:1965-1966. [PMID: 37303028 DOI: 10.1007/s10840-023-01587-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Accepted: 06/01/2023] [Indexed: 06/13/2023]
Affiliation(s)
| | - Piotr Futyma
- St. Joseph's Heart Rhythm Center, Rzeszów, Poland
- University of Rzeszów, Rzeszów, Poland
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Gagyi RB, Yap SC, Noten AME, Wijchers S, Szili-Torok T. The performance of dipole charge density mapping integrated with robotic magnetic navigation in the treatment of atrial tachycardias. J Interv Card Electrophysiol 2023; 66:2103-2111. [PMID: 37076739 PMCID: PMC10694103 DOI: 10.1007/s10840-023-01552-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Accepted: 04/14/2023] [Indexed: 04/21/2023]
Abstract
BACKGROUND Catheter ablation (CA) has become a well-established first-line therapy for a broad spectrum of arrhythmias, including atrial tachycardias (ATs). In this study we aimed to assess the performance of the integrated novel high-resolution new generation noncontact mapping system (AcQMap) with robotic magnetic navigation (RMN) system in CA procedures for patients with ATs including comparing patient subgroups based on the utilized mapping modality, arrhythmia mechanism, localization and type of procedure. METHODS All patients undergoing CA for AT using the AcQMap-RMN system were included. Procedural safety and efficacy were characterized by intra- and post-procedural complications. Acute procedural success and the long-term outcome were assessed in the overall group and in the subgroups. RESULTS A total number of 70 patients were referred for CA with atrial arrhythmias including 67 AT/AFL (mean age 57.1 ± 14.4 years), and 3 additional patients with inappropriate sinus tachycardia. Thirty-eight patients had de novo AT, 24 had post-PVI AT including 2 patients with perinodal AT, and 5 had post-MAZE AT. Two patients (2.9%) suffered post-procedural complications including 1 patient with groin hematoma and 1 patient with a transient ischemic attack. Acute success was achieved in 63/67 (94.0%) procedures. Thirteen patients (19.4%) had documented recurrence at the end of the 12-months follow-up period. The performance of AcQMap was equally good in focal vs. reentry mechanisms (p = 0.61, acute success), in the left and right atrium (p = 0.21). CONCLUSIONS AcQMap-RMN integration might improve success rates in CA of ATs with low number of complications.
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Affiliation(s)
- Rita B Gagyi
- Thoraxcenter, Department of Clinical Electrophysiology, Postbus 2040, 3000 CA Rotterdam, Molewaterplein 40, 3015 GD Rotterdam, Erasmus, MC, The Netherlands
| | - Sing-Chien Yap
- Thoraxcenter, Department of Clinical Electrophysiology, Postbus 2040, 3000 CA Rotterdam, Molewaterplein 40, 3015 GD Rotterdam, Erasmus, MC, The Netherlands
| | - Anna M E Noten
- Thoraxcenter, Department of Clinical Electrophysiology, Postbus 2040, 3000 CA Rotterdam, Molewaterplein 40, 3015 GD Rotterdam, Erasmus, MC, The Netherlands
| | - Sip Wijchers
- Thoraxcenter, Department of Clinical Electrophysiology, Postbus 2040, 3000 CA Rotterdam, Molewaterplein 40, 3015 GD Rotterdam, Erasmus, MC, The Netherlands
| | - Tamas Szili-Torok
- Thoraxcenter, Department of Clinical Electrophysiology, Postbus 2040, 3000 CA Rotterdam, Molewaterplein 40, 3015 GD Rotterdam, Erasmus, MC, The Netherlands.
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Pope MT, Betts TR. Global Substrate Mapping and Targeted Ablation with Novel Gold-tip Catheter in De Novo Persistent AF. Arrhythm Electrophysiol Rev 2022; 11:e06. [PMID: 35755327 PMCID: PMC9204651 DOI: 10.15420/aer.2021.64] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Accepted: 02/14/2022] [Indexed: 11/04/2022] Open
Abstract
Results from catheter ablation for persistent AF are suboptimal, with no strategy other than pulmonary vein isolation showing clear benefit. Recently employed empirical strategies beyond pulmonary vein isolation involve widespread atrial ablation in all patients and do not take into account patient-specific differences in AF mechanisms or phenotype. Charge density mapping using the non-contact AcQMap system (Acutus Medical) allows visualisation of whole-chamber activation during AF and reveals localised patterns of complex activation thought to represent important mechanisms for AF maintenance that can be targeted with focal ablation. In this review, the authors outline the fundamentals of this technology, the initial data exploring the mechanistic role of activation patterns seen and the application to ablation of persistent AF.
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Affiliation(s)
- Michael Tb Pope
- Department of Cardiology, Oxford University Hospitals NHS Foundation Trust, Oxford, UK.,Department for Human Development and Health, University of Southampton, Southampton, UK
| | - Timothy R Betts
- Department of Cardiology, Oxford University Hospitals NHS Foundation Trust, Oxford, UK.,University of Oxford Biomedical Research Centre, Oxford, UK
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Ramirez FD, Winterfield JR, Shi X, Chou D, Robinson D, Angel N, Shah P, Sorrell T, Ghafoori E, Vanderper A, Mariappan L, Soré B, Peyrat JM, Loyer V, Nakatani Y, Cochet H, Jaïs P. Non-contact whole-chamber charge density mapping of the left ventricle: preclinical evaluation in a sheep model. Heart Rhythm 2022; 19:828-836. [PMID: 35032670 DOI: 10.1016/j.hrthm.2022.01.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Revised: 01/06/2022] [Accepted: 01/07/2022] [Indexed: 11/19/2022]
Abstract
BACKGROUND Conventional contact-based electroanatomic mapping is poorly suited for rapid or dynamic ventricular arrhythmias. Whole-chamber charge density (CD) mapping could efficiently characterize complex ventricular tachyarrhythmias and yield insights into their underlying mechanisms. OBJECTIVE This study sought to evaluate the feasibility and accuracy of non-contact whole-chamber left ventricular (LV) CD mapping, and to characterize CD activation patterns during sinus rhythm, ventricular pacing, and ventricular fibrillation (VF). METHODS Ischemic scar as defined by CD amplitude thresholds was compared to late gadolinium enhancement criteria on magnetic resonance imaging using an iterative closest point algorithm. Electrograms recorded at sites of tissue contact were compared to the nearest non-contact CD-derived electrograms to calculate signal morphology cross-correlations and time differences. Regions of consistently slow conduction were examined relative to areas of scar and to localized irregular activation (LIA) during VF. RESULTS Areas under receiver operating characteristic curves (AUCs) of CD-defined dense and total LV scar were 0.92 ± 0.03 and 0.87 ± 0.06, with accuracies of 0.86±0.03 and 0.80±0.05, respectively. Morphology cross-correlation between 8,677 contact and corresponding non-contact electrograms was 0.93±0.10, with a mean time difference of 2.5±5.6 msec. Areas of consistently slow conduction tended to occur at scar borders and exhibited spatial agreement with LIA during VF (AUC 0.90±0.02). CONCLUSION Non-contact LV CD mapping can accurately delineate ischemic scar. CD-derived ventricular electrograms correlate strongly with conventional contact-based electrograms. Regions with consistently slow conduction are often at scar borders and tend to harbor LIA during VF.
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Affiliation(s)
- F Daniel Ramirez
- Electrophysiology and Heart Modelling Institute (LIRYC), Bordeaux-Pessac, France; Department of Electrophysiology and Cardiac Stimulation, Centre Hospitalier Universitaire de Bordeaux, Bordeaux-Pessac, France; Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario Canada
| | - Jeffrey R Winterfield
- Division of Cardiology, Medical University of South Carolina, Charleston, South Carolina
| | | | | | - Dave Robinson
- Acutus Medical, Carlsbad, California; inHEART, Bordeaux-Pessac, France
| | | | | | | | | | | | | | | | | | - Virginie Loyer
- Electrophysiology and Heart Modelling Institute (LIRYC), Bordeaux-Pessac, France
| | - Yosuke Nakatani
- Electrophysiology and Heart Modelling Institute (LIRYC), Bordeaux-Pessac, France; Department of Electrophysiology and Cardiac Stimulation, Centre Hospitalier Universitaire de Bordeaux, Bordeaux-Pessac, France
| | - Hubert Cochet
- Electrophysiology and Heart Modelling Institute (LIRYC), Bordeaux-Pessac, France; Department of Electrophysiology and Cardiac Stimulation, Centre Hospitalier Universitaire de Bordeaux, Bordeaux-Pessac, France; inHEART, Bordeaux-Pessac, France
| | - Pierre Jaïs
- Electrophysiology and Heart Modelling Institute (LIRYC), Bordeaux-Pessac, France; Department of Electrophysiology and Cardiac Stimulation, Centre Hospitalier Universitaire de Bordeaux, Bordeaux-Pessac, France; inHEART, Bordeaux-Pessac, France.
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