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Zuhair M, Keene D, Kanagaratnam P, Lim PB. Percutaneous Neuromodulation for Atrial Fibrillation. Card Electrophysiol Clin 2024; 16:281-296. [PMID: 39084721 DOI: 10.1016/j.ccep.2023.09.001] [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] [Indexed: 08/02/2024]
Abstract
Percutaneous neuromodulation is emerging as a promising therapeutic approach for atrial fibrillation (AF). This article explores techniques such as ganglionated plexi (GP) ablation, and vagus nerve stimulation, pinpointing their potential in modulating AF triggers and maintenance. Noninvasive methods, such as transcutaneous low-level tragus stimulation, offer innovative treatment pathways, with early trials indicating a significant reduction in AF burden. GP ablation may address autonomic triggers, and the potential for GP ablation in neuromodulation is discussed. The article stresses the necessity for more rigorous clinical trials to validate the safety, reproducibility, and efficacy of these neuromodulation techniques in AF treatment.
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Affiliation(s)
- Mohamed Zuhair
- National Heart and Lung Institute, Imperial College London, Du Cane Road, London W12, UK.
| | - Daniel Keene
- National Heart and Lung Institute, Imperial College London, Du Cane Road, London W12, UK
| | - Prapa Kanagaratnam
- National Heart and Lung Institute, Imperial College London, Du Cane Road, London W12, UK
| | - Phang Boon Lim
- National Heart and Lung Institute, Imperial College London, Du Cane Road, London W12, UK
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Coyle C, Koutsoftidis S, Kim MY, Porter B, Keene D, Luther V, Handa B, Kay J, Lim E, Malcolme-Lawes L, Koa-Wing M, Lim PB, Whinnett ZI, Ng FS, Qureshi N, Peters NS, Linton NWF, Drakakis E, Kanagaratnam P. Feasibility of mapping and ablating ectopy-triggering ganglionated plexus reproducibly in persistent atrial fibrillation. J Interv Card Electrophysiol 2023:10.1007/s10840-023-01517-9. [PMID: 36867371 DOI: 10.1007/s10840-023-01517-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2022] [Accepted: 02/19/2023] [Indexed: 03/04/2023]
Abstract
BACKGROUND Ablation of autonomic ectopy-triggering ganglionated plexuses (ET-GP) has been used to treat paroxysmal atrial fibrillation (AF). It is not known if ET-GP localisation is reproducible between different stimulators or whether ET-GP can be mapped and ablated in persistent AF. We tested the reproducibility of the left atrial ET-GP location using different high-frequency high-output stimulators in AF. In addition, we tested the feasibility of identifying ET-GP locations in persistent atrial fibrillation. METHODS Nine patients undergoing clinically-indicated paroxysmal AF ablation received pacing-synchronised high-frequency stimulation (HFS), delivered in SR during the left atrial refractory period, to compare ET-GP localisation between a custom-built current-controlled stimulator (Tau20) and a voltage-controlled stimulator (Grass S88, SIU5). Two patients with persistent AF underwent cardioversion, left atrial ET-GP mapping with the Tau20 and ablation (Precision™, Tacticath™ [n = 1] or Carto™, SmartTouch™ [n = 1]). Pulmonary vein isolation (PVI) was not performed. Efficacy of ablation at ET-GP sites alone without PVI was assessed at 1 year. RESULTS The mean output to identify ET-GP was 34 mA (n = 5). Reproducibility of response to synchronised HFS was 100% (Tau20 vs Grass S88; [n = 16] [kappa = 1, SE = 0.00, 95% CI 1 to 1)][Tau20 v Tau20; [n = 13] [kappa = 1, SE = 0, 95% CI 1 to 1]). Two patients with persistent AF had 10 and 7 ET-GP sites identified requiring 6 and 3 min of radiofrequency ablation respectively to abolish ET-GP response. Both patients were free from AF for > 365 days without anti-arrhythmics. CONCLUSIONS ET-GP sites are identified at the same location by different stimulators. ET-GP ablation alone was able to prevent AF recurrence in persistent AF, and further studies would be warranted.
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Affiliation(s)
- Clare Coyle
- NHLI, Imperial College London, London, UK
- Imperial Centre for Cardiac Engineering, Imperial College London, London, UK
- Department of Cardiology, Hammersmith Hospital, Du Cane Road, London, W12 0HS, UK
| | | | - Min-Young Kim
- NHLI, Imperial College London, London, UK
- Imperial Centre for Cardiac Engineering, Imperial College London, London, UK
- Department of Cardiology, Hammersmith Hospital, Du Cane Road, London, W12 0HS, UK
| | - Bradley Porter
- Department of Cardiology, Hammersmith Hospital, Du Cane Road, London, W12 0HS, UK
| | - Daniel Keene
- Department of Cardiology, Hammersmith Hospital, Du Cane Road, London, W12 0HS, UK
| | - Vishal Luther
- Department of Cardiology, Hammersmith Hospital, Du Cane Road, London, W12 0HS, UK
| | - Balvinder Handa
- Department of Cardiology, Hammersmith Hospital, Du Cane Road, London, W12 0HS, UK
| | - Jamie Kay
- NHLI, Imperial College London, London, UK
| | - Elaine Lim
- Department of Cardiology, Hammersmith Hospital, Du Cane Road, London, W12 0HS, UK
| | | | - Michael Koa-Wing
- Department of Cardiology, Hammersmith Hospital, Du Cane Road, London, W12 0HS, UK
| | - Phang Boon Lim
- NHLI, Imperial College London, London, UK
- Imperial Centre for Cardiac Engineering, Imperial College London, London, UK
- Department of Cardiology, Hammersmith Hospital, Du Cane Road, London, W12 0HS, UK
| | - Zachary I Whinnett
- NHLI, Imperial College London, London, UK
- Imperial Centre for Cardiac Engineering, Imperial College London, London, UK
- Department of Cardiology, Hammersmith Hospital, Du Cane Road, London, W12 0HS, UK
| | - Fu Siong Ng
- NHLI, Imperial College London, London, UK
- Imperial Centre for Cardiac Engineering, Imperial College London, London, UK
- Department of Cardiology, Hammersmith Hospital, Du Cane Road, London, W12 0HS, UK
| | - Norman Qureshi
- NHLI, Imperial College London, London, UK
- Imperial Centre for Cardiac Engineering, Imperial College London, London, UK
- Department of Cardiology, Hammersmith Hospital, Du Cane Road, London, W12 0HS, UK
| | - Nicholas S Peters
- NHLI, Imperial College London, London, UK
- Imperial Centre for Cardiac Engineering, Imperial College London, London, UK
- Department of Cardiology, Hammersmith Hospital, Du Cane Road, London, W12 0HS, UK
| | - Nicholas W F Linton
- NHLI, Imperial College London, London, UK
- Imperial Centre for Cardiac Engineering, Imperial College London, London, UK
- Department of Cardiology, Hammersmith Hospital, Du Cane Road, London, W12 0HS, UK
- Department of Bioengineering, Imperial College London, London, UK
| | | | - Prapa Kanagaratnam
- NHLI, Imperial College London, London, UK.
- Imperial Centre for Cardiac Engineering, Imperial College London, London, UK.
- Department of Cardiology, Hammersmith Hospital, Du Cane Road, London, W12 0HS, UK.
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Rackley J, Nudy M, Gonzalez MD, Naccarelli G, Maheshwari A. Pulmonary vein isolation with adjunctive left atrial ganglionic plexus ablation for treatment of atrial fibrillation: a meta-analysis of randomized controlled trials. J Interv Card Electrophysiol 2023; 66:333-342. [PMID: 35419670 DOI: 10.1007/s10840-022-01212-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Accepted: 03/29/2022] [Indexed: 11/26/2022]
Abstract
BACKGROUND Adjunctive ganglionic plexus (GP) ablation may increase the efficacy of pulmonary vein isolation (PVI) for treatment of atrial fibrillation (AF). Prior meta-analyses examining PVI with adjunctive GP ablation have included non-randomized trials and have included trials evaluating thorascopic epicardial ablation. The objective of this study is to perform a meta-analysis of randomized controlled trials (RCTs) comparing endocardial catheter-based PVI to PVI with adjunctive GP ablation. METHODS Summary odds ratio (OR) and 95% confidence intervals (CIs) were calculated. Heterogeneity was assessed with I2 values. Sub-group analysis was performed comparing arrhythmia recurrence between patients with paroxysmal versus persistent AF at trial baseline. Meta-regressions were performed with mean left atrial diameter and left ventricular ejection fraction at trial baseline as the moderator variables. RESULTS Five RCTs were identified including 814 patients: 406 PVI + GP ablation and 408 PVI alone. The mean age of participants was 56.5 years and 74.7% were male. Four of these trials evaluated catheter-based endocardial ablation for a total of 574 patients: 289 PVI + GP ablation and 285 PVI alone. The odds of arrhythmia recurrence in patients undergoing adjunctive GP ablation with PVI compared with PVI alone were a reduced: odds ratio (OR) 0.58, 95% confidence interval (CI) 0.41-0.82, I2 = 40.2%. In the subgroup analysis, the odds of arrhythmia recurrence with adjunctive GP ablation were reduced in those with paroxysmal AF (OR 0.396, 95% CI 0.23-0.69, I2 = 0%). A non-significant trend to reduced arrhythmia recurrence was also observed in those with persistent AF (OR 0.726, 95% CI 0.475-1.112, I2 = 0%). When performing the meta-regression, increased left atrial diameter was associated with decreased treatment effect of adjunctive GP ablation (R2 index = 1.0, I2 = 0%). CONCLUSIONS The addition of GP ablation to PVI was associated with reduced arrhythmia recurrence. Adjunctive GP ablation was more effective in paroxysmal AF and in patients with smaller atria. Larger RCTs are needed to confirm the efficacy of GP + PVI ablation.
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Affiliation(s)
- Justin Rackley
- Heart and Vascular Institute, Division of Cardiology, Penn State College of Medicine, 500 University Drive, Hershey, PA, 17033, USA
| | - Matthew Nudy
- Heart and Vascular Institute, Division of Cardiology, Penn State College of Medicine, 500 University Drive, Hershey, PA, 17033, USA
| | - Mario D Gonzalez
- Heart and Vascular Institute, Division of Cardiology, Penn State College of Medicine, 500 University Drive, Hershey, PA, 17033, USA
| | - Gerald Naccarelli
- Heart and Vascular Institute, Division of Cardiology, Penn State College of Medicine, 500 University Drive, Hershey, PA, 17033, USA
| | - Ankit Maheshwari
- Heart and Vascular Institute, Division of Cardiology, Penn State College of Medicine, 500 University Drive, Hershey, PA, 17033, USA.
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De Innocentiis C, Astore P, Giannantonio M, Ienco V, Santamaria M. Multivessel coronary spasm triggered by ganglionated plexi stimulation during atrial fibrillation radiofrequency catheter ablation: a case report. Eur Heart J Case Rep 2023; 7:ytad007. [PMID: 36845832 PMCID: PMC9949709 DOI: 10.1093/ehjcr/ytad007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2022] [Revised: 08/11/2022] [Accepted: 01/04/2023] [Indexed: 01/11/2023]
Abstract
Background Atrial fibrillation (AF) is the most common sustained cardiac arrhythmia in adults, and it is associated with a high burden of mortality and morbidity worldwide. AF can be managed with rate-control or rhythm-control strategies. The latter is increasingly used to improve symptoms and prognosis in selected patients, especially after the development of catheter ablation. Although this technique is generally considered safe, it is not free from rare but life-threatening procedure-related adverse events. Among these, coronary artery spasm (CAS) is an uncommon but potentially fatal complication that requires immediate diagnosis and treatment. Case summary We report a case of severe multivessel CAS triggered by ganglionated plexi stimulation during pulmonary vein isolation with radiofrequency catheter ablation in a patient with persistent AF, promptly resolved after intracoronary nitrate administration. Discussion Although rare, CAS is a serious complication of AF catheter ablation. Immediate invasive coronary angiography is key for both diagnosis confirmation and treatment of such dangerous condition. As the number of invasive procedures increases, it is important that both interventional and general cardiologists are aware of possible procedure-related adverse events.
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Affiliation(s)
- Carlo De Innocentiis
- Arrhythmology and Electrophysiology Unit, Gemelli Molise Hospital, Largo Agostino Gemelli, 1, 86100 Campobasso (CB), Italy
| | - Pasquale Astore
- Arrhythmology and Electrophysiology Unit, Gemelli Molise Hospital, Largo Agostino Gemelli, 1, 86100 Campobasso (CB), Italy
| | - Maria Giannantonio
- Anesthesiology and Intensive Care Unit, Gemelli Molise Hospital, Largo Agostino Gemelli, 1, 86100 Campobasso (CB), Italy
| | - Vincenzo Ienco
- Interventional Cardiology Unit, Gemelli Molise Hospital, Largo Agostino Gemelli, 1, 86100 Campobasso (CB), Italy
| | - Matteo Santamaria
- Arrhythmology and Electrophysiology Unit, Gemelli Molise Hospital, Largo Agostino Gemelli, 1, 86100 Campobasso (CB), Italy
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Aksu T, Skeete JR, Huang HH. Ganglionic Plexus Ablation: A Step-by-step Guide for Electrophysiologists and Review of Modalities for Neuromodulation for the Management of Atrial Fibrillation. Arrhythm Electrophysiol Rev 2023; 12:e02. [PMID: 36845167 PMCID: PMC9945432 DOI: 10.15420/aer.2022.37] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Accepted: 11/29/2022] [Indexed: 02/01/2023] Open
Abstract
As the most common sustained arrhythmia, AF is a complex clinical entity which remains a difficult condition to durably treat in the majority of patients. Over the past few decades, the management of AF has focused mainly on pulmonary vein triggers for its initiation and perpetuation. It is well known that the autonomic nervous system (ANS) has a significant role in the milieu predisposing to the triggers, perpetuators and substrate for AF. Neuromodulation of ANS - ganglionated plexus ablation, vein of Marshall ethanol infusion, transcutaneous tragal stimulation, renal nerve denervation, stellate ganglion block and baroreceptor stimulation - constitute an emerging therapeutic approach for AF. The purpose of this review is to summarise and critically appraise the currently available evidence for neuromodulation modalities in AF.
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Affiliation(s)
- Tolga Aksu
- Department of Cardiology, Yeditepe University Hospital, Istanbul, Turkey
| | | | - Henry H Huang
- Department of Cardiology, Rush Medical College, Chicago, IL, US
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Markman TM, Khoshknab M, Santangeli P, Marchlinski FE, Nazarian S. Feasibility of Computed Tomography-Guided Cardioneuroablation for Atrial Fibrillation. JACC Clin Electrophysiol 2022; 8:1449-1450. [PMID: 35907756 DOI: 10.1016/j.jacep.2022.06.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2022] [Revised: 05/19/2022] [Accepted: 06/06/2022] [Indexed: 12/24/2022]
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Stojadinović P, Wichterle D, Peichl P, Nakagawa H, Čihák R, Hašková J, Kautzner J. Autonomic Changes Are More Durable After Radiofrequency Than Pulsed Electric Field Pulmonary Vein Ablation. JACC Clin Electrophysiol 2022; 8:895-904. [PMID: 35863816 DOI: 10.1016/j.jacep.2022.04.017] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2021] [Revised: 03/28/2022] [Accepted: 04/24/2022] [Indexed: 10/17/2022]
Abstract
BACKGROUND Pulmonary vein isolation (PVI) by radiofrequency (RF) energy is associated with a collateral ganglionated plexi ablation. Pulsed electric field (PEF) is a nonthermal energy source that preferentially affects the myocardial cells and spares neural tissue. OBJECTIVES This study investigated whether PVI by a PEF compared with RF energy will result in less prominent alteration of the cardiac autonomic nervous system. METHODS A total of 31 patients with atrial fibrillation underwent PVI using a novel lattice-tip catheter and PEF energy (n = 18) or a conventional irrigated-tip catheter and RF energy (n = 13). The response of the sinoatrial node and atrioventricular node to extracardiac high-frequency, high-output, right vagal nerve stimulation was evaluated at baseline and during and at the end of the ablation procedure. Substantial reduction in responsiveness was arbitrarily defined as stimulation-inducible pause <1.5 seconds. RESULTS Reduced response of the sinoatrial node was documented in 13 of 13 (100%) and 6 of 18 (33%) patients (P = 0.0001) in RF and PEF groups, respectively. Reduced response of the atrioventricular node was found in 10 of 11 (93%) and 6 of 18 (33%) patients (P = 0.002) in RF and PEF groups, respectively. The major effects were observed predominantly during ablation around the right pulmonary veins. Early recovery of ganglionated plexi function was noticed only in the PEF ablation group. RF ablation resulted in higher acceleration of the sinus rhythm compared with PEF ablation (20 ± 13 beats/min vs 12 ± 10 beats/min; P = 0.04). CONCLUSIONS PEF compared with RF energy used for PVI induces significantly weaker and less durable suppression of cardiac autonomic regulations.
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Affiliation(s)
| | - Dan Wichterle
- Institute for Clinical and Experimental Medicine, Prague, Czech Republic
| | - Petr Peichl
- Institute for Clinical and Experimental Medicine, Prague, Czech Republic
| | - Hiroshi Nakagawa
- Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio, USA
| | - Robert Čihák
- Institute for Clinical and Experimental Medicine, Prague, Czech Republic
| | - Jana Hašková
- Institute for Clinical and Experimental Medicine, Prague, Czech Republic
| | - Josef Kautzner
- Institute for Clinical and Experimental Medicine, Prague, Czech Republic
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8
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Kim MY, Coyle C, Tomlinson DR, Sikkel MB, Sohaib A, Luther V, Leong KM, Malcolme-Lawes L, Low B, Sandler B, Lim E, Todd M, Fudge M, Wright IJ, Koa-Wing M, Ng FS, Qureshi NA, Whinnett ZI, Peters NS, Newcomb D, Wood C, Dhillon G, Hunter RJ, Lim PB, Linton NWF, Kanagaratnam P. Ectopy-triggering ganglionated plexuses ablation to prevent atrial fibrillation: GANGLIA-AF study. Heart Rhythm 2022; 19:516-524. [PMID: 34915187 PMCID: PMC8976158 DOI: 10.1016/j.hrthm.2021.12.010] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2021] [Revised: 11/30/2021] [Accepted: 12/01/2021] [Indexed: 01/26/2023]
Abstract
BACKGROUND The ganglionated plexuses (GPs) of the intrinsic cardiac autonomic system may play a role in atrial fibrillation (AF). OBJECTIVE We hypothesized that ablating the ectopy-triggering GPs (ET-GPs) prevents AF. METHODS GANGLIA-AF (ClinicalTrials.gov identifier NCT02487654) was a prospective, randomized, controlled, 3-center trial. ET-GPs were mapped using high frequency stimulation, delivered within the atrial refractory period and ablated until nonfunctional. If triggered AF became incessant, atrioventricular dissociating GPs were ablated. We compared GP ablation (GPA) without pulmonary vein isolation (PVI) against PVI in patients with paroxysmal AF. Follow-up was for 12 months including 3-monthly 48-hour Holter monitors. The primary end point was documented ≥30 seconds of atrial arrhythmia after a 3-month blanking period. RESULTS A total of 102 randomized patients were analyzed on a per-protocol basis after GPA (n = 52; 51%) or PVI (n = 50; 49%). Patients who underwent GPA had 89 ± 26 high frequency stimulation sites tested, identifying a median of 18.5% (interquartile range 16%-21%) of GPs. The radiofrequency ablation time was 22.9 ± 9.8 minutes in GPA and 38 ± 14.4 minutes in PVI (P < .0001). The freedom from ≥30 seconds of atrial arrhythmia at 12-month follow-up was 50% (26 of 52) with GPA vs 64% (32 of 50) with PVI (log-rank, P = .09). ET-GPA without atrioventricular dissociating GPA achieved 58% (22 of 38) freedom from the primary end point. There was a significantly higher reduction in antiarrhythmic drug usage postablation after GPA than after PVI (55.5% vs 36%; P = .05). Patients were referred for redo ablation procedures in 31% (16 of 52) after GPA and 24% (12 of 50) after PVI (P = .53). CONCLUSION GPA did not prevent atrial arrhythmias more than PVI. However, less radiofrequency ablation was delivered to achieve a higher reduction in antiarrhythmic drug usage with GPA than with PVI.
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Affiliation(s)
- Min-Young Kim
- Myocardial Function Section, National Heart and Lung Institute, Imperial College London, London, United Kingdom; Cardiology Department, Hammersmith Hospital, Imperial College Healthcare NHS Trust, London, United Kingdom; Imperial Centre for Cardiac Engineering, Imperial College London, London, United Kingdom
| | - Clare Coyle
- Myocardial Function Section, National Heart and Lung Institute, Imperial College London, London, United Kingdom; Cardiology Department, Hammersmith Hospital, Imperial College Healthcare NHS Trust, London, United Kingdom; Imperial Centre for Cardiac Engineering, Imperial College London, London, United Kingdom
| | - David R Tomlinson
- Cardiology Department, Derriford Hospital, University Hospitals Plymouth NHS Trust, Plymouth, United Kingdom
| | - Markus B Sikkel
- Myocardial Function Section, National Heart and Lung Institute, Imperial College London, London, United Kingdom
| | - Afzal Sohaib
- Cardiology Department, St Bartholomew's Hospital, Barts Health NHS Trust, London, United Kingdom
| | - Vishal Luther
- Cardiology Department, Hammersmith Hospital, Imperial College Healthcare NHS Trust, London, United Kingdom
| | - Kevin M Leong
- Cardiology Department, Hammersmith Hospital, Imperial College Healthcare NHS Trust, London, United Kingdom
| | - Louisa Malcolme-Lawes
- Cardiology Department, Hammersmith Hospital, Imperial College Healthcare NHS Trust, London, United Kingdom
| | - Benjamin Low
- Cardiology Department, Hammersmith Hospital, Imperial College Healthcare NHS Trust, London, United Kingdom
| | - Belinda Sandler
- Myocardial Function Section, National Heart and Lung Institute, Imperial College London, London, United Kingdom
| | - Elaine Lim
- Cardiology Department, Hammersmith Hospital, Imperial College Healthcare NHS Trust, London, United Kingdom
| | - Michelle Todd
- Cardiology Department, Hammersmith Hospital, Imperial College Healthcare NHS Trust, London, United Kingdom
| | - Michael Fudge
- Cardiology Department, Hammersmith Hospital, Imperial College Healthcare NHS Trust, London, United Kingdom
| | - Ian J Wright
- Cardiology Department, Hammersmith Hospital, Imperial College Healthcare NHS Trust, London, United Kingdom
| | - Michael Koa-Wing
- Cardiology Department, Hammersmith Hospital, Imperial College Healthcare NHS Trust, London, United Kingdom
| | - Fu Siong Ng
- Cardiology Department, Hammersmith Hospital, Imperial College Healthcare NHS Trust, London, United Kingdom
| | - Norman A Qureshi
- Cardiology Department, Hammersmith Hospital, Imperial College Healthcare NHS Trust, London, United Kingdom
| | - Zachary I Whinnett
- Cardiology Department, Hammersmith Hospital, Imperial College Healthcare NHS Trust, London, United Kingdom
| | - Nicholas S Peters
- Myocardial Function Section, National Heart and Lung Institute, Imperial College London, London, United Kingdom; Cardiology Department, Hammersmith Hospital, Imperial College Healthcare NHS Trust, London, United Kingdom; Imperial Centre for Cardiac Engineering, Imperial College London, London, United Kingdom
| | - Daniel Newcomb
- Cardiology Department, Derriford Hospital, University Hospitals Plymouth NHS Trust, Plymouth, United Kingdom
| | - Cherith Wood
- Cardiology Department, Derriford Hospital, University Hospitals Plymouth NHS Trust, Plymouth, United Kingdom
| | - Gurpreet Dhillon
- Cardiology Department, St Bartholomew's Hospital, Barts Health NHS Trust, London, United Kingdom
| | - Ross J Hunter
- Cardiology Department, St Bartholomew's Hospital, Barts Health NHS Trust, London, United Kingdom
| | - Phang Boon Lim
- Cardiology Department, Hammersmith Hospital, Imperial College Healthcare NHS Trust, London, United Kingdom
| | - Nicholas W F Linton
- Cardiology Department, Hammersmith Hospital, Imperial College Healthcare NHS Trust, London, United Kingdom; Imperial Centre for Cardiac Engineering, Imperial College London, London, United Kingdom; Department of Bioengineering, Imperial College London, London, United Kingdom
| | - Prapa Kanagaratnam
- Myocardial Function Section, National Heart and Lung Institute, Imperial College London, London, United Kingdom; Cardiology Department, Hammersmith Hospital, Imperial College Healthcare NHS Trust, London, United Kingdom; Imperial Centre for Cardiac Engineering, Imperial College London, London, United Kingdom.
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9
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Morita N, Iida T, Nanao T, Ushijima A, Ueno A, Ikari Y, Kobayashi Y. Effect of ganglionated plexi ablation by high-density mapping on long-term suppression of paroxysmal atrial fibrillation - The first clinical survey on ablation of the dorsal right plexusus. Heart Rhythm O2 2021; 2:480-488. [PMID: 34667963 PMCID: PMC8505203 DOI: 10.1016/j.hroo.2021.07.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
Abstract
Background Long-term outcomes of suppressing paroxysmal atrial fibrillation (PAF) with additive ganglionated plexus (GP) ablation (GPA) remains unknown. Objectives The aim of the study is to assess potential role of additional GPA for PAF suppression. Methods This study consisted of 225 patients; 68 (group A: 58 male, aged 60 ± 11 years) underwent pulmonary vein isolation (PVI) alone and 157 (group B: 137 male, aged 61 ± 11 years) GPA followed by PVI. GPA was performed based on the high-density mapping with high-frequency stimulation (HFS) delivered to left atrial (LA) major GP. The latter 85 group B patients (54%) underwent ablation to a posteromedial area within superior vena cava as a part of dorsal right atrial GP (SVC-Ao GP). Results In group B, HFS was applied to 126 ± 32 sites, with a median of 47 GP sites (40.0%) being ablated. In patients undergoing an SVC-Ao GPA, HFS and the SVC-Ao GPA were applied at a median of 15 and 4 sites (29.4%), respectively. The PVI with a GPA provided higher PAF suppression than a PVI alone during more than 4 years of follow-up (56.7% vs 38.2%, odds ratio: 0.42, 95% confidence interval: 0.23-0.76, P < .05), but the SVC-Ao GPA did not provide further suppressive effects. Multivariate analyses revealed that tachycardia-bradycardia syndrome and non-PV foci were independent predictors of PAF recurrence after PVI with a GPA (P < .01). Conclusion GPA to LA major GP by high-density mapping provides long-term benefits for PAF suppression over 4 years of follow-up, but the effect of an empiric SVC-Ao GPA could not be appreciated, suggesting little effect on suppressing non-PV foci.
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Affiliation(s)
- Norishige Morita
- Division of Cardiology, Department of Medicine, Tokai University Hachioji Hospital, Tokyo, Japan
| | - Takayuki Iida
- Division of Cardiology, Department of Medicine, Tokai University Hachioji Hospital, Tokyo, Japan
| | - Tomihisa Nanao
- Division of Cardiology, Department of Medicine, Tokai University Hachioji Hospital, Tokyo, Japan
| | - Akiko Ushijima
- Division of Cardiology, Department of Medicine, Tokai University Hachioji Hospital, Tokyo, Japan
| | - Akira Ueno
- Division of Cardiology, Department of Medicine, Tokai University Hachioji Hospital, Tokyo, Japan
| | - Yuji Ikari
- Division of Cardiology, Department of Medicine, Tokai University Hospital, Kanagawa, Japan
| | - Yoshinori Kobayashi
- Division of Cardiology, Department of Medicine, Tokai University Hachioji Hospital, Tokyo, Japan
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10
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Hanna P, Buch E, Stavrakis S, Meyer C, Tompkins JD, Ardell JL, Shivkumar K. Neuroscientific therapies for atrial fibrillation. Cardiovasc Res 2021; 117:1732-1745. [PMID: 33989382 PMCID: PMC8208752 DOI: 10.1093/cvr/cvab172] [Citation(s) in RCA: 34] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Accepted: 05/13/2021] [Indexed: 02/06/2023] Open
Abstract
The cardiac autonomic nervous system (ANS) plays an integral role in normal cardiac physiology as well as in disease states that cause cardiac arrhythmias. The cardiac ANS, comprised of a complex neural hierarchy in a nested series of interacting feedback loops, regulates atrial electrophysiology and is itself susceptible to remodelling by atrial rhythm. In light of the challenges of treating atrial fibrillation (AF) with conventional pharmacologic and myoablative techniques, increasingly interest has begun to focus on targeting the cardiac neuraxis for AF. Strong evidence from animal models and clinical patients demonstrates that parasympathetic and sympathetic activity within this neuraxis may trigger AF, and the ANS may either induce atrial remodelling or undergo remodelling itself to serve as a substrate for AF. Multiple nexus points within the cardiac neuraxis are therapeutic targets, and neuroablative and neuromodulatory therapies for AF include ganglionated plexus ablation, epicardial botulinum toxin injection, vagal nerve (tragus) stimulation, renal denervation, stellate ganglion block/resection, baroreceptor activation therapy, and spinal cord stimulation. Pre-clinical and clinical studies on these modalities have had promising results and are reviewed here.
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Affiliation(s)
- Peter Hanna
- University of California Los Angeles (UCLA) Cardiac Arrhythmia Center, David Geffen School of Medicine, UCLA, 100 Medical Plaza, Suite 660, Los Angeles, CA 90095, USA
- Neurocardiology Research Program of Excellence, David Geffen School of Medicine, UCLA, 100 Medical Plaza, Suite 660, Los Angeles, CA 90095, USA
- Molecular, Cellular & Integrative Physiology Program, David Geffen School of Medicine, UCLA, 100 Medical Plaza, Suite 660, Los Angeles, CA 90095, USA
| | - Eric Buch
- University of California Los Angeles (UCLA) Cardiac Arrhythmia Center, David Geffen School of Medicine, UCLA, 100 Medical Plaza, Suite 660, Los Angeles, CA 90095, USA
| | - Stavros Stavrakis
- Heart Rhythm Institute, University of Oklahoma Health Sciences Center, 1100 N Lindsay Ave, Oklahoma City, OK 73104, USA
| | - Christian Meyer
- Division of Cardiology, cardiac Neuro- and Electrophysiology Research Consortium (cNEP), EVK Düsseldorf, Teaching Hospital University of Düsseldorf, Kirchfeldstraße 40, 40217 Düsseldorf, Germany
- Institute of Neural and Sensory Physiology, cardiac Neuro- and Electrophysiology Research Consortium (cNEP), University of Düsseldorf, Universitätsstraße 1, 40225 Düsseldorf, Germany
| | - John D Tompkins
- University of California Los Angeles (UCLA) Cardiac Arrhythmia Center, David Geffen School of Medicine, UCLA, 100 Medical Plaza, Suite 660, Los Angeles, CA 90095, USA
- Neurocardiology Research Program of Excellence, David Geffen School of Medicine, UCLA, 100 Medical Plaza, Suite 660, Los Angeles, CA 90095, USA
| | - Jeffrey L Ardell
- University of California Los Angeles (UCLA) Cardiac Arrhythmia Center, David Geffen School of Medicine, UCLA, 100 Medical Plaza, Suite 660, Los Angeles, CA 90095, USA
- Neurocardiology Research Program of Excellence, David Geffen School of Medicine, UCLA, 100 Medical Plaza, Suite 660, Los Angeles, CA 90095, USA
- Molecular, Cellular & Integrative Physiology Program, David Geffen School of Medicine, UCLA, 100 Medical Plaza, Suite 660, Los Angeles, CA 90095, USA
| | - Kalyanam Shivkumar
- University of California Los Angeles (UCLA) Cardiac Arrhythmia Center, David Geffen School of Medicine, UCLA, 100 Medical Plaza, Suite 660, Los Angeles, CA 90095, USA
- Neurocardiology Research Program of Excellence, David Geffen School of Medicine, UCLA, 100 Medical Plaza, Suite 660, Los Angeles, CA 90095, USA
- Molecular, Cellular & Integrative Physiology Program, David Geffen School of Medicine, UCLA, 100 Medical Plaza, Suite 660, Los Angeles, CA 90095, USA
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11
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Aksu T, Gopinathannair R, Gupta D, Pauza DH. Intrinsic cardiac autonomic nervous system: What do clinical electrophysiologists need to know about the "heart brain"? J Cardiovasc Electrophysiol 2021; 32:1737-1747. [PMID: 33928710 DOI: 10.1111/jce.15058] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Accepted: 04/23/2021] [Indexed: 11/29/2022]
Abstract
It is increasingly recognized that the autonomic nervous system (ANS) is a major contributor in many cardiac arrhythmias. Cardiac ANS can be divided into extrinsic and intrinsic parts according to the course of nerve fibers and localization of ganglia and neuron bodies. Although the role of the extrinsic part has historically gained more attention, the intrinsic cardiac ANS may affect cardiac function independently as well as influence the effects of the extrinsic nerves. Catheter-based modulation of the intrinsic cardiac ANS is emerging as a novel therapy for the management of patients with brady and tachyarrhythmias resulting from hyperactive vagal activation. However, the distribution of intrinsic cardiac nerve plexus in the human heart and the functional properties of intrinsic cardiac neural elements remain insufficiently understood. The present review aims to bring the clinical and anatomical elements of the immune effector cell-associated neurotoxicity together, by reviewing neuroanatomical terminologies and physiological functions, to guide the clinical electrophysiologist in the catheter lab and to serve as a reference for further research.
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Affiliation(s)
- Tolga Aksu
- Department of Cardiology, Yeditepe University Hospital, Istanbul, Turkey
| | - Rakesh Gopinathannair
- Departments of Electrophysiology, Kansas City Heart Rhythm Institute and Research Foundation, Kansas City, Missouri, USA
| | - Dhiraj Gupta
- Department of Electrophysiology, Liverpool Heart and Chest Hospital, Liverpool, United Kingdom
| | - Dainius H Pauza
- Department of Anatomy, Lithuanian University of Health Sciences, Kaunas, Lithuania
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12
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Sandler B, Kim MY, Sikkel MB, Malcolme-Lawes L, Koa-Wing M, Whinnett ZI, Coyle C, Linton NWF, Lim PB, Kanagaratnam P. Targeting the ectopy-triggering ganglionated plexuses without pulmonary vein isolation prevents atrial fibrillation. J Cardiovasc Electrophysiol 2021; 32:235-244. [PMID: 33421265 PMCID: PMC8611799 DOI: 10.1111/jce.14870] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Revised: 11/24/2020] [Accepted: 12/05/2020] [Indexed: 01/19/2023]
Abstract
BACKGROUND Ganglionated plexuses (GPs) are implicated in atrial fibrillation (AF). Endocardial high-frequency stimulation (HFS) delivered within the local atrial refractory period can trigger ectopy and AF from specific GP sites (ET-GP). The aim of this study was to understand the role of ET-GP ablation in the treatment of AF. METHODS Patients with paroxysmal AF indicated for ablation were recruited. HFS mapping was performed globally around the left atrium to identify ET-GP. ET-GP was defined as atrial ectopy or atrial arrhythmia triggered by HFS. All ET-GP were ablated, and PVs were left electrically connected. Outcomes were compared with a control group receiving pulmonary vein isolation (PVI). Patients were followed-up for 12 months with multiple 48-h Holter ECGs. Primary endpoint was ≥30 s AF/atrial tachycardia in ECGs. RESULTS In total, 67 patients were recruited and randomized to ET-GP ablation (n = 39) or PVI (n = 28). In the ET-GP ablation group, 103 ± 28 HFS sites were tested per patient, identifying 21 ± 10 (20%) GPs. ET-GP ablation used 23.3 ± 4.1 kWs total radiofrequency (RF) energy per patient, compared with 55.7 ± 22.7 kWs in PVI (p = <.0001). Duration of procedure was 3.7 ± 1.0 and 3.3 ± 0.7 h in ET-GP ablation group and PVI, respectively (p = .07). Follow-up at 12 months showed that 61% and 49% were free from ≥30 s of AF/AT with PVI and ET-GP ablation respectively (log-rank p = .27). CONCLUSIONS It is feasible to perform detailed global functional mapping with HFS and ablate ET-GP to prevent AF. This provides direct evidence that ET-GPs are part of the AF mechanism. The lower RF requirement implies that ET-GP targets the AF pathway more specifically.
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Affiliation(s)
- Belinda Sandler
- Myocardial Function Section, National Heart and Lung Institute, Imperial College London, London, UK.,Imperial Centre for Cardiac Engineering, Imperial College London, London, UK
| | - Min-Young Kim
- Myocardial Function Section, National Heart and Lung Institute, Imperial College London, London, UK.,Imperial Centre for Cardiac Engineering, Imperial College London, London, UK
| | - Markus B Sikkel
- Myocardial Function Section, National Heart and Lung Institute, Imperial College London, London, UK.,Imperial Centre for Cardiac Engineering, Imperial College London, London, UK.,Department of Cardiology, Hammersmith Hospital, Imperial College Healthcare NHS Trust, London, UK
| | - Louisa Malcolme-Lawes
- Imperial Centre for Cardiac Engineering, Imperial College London, London, UK.,Department of Cardiology, Hammersmith Hospital, Imperial College Healthcare NHS Trust, London, UK
| | - Michael Koa-Wing
- Imperial Centre for Cardiac Engineering, Imperial College London, London, UK.,Department of Cardiology, Hammersmith Hospital, Imperial College Healthcare NHS Trust, London, UK
| | - Zachary I Whinnett
- Imperial Centre for Cardiac Engineering, Imperial College London, London, UK.,Department of Cardiology, Hammersmith Hospital, Imperial College Healthcare NHS Trust, London, UK
| | - Clare Coyle
- Myocardial Function Section, National Heart and Lung Institute, Imperial College London, London, UK.,Imperial Centre for Cardiac Engineering, Imperial College London, London, UK.,Department of Cardiology, Hammersmith Hospital, Imperial College Healthcare NHS Trust, London, UK
| | - Nick W F Linton
- Myocardial Function Section, National Heart and Lung Institute, Imperial College London, London, UK.,Imperial Centre for Cardiac Engineering, Imperial College London, London, UK.,Department of Cardiology, Hammersmith Hospital, Imperial College Healthcare NHS Trust, London, UK
| | - Phang B Lim
- Myocardial Function Section, National Heart and Lung Institute, Imperial College London, London, UK.,Imperial Centre for Cardiac Engineering, Imperial College London, London, UK.,Department of Cardiology, Hammersmith Hospital, Imperial College Healthcare NHS Trust, London, UK
| | - Prapa Kanagaratnam
- Myocardial Function Section, National Heart and Lung Institute, Imperial College London, London, UK.,Imperial Centre for Cardiac Engineering, Imperial College London, London, UK.,Department of Cardiology, Hammersmith Hospital, Imperial College Healthcare NHS Trust, London, UK
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13
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Kim MY, Lim PB, Coyle C, Sandler B, Koa-Wing M, Kanagaratnam P. Single Ectopy-Triggering Ganglionated Plexus Ablation Without Pulmonary Vein Isolation Prevents Atrial Fibrillation. JACC Case Rep 2020; 2:2004-2009. [PMID: 34317098 PMCID: PMC8299246 DOI: 10.1016/j.jaccas.2020.07.058] [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: 05/15/2020] [Revised: 07/02/2020] [Accepted: 07/16/2020] [Indexed: 01/26/2023]
Abstract
A 58-year-old woman with drug-refractory symptoms of paroxysmal atrial fibrillation (AF) was referred for AF ablation. A single site of ganglionated plexus triggering pulmonary vein ectopy and AF was ablated, without pulmonary vein isolation. This procedure led to long-term freedom from AF. (Level of Difficulty: Advanced.).
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Affiliation(s)
- Min-Young Kim
- Myocardial Function Section, Imperial Centre for Translational and Experimental Medicine, Imperial College London, London, United Kingdom
- Department of Cardiology, Imperial College Healthcare NHS Trust, London, United Kingdom
- Imperial Centre for Cardiac Engineering, Imperial College London, London, United Kingdom
| | - Phang Boon Lim
- Department of Cardiology, Imperial College Healthcare NHS Trust, London, United Kingdom
- Imperial Centre for Cardiac Engineering, Imperial College London, London, United Kingdom
| | - Clare Coyle
- Myocardial Function Section, Imperial Centre for Translational and Experimental Medicine, Imperial College London, London, United Kingdom
- Department of Cardiology, Imperial College Healthcare NHS Trust, London, United Kingdom
- Imperial Centre for Cardiac Engineering, Imperial College London, London, United Kingdom
| | - Belinda Sandler
- Myocardial Function Section, Imperial Centre for Translational and Experimental Medicine, Imperial College London, London, United Kingdom
- Department of Cardiology, Imperial College Healthcare NHS Trust, London, United Kingdom
- Imperial Centre for Cardiac Engineering, Imperial College London, London, United Kingdom
| | - Michael Koa-Wing
- Department of Cardiology, Imperial College Healthcare NHS Trust, London, United Kingdom
- Imperial Centre for Cardiac Engineering, Imperial College London, London, United Kingdom
| | - Prapa Kanagaratnam
- Department of Cardiology, Imperial College Healthcare NHS Trust, London, United Kingdom
- Imperial Centre for Cardiac Engineering, Imperial College London, London, United Kingdom
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14
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Aksu T, Yalin K, Gopinathannair R. Fractionation mapping software to map ganglionated plexus sites during sinus rhythm. J Cardiovasc Electrophysiol 2020; 31:3326-3329. [PMID: 32954554 DOI: 10.1111/jce.14753] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Revised: 09/03/2020] [Accepted: 09/16/2020] [Indexed: 12/22/2022]
Abstract
Ablation of ganglionated plexuses (GPs) is a relatively new technique in patients with vasovagal syncope. Due to individual variation of GP settlement, reproducible GP detection methods are needed to during electrophysiologic study. In the present case, fractionation mapping software of Ensite system was tested to detect localization of GPs and first compared with previously validated fractionated electrograms based strategy.
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Affiliation(s)
- Tolga Aksu
- Department of Cardiology, Kocaeli Derince Training and Research Hospital, University of Health Science, Kocaeli, Turkey
| | - Kivanc Yalin
- Department of Cardiology, Faculty of Medicine, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Rakesh Gopinathannair
- Department of Electrophysiology, Kansas City Heart Rhythm Institute and Research Foundation, Overland Park, Kansas, USA
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15
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Kim MY, Sandler BC, Sikkel MB, Cantwell CD, Leong KM, Luther V, Malcolme-Lawes L, Koa-Wing M, Ng FS, Qureshi N, Sohaib A, Whinnett ZI, Fudge M, Lim E, Todd M, Wright I, Peters NS, Lim PB, Linton NWF, Kanagaratnam P. Anatomical Distribution of Ectopy-Triggering Plexuses in Patients With Atrial Fibrillation. Circ Arrhythm Electrophysiol 2020; 13:e008715. [PMID: 32718187 DOI: 10.1161/circep.120.008715] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Min-Young Kim
- Myocardial Function Section, Imperial Centre for Translational and Experimental Medicine (M.-Y.K., B.C.S., M.B.S., C.D.C., F.S.N., N.S.P., P.B.L., N.W.F.L., P.K.), Imperial College London, United Kingdom.,Imperial Centre for Cardiac Engineering (M.-Y.K., B.C.S., M.B.S., C.D.C., K.M.L., V.L., L.M.-L., M.K.-W., F.S.N., N.Q., A.S., Z.I.W., M.F., E.L., M.T., I.W., N.S.P., P.B.L., N.W.F.L.), Imperial College London, United Kingdom
| | - Belinda C Sandler
- Myocardial Function Section, Imperial Centre for Translational and Experimental Medicine (M.-Y.K., B.C.S., M.B.S., C.D.C., F.S.N., N.S.P., P.B.L., N.W.F.L., P.K.), Imperial College London, United Kingdom.,Imperial Centre for Cardiac Engineering (M.-Y.K., B.C.S., M.B.S., C.D.C., K.M.L., V.L., L.M.-L., M.K.-W., F.S.N., N.Q., A.S., Z.I.W., M.F., E.L., M.T., I.W., N.S.P., P.B.L., N.W.F.L.), Imperial College London, United Kingdom
| | - Markus B Sikkel
- Myocardial Function Section, Imperial Centre for Translational and Experimental Medicine (M.-Y.K., B.C.S., M.B.S., C.D.C., F.S.N., N.S.P., P.B.L., N.W.F.L., P.K.), Imperial College London, United Kingdom.,Imperial Centre for Cardiac Engineering (M.-Y.K., B.C.S., M.B.S., C.D.C., K.M.L., V.L., L.M.-L., M.K.-W., F.S.N., N.Q., A.S., Z.I.W., M.F., E.L., M.T., I.W., N.S.P., P.B.L., N.W.F.L.), Imperial College London, United Kingdom.,Department of Cardiology, Imperial College Healthcare NHS Trust, London, United Kingdom (M.B.S., K.M.L., V.L., L.M.-L., M.K.-W., F.S.N., N.Q., A.S., Z.I.W., M.F., M.F., E.L., M.T., I.W., N.S.P., P.B.L., N.W.F.L.)
| | - Christopher D Cantwell
- Myocardial Function Section, Imperial Centre for Translational and Experimental Medicine (M.-Y.K., B.C.S., M.B.S., C.D.C., F.S.N., N.S.P., P.B.L., N.W.F.L., P.K.), Imperial College London, United Kingdom.,Imperial Centre for Cardiac Engineering (M.-Y.K., B.C.S., M.B.S., C.D.C., K.M.L., V.L., L.M.-L., M.K.-W., F.S.N., N.Q., A.S., Z.I.W., M.F., E.L., M.T., I.W., N.S.P., P.B.L., N.W.F.L.), Imperial College London, United Kingdom
| | - Kevin M Leong
- Imperial Centre for Cardiac Engineering (M.-Y.K., B.C.S., M.B.S., C.D.C., K.M.L., V.L., L.M.-L., M.K.-W., F.S.N., N.Q., A.S., Z.I.W., M.F., E.L., M.T., I.W., N.S.P., P.B.L., N.W.F.L.), Imperial College London, United Kingdom.,Department of Cardiology, Imperial College Healthcare NHS Trust, London, United Kingdom (M.B.S., K.M.L., V.L., L.M.-L., M.K.-W., F.S.N., N.Q., A.S., Z.I.W., M.F., M.F., E.L., M.T., I.W., N.S.P., P.B.L., N.W.F.L.)
| | - Vishal Luther
- Imperial Centre for Cardiac Engineering (M.-Y.K., B.C.S., M.B.S., C.D.C., K.M.L., V.L., L.M.-L., M.K.-W., F.S.N., N.Q., A.S., Z.I.W., M.F., E.L., M.T., I.W., N.S.P., P.B.L., N.W.F.L.), Imperial College London, United Kingdom.,Department of Cardiology, Imperial College Healthcare NHS Trust, London, United Kingdom (M.B.S., K.M.L., V.L., L.M.-L., M.K.-W., F.S.N., N.Q., A.S., Z.I.W., M.F., M.F., E.L., M.T., I.W., N.S.P., P.B.L., N.W.F.L.)
| | - Louisa Malcolme-Lawes
- Imperial Centre for Cardiac Engineering (M.-Y.K., B.C.S., M.B.S., C.D.C., K.M.L., V.L., L.M.-L., M.K.-W., F.S.N., N.Q., A.S., Z.I.W., M.F., E.L., M.T., I.W., N.S.P., P.B.L., N.W.F.L.), Imperial College London, United Kingdom.,Department of Cardiology, Imperial College Healthcare NHS Trust, London, United Kingdom (M.B.S., K.M.L., V.L., L.M.-L., M.K.-W., F.S.N., N.Q., A.S., Z.I.W., M.F., M.F., E.L., M.T., I.W., N.S.P., P.B.L., N.W.F.L.)
| | - Michael Koa-Wing
- Imperial Centre for Cardiac Engineering (M.-Y.K., B.C.S., M.B.S., C.D.C., K.M.L., V.L., L.M.-L., M.K.-W., F.S.N., N.Q., A.S., Z.I.W., M.F., E.L., M.T., I.W., N.S.P., P.B.L., N.W.F.L.), Imperial College London, United Kingdom.,Department of Cardiology, Imperial College Healthcare NHS Trust, London, United Kingdom (M.B.S., K.M.L., V.L., L.M.-L., M.K.-W., F.S.N., N.Q., A.S., Z.I.W., M.F., M.F., E.L., M.T., I.W., N.S.P., P.B.L., N.W.F.L.)
| | - Fu Siong Ng
- Myocardial Function Section, Imperial Centre for Translational and Experimental Medicine (M.-Y.K., B.C.S., M.B.S., C.D.C., F.S.N., N.S.P., P.B.L., N.W.F.L., P.K.), Imperial College London, United Kingdom.,Imperial Centre for Cardiac Engineering (M.-Y.K., B.C.S., M.B.S., C.D.C., K.M.L., V.L., L.M.-L., M.K.-W., F.S.N., N.Q., A.S., Z.I.W., M.F., E.L., M.T., I.W., N.S.P., P.B.L., N.W.F.L.), Imperial College London, United Kingdom.,Department of Cardiology, Imperial College Healthcare NHS Trust, London, United Kingdom (M.B.S., K.M.L., V.L., L.M.-L., M.K.-W., F.S.N., N.Q., A.S., Z.I.W., M.F., M.F., E.L., M.T., I.W., N.S.P., P.B.L., N.W.F.L.)
| | - Norman Qureshi
- Imperial Centre for Cardiac Engineering (M.-Y.K., B.C.S., M.B.S., C.D.C., K.M.L., V.L., L.M.-L., M.K.-W., F.S.N., N.Q., A.S., Z.I.W., M.F., E.L., M.T., I.W., N.S.P., P.B.L., N.W.F.L.), Imperial College London, United Kingdom.,Department of Cardiology, Imperial College Healthcare NHS Trust, London, United Kingdom (M.B.S., K.M.L., V.L., L.M.-L., M.K.-W., F.S.N., N.Q., A.S., Z.I.W., M.F., M.F., E.L., M.T., I.W., N.S.P., P.B.L., N.W.F.L.)
| | - Afzal Sohaib
- Imperial Centre for Cardiac Engineering (M.-Y.K., B.C.S., M.B.S., C.D.C., K.M.L., V.L., L.M.-L., M.K.-W., F.S.N., N.Q., A.S., Z.I.W., M.F., E.L., M.T., I.W., N.S.P., P.B.L., N.W.F.L.), Imperial College London, United Kingdom.,Department of Cardiology, Imperial College Healthcare NHS Trust, London, United Kingdom (M.B.S., K.M.L., V.L., L.M.-L., M.K.-W., F.S.N., N.Q., A.S., Z.I.W., M.F., M.F., E.L., M.T., I.W., N.S.P., P.B.L., N.W.F.L.).,Department of Cardiology, Barts Health NHS Trust, London, United Kingdom (A.S.)
| | - Zachary I Whinnett
- Imperial Centre for Cardiac Engineering (M.-Y.K., B.C.S., M.B.S., C.D.C., K.M.L., V.L., L.M.-L., M.K.-W., F.S.N., N.Q., A.S., Z.I.W., M.F., E.L., M.T., I.W., N.S.P., P.B.L., N.W.F.L.), Imperial College London, United Kingdom.,Department of Cardiology, Imperial College Healthcare NHS Trust, London, United Kingdom (M.B.S., K.M.L., V.L., L.M.-L., M.K.-W., F.S.N., N.Q., A.S., Z.I.W., M.F., M.F., E.L., M.T., I.W., N.S.P., P.B.L., N.W.F.L.)
| | - Michael Fudge
- Imperial Centre for Cardiac Engineering (M.-Y.K., B.C.S., M.B.S., C.D.C., K.M.L., V.L., L.M.-L., M.K.-W., F.S.N., N.Q., A.S., Z.I.W., M.F., E.L., M.T., I.W., N.S.P., P.B.L., N.W.F.L.), Imperial College London, United Kingdom.,Department of Cardiology, Imperial College Healthcare NHS Trust, London, United Kingdom (M.B.S., K.M.L., V.L., L.M.-L., M.K.-W., F.S.N., N.Q., A.S., Z.I.W., M.F., M.F., E.L., M.T., I.W., N.S.P., P.B.L., N.W.F.L.)
| | - Elaine Lim
- Imperial Centre for Cardiac Engineering (M.-Y.K., B.C.S., M.B.S., C.D.C., K.M.L., V.L., L.M.-L., M.K.-W., F.S.N., N.Q., A.S., Z.I.W., M.F., E.L., M.T., I.W., N.S.P., P.B.L., N.W.F.L.), Imperial College London, United Kingdom.,Department of Cardiology, Imperial College Healthcare NHS Trust, London, United Kingdom (M.B.S., K.M.L., V.L., L.M.-L., M.K.-W., F.S.N., N.Q., A.S., Z.I.W., M.F., M.F., E.L., M.T., I.W., N.S.P., P.B.L., N.W.F.L.)
| | - Michelle Todd
- Imperial Centre for Cardiac Engineering (M.-Y.K., B.C.S., M.B.S., C.D.C., K.M.L., V.L., L.M.-L., M.K.-W., F.S.N., N.Q., A.S., Z.I.W., M.F., E.L., M.T., I.W., N.S.P., P.B.L., N.W.F.L.), Imperial College London, United Kingdom.,Department of Cardiology, Imperial College Healthcare NHS Trust, London, United Kingdom (M.B.S., K.M.L., V.L., L.M.-L., M.K.-W., F.S.N., N.Q., A.S., Z.I.W., M.F., M.F., E.L., M.T., I.W., N.S.P., P.B.L., N.W.F.L.)
| | - Ian Wright
- Imperial Centre for Cardiac Engineering (M.-Y.K., B.C.S., M.B.S., C.D.C., K.M.L., V.L., L.M.-L., M.K.-W., F.S.N., N.Q., A.S., Z.I.W., M.F., E.L., M.T., I.W., N.S.P., P.B.L., N.W.F.L.), Imperial College London, United Kingdom.,Department of Cardiology, Imperial College Healthcare NHS Trust, London, United Kingdom (M.B.S., K.M.L., V.L., L.M.-L., M.K.-W., F.S.N., N.Q., A.S., Z.I.W., M.F., M.F., E.L., M.T., I.W., N.S.P., P.B.L., N.W.F.L.)
| | - Nicholas S Peters
- Myocardial Function Section, Imperial Centre for Translational and Experimental Medicine (M.-Y.K., B.C.S., M.B.S., C.D.C., F.S.N., N.S.P., P.B.L., N.W.F.L., P.K.), Imperial College London, United Kingdom.,Imperial Centre for Cardiac Engineering (M.-Y.K., B.C.S., M.B.S., C.D.C., K.M.L., V.L., L.M.-L., M.K.-W., F.S.N., N.Q., A.S., Z.I.W., M.F., E.L., M.T., I.W., N.S.P., P.B.L., N.W.F.L.), Imperial College London, United Kingdom.,Department of Cardiology, Imperial College Healthcare NHS Trust, London, United Kingdom (M.B.S., K.M.L., V.L., L.M.-L., M.K.-W., F.S.N., N.Q., A.S., Z.I.W., M.F., M.F., E.L., M.T., I.W., N.S.P., P.B.L., N.W.F.L.)
| | - Phang Boon Lim
- Myocardial Function Section, Imperial Centre for Translational and Experimental Medicine (M.-Y.K., B.C.S., M.B.S., C.D.C., F.S.N., N.S.P., P.B.L., N.W.F.L., P.K.), Imperial College London, United Kingdom.,Imperial Centre for Cardiac Engineering (M.-Y.K., B.C.S., M.B.S., C.D.C., K.M.L., V.L., L.M.-L., M.K.-W., F.S.N., N.Q., A.S., Z.I.W., M.F., E.L., M.T., I.W., N.S.P., P.B.L., N.W.F.L.), Imperial College London, United Kingdom.,Department of Cardiology, Imperial College Healthcare NHS Trust, London, United Kingdom (M.B.S., K.M.L., V.L., L.M.-L., M.K.-W., F.S.N., N.Q., A.S., Z.I.W., M.F., M.F., E.L., M.T., I.W., N.S.P., P.B.L., N.W.F.L.)
| | - Nicholas W F Linton
- Myocardial Function Section, Imperial Centre for Translational and Experimental Medicine (M.-Y.K., B.C.S., M.B.S., C.D.C., F.S.N., N.S.P., P.B.L., N.W.F.L., P.K.), Imperial College London, United Kingdom.,Imperial Centre for Cardiac Engineering (M.-Y.K., B.C.S., M.B.S., C.D.C., K.M.L., V.L., L.M.-L., M.K.-W., F.S.N., N.Q., A.S., Z.I.W., M.F., E.L., M.T., I.W., N.S.P., P.B.L., N.W.F.L.), Imperial College London, United Kingdom.,Department of Cardiology, Imperial College Healthcare NHS Trust, London, United Kingdom (M.B.S., K.M.L., V.L., L.M.-L., M.K.-W., F.S.N., N.Q., A.S., Z.I.W., M.F., M.F., E.L., M.T., I.W., N.S.P., P.B.L., N.W.F.L.)
| | - Prapa Kanagaratnam
- Myocardial Function Section, Imperial Centre for Translational and Experimental Medicine (M.-Y.K., B.C.S., M.B.S., C.D.C., F.S.N., N.S.P., P.B.L., N.W.F.L., P.K.), Imperial College London, United Kingdom
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16
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Kim MY, Sandler B, Sikkel MB, Cantwell CD, Leong KM, Luther V, Malcolme-Lawes L, Koa-Wing M, Ng FS, Qureshi N, Sohaib A, Whinnett ZI, Fudge M, Lim E, Todd M, Wright I, Peters NS, Lim PB, Linton NWF, Kanagaratnam P. The ectopy-triggering ganglionated plexuses in atrial fibrillation. Auton Neurosci 2020; 228:102699. [PMID: 32769021 PMCID: PMC7511599 DOI: 10.1016/j.autneu.2020.102699] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2019] [Revised: 06/27/2020] [Accepted: 07/09/2020] [Indexed: 01/08/2023]
Abstract
BACKGROUND Epicardial ganglionated plexuses (GP) have an important role in the pathogenesis of atrial fibrillation (AF). The relationship between anatomical, histological and functional effects of GP is not well known. We previously described atrioventricular (AV) dissociating GP (AVD-GP) locations. In this study, we hypothesised that ectopy triggering GP (ET-GP) are upstream triggers of atrial ectopy/AF and have different anatomical distribution to AVD-GP. OBJECTIVES We mapped and characterised ET-GP to understand their neural mechanism in AF and anatomical distribution in the left atrium (LA). METHODS 26 patients with paroxysmal AF were recruited. All were paced in the LA with an ablation catheter. High frequency stimulation (HFS) was synchronised to each paced stimulus for delivery within the local atrial refractory period. HFS responses were tagged onto CARTO™ 3D LA geometry. All geometries were transformed onto one reference LA shell. A probability distribution atlas of ET-GP was created. This identified high/low ET-GP probability regions. RESULTS 2302 sites were tested with HFS, identifying 579 (25%) ET-GP. 464 ET-GP were characterised, where 74 (16%) triggered ≥30s AF/AT. Median 97 (IQR 55) sites were tested, identifying 19 (20%) ET-GP per patient. >30% of ET-GP were in the roof, mid-anterior wall, around all PV ostia except in the right inferior PV (RIPV) in the posterior wall. CONCLUSION ET-GP can be identified by endocardial stimulation and their anatomical distribution, in contrast to AVD-GP, would be more likely to be affected by wide antral circumferential ablation. This may contribute to AF ablation outcomes.
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Affiliation(s)
- Min-Young Kim
- Myocardial Function Section, NHLI, Imperial College London, UK; Imperial Centre for Cardiac Engineering, Imperial College London, London, UK
| | - Belinda Sandler
- Myocardial Function Section, NHLI, Imperial College London, UK; Imperial Centre for Cardiac Engineering, Imperial College London, London, UK
| | - Markus B Sikkel
- Myocardial Function Section, NHLI, Imperial College London, UK; Department of Cardiology, Imperial College Healthcare NHS Trust, London, UK; Imperial Centre for Cardiac Engineering, Imperial College London, London, UK
| | - Christopher D Cantwell
- Myocardial Function Section, NHLI, Imperial College London, UK; Imperial Centre for Cardiac Engineering, Imperial College London, London, UK
| | - Kevin M Leong
- Department of Cardiology, Imperial College Healthcare NHS Trust, London, UK; Imperial Centre for Cardiac Engineering, Imperial College London, London, UK
| | - Vishal Luther
- Department of Cardiology, Imperial College Healthcare NHS Trust, London, UK; Imperial Centre for Cardiac Engineering, Imperial College London, London, UK
| | - Louisa Malcolme-Lawes
- Department of Cardiology, Imperial College Healthcare NHS Trust, London, UK; Imperial Centre for Cardiac Engineering, Imperial College London, London, UK
| | - Michael Koa-Wing
- Department of Cardiology, Imperial College Healthcare NHS Trust, London, UK; Imperial Centre for Cardiac Engineering, Imperial College London, London, UK
| | - Fu Siong Ng
- Myocardial Function Section, NHLI, Imperial College London, UK; Department of Cardiology, Imperial College Healthcare NHS Trust, London, UK; Imperial Centre for Cardiac Engineering, Imperial College London, London, UK
| | - Norman Qureshi
- Department of Cardiology, Imperial College Healthcare NHS Trust, London, UK; Imperial Centre for Cardiac Engineering, Imperial College London, London, UK
| | - Afzal Sohaib
- Department of Cardiology, Imperial College Healthcare NHS Trust, London, UK; Imperial Centre for Cardiac Engineering, Imperial College London, London, UK; Barts Health NHS Trust, UK
| | - Zachary I Whinnett
- Department of Cardiology, Imperial College Healthcare NHS Trust, London, UK; Imperial Centre for Cardiac Engineering, Imperial College London, London, UK
| | - Michael Fudge
- Department of Cardiology, Imperial College Healthcare NHS Trust, London, UK; Imperial Centre for Cardiac Engineering, Imperial College London, London, UK
| | - Elaine Lim
- Department of Cardiology, Imperial College Healthcare NHS Trust, London, UK; Imperial Centre for Cardiac Engineering, Imperial College London, London, UK
| | - Michelle Todd
- Department of Cardiology, Imperial College Healthcare NHS Trust, London, UK; Imperial Centre for Cardiac Engineering, Imperial College London, London, UK
| | - Ian Wright
- Department of Cardiology, Imperial College Healthcare NHS Trust, London, UK; Imperial Centre for Cardiac Engineering, Imperial College London, London, UK
| | - Nicholas S Peters
- Myocardial Function Section, NHLI, Imperial College London, UK; Department of Cardiology, Imperial College Healthcare NHS Trust, London, UK; Imperial Centre for Cardiac Engineering, Imperial College London, London, UK
| | - Phang Boon Lim
- Myocardial Function Section, NHLI, Imperial College London, UK; Department of Cardiology, Imperial College Healthcare NHS Trust, London, UK; Imperial Centre for Cardiac Engineering, Imperial College London, London, UK
| | - Nicholas W F Linton
- Myocardial Function Section, NHLI, Imperial College London, UK; Department of Cardiology, Imperial College Healthcare NHS Trust, London, UK; Imperial Centre for Cardiac Engineering, Imperial College London, London, UK
| | - Prapa Kanagaratnam
- Myocardial Function Section, NHLI, Imperial College London, UK; Department of Cardiology, Imperial College Healthcare NHS Trust, London, UK; Imperial Centre for Cardiac Engineering, Imperial College London, London, UK.
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17
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Clayton RH, Aboelkassem Y, Cantwell CD, Corrado C, Delhaas T, Huberts W, Lei CL, Ni H, Panfilov AV, Roney C, dos Santos RW. An audit of uncertainty in multi-scale cardiac electrophysiology models. PHILOSOPHICAL TRANSACTIONS. SERIES A, MATHEMATICAL, PHYSICAL, AND ENGINEERING SCIENCES 2020; 378:20190335. [PMID: 32448070 PMCID: PMC7287340 DOI: 10.1098/rsta.2019.0335] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 03/16/2020] [Indexed: 05/21/2023]
Abstract
Models of electrical activation and recovery in cardiac cells and tissue have become valuable research tools, and are beginning to be used in safety-critical applications including guidance for clinical procedures and for drug safety assessment. As a consequence, there is an urgent need for a more detailed and quantitative understanding of the ways that uncertainty and variability influence model predictions. In this paper, we review the sources of uncertainty in these models at different spatial scales, discuss how uncertainties are communicated across scales, and begin to assess their relative importance. We conclude by highlighting important challenges that continue to face the cardiac modelling community, identifying open questions, and making recommendations for future studies. This article is part of the theme issue 'Uncertainty quantification in cardiac and cardiovascular modelling and simulation'.
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Affiliation(s)
- Richard H. Clayton
- Insigneo institute for in-silico Medicine and Department of Computer Science, University of Sheffield, Sheffield, UK
- e-mail:
| | - Yasser Aboelkassem
- Department of Bioengineering, University of California, San Diego, CA, USA
| | | | - Cesare Corrado
- Division of Imaging Sciences and Biomedical Engineering, King’s College London, London, UK
| | - Tammo Delhaas
- School of Cardiovascular Diseases, Maastricht University, Maastricht, The Netherlands
| | - Wouter Huberts
- School of Cardiovascular Diseases, Maastricht University, Maastricht, The Netherlands
- Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands
| | - Chon Lok Lei
- Computational Biology and Health Informatics, Department of Computer Science, University of Oxford, Oxford, UK
| | - Haibo Ni
- Department of Pharmacology, University of California, Davis, CA, USA
| | - Alexander V. Panfilov
- Department of Physics and Astronomy, University of Gent, Gent, Belgium
- Laboratory of Computational Biology and Medicine, Ural Federal University, Ekaterinburg, Russia
| | - Caroline Roney
- Division of Imaging Sciences and Biomedical Engineering, King’s College London, London, UK
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18
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Aksu T, Guler TE, Bozyel S, Yalin K. Selective vagal innervation principles of ganglionated plexi: step-by-step cardioneuroablation in a patient with vasovagal syncope. J Interv Card Electrophysiol 2020; 60:453-458. [DOI: 10.1007/s10840-020-00757-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2019] [Accepted: 04/17/2020] [Indexed: 11/28/2022]
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19
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Dhillon GS, Schilling RJ, Honarbakhsh S, Graham A, Abbass H, Waddingham P, Sawhney V, Creta A, Sporton S, Finlay M, Providencia R, Chow A, Earley MJ, Lowe M, Lambiase PD, Hunter RJ. Impact of pulmonary vein isolation on mechanisms sustaining persistent atrial fibrillation: Predicting the acute response. J Cardiovasc Electrophysiol 2020; 31:903-912. [PMID: 32048786 DOI: 10.1111/jce.14392] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2019] [Revised: 01/06/2020] [Accepted: 01/10/2020] [Indexed: 01/06/2023]
Abstract
BACKGROUND Noninvasive mapping identifies potential drivers (PDs) in atrial fibrillation (AF). We analyzed the impact of pulmonary vein isolation (PVI) on PDs and whether baseline PD pattern predicted termination of AF. METHODS Patients with persistent AF less than 2 years underwent electrocardiographic imaging mapping before and after cryoballoon PVI. We recorded the number of PD occurrences, characteristics (rotational wavefronts ≥ 1.5 revolutions or focal activations), and distribution using an 18-segment atrial model. RESULTS Of 100 patients recruited, PVI terminated AF in 15 patients; 21.3% ± 9.1% (8.7 ± 4.8) of PDs occurred at the pulmonary veins (PVs) and posterior wall. PVI had no impact on PD occurrences outside the PVs and posterior wall (33.2 ± 12.9 vs 31.6 ± 12.5; P = .164), distribution over the remaining 13 segments (9 [8-11] vs 9 [8-10]; P = .634), the proportion of PDs that was rotational (82.9% ± 9.7% vs 83.6% ± 10.1%; P = .496), or temporal stability (2.4 ± 0.4 vs 2.4 ± 0.5 rotations; P = .541). Fewer focal PDs (area under the curve, 0.683; 95% CI, 0.528-0.839; P = .024) but not rotational PDs (P = .626) predicted AF termination with PVI. CONCLUSIONS PVI did not have a global impact on PDs outside the PVs and posterior wall. Although fewer focal PDs predicted termination of AF with PVI, the burden of rotational PDs did not. It is accepted though not all PDs are necessarily real or important. Outcome data are needed to confirm whether noninvasive mapping can predict patients likely to respond to PVI.
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Affiliation(s)
- Gurpreet S Dhillon
- Barts Heart Centre, St Bartholomew's Hospital, Barts Health NHS Trust, London, UK
| | - Richard J Schilling
- Barts Heart Centre, St Bartholomew's Hospital, Barts Health NHS Trust, London, UK
| | - Shohreh Honarbakhsh
- Barts Heart Centre, St Bartholomew's Hospital, Barts Health NHS Trust, London, UK
| | - Adam Graham
- Barts Heart Centre, St Bartholomew's Hospital, Barts Health NHS Trust, London, UK
| | - Hakam Abbass
- Barts Heart Centre, St Bartholomew's Hospital, Barts Health NHS Trust, London, UK
| | - Peter Waddingham
- Barts Heart Centre, St Bartholomew's Hospital, Barts Health NHS Trust, London, UK
| | - Vinit Sawhney
- Barts Heart Centre, St Bartholomew's Hospital, Barts Health NHS Trust, London, UK
| | - Antonio Creta
- Barts Heart Centre, St Bartholomew's Hospital, Barts Health NHS Trust, London, UK
| | - Simon Sporton
- Barts Heart Centre, St Bartholomew's Hospital, Barts Health NHS Trust, London, UK
| | - Malcolm Finlay
- Barts Heart Centre, St Bartholomew's Hospital, Barts Health NHS Trust, London, UK
| | - Rui Providencia
- Barts Heart Centre, St Bartholomew's Hospital, Barts Health NHS Trust, London, UK
| | - Anthony Chow
- Barts Heart Centre, St Bartholomew's Hospital, Barts Health NHS Trust, London, UK
| | - Mark J Earley
- Barts Heart Centre, St Bartholomew's Hospital, Barts Health NHS Trust, London, UK
| | - Martin Lowe
- Barts Heart Centre, St Bartholomew's Hospital, Barts Health NHS Trust, London, UK
| | - Pier D Lambiase
- Barts Heart Centre, St Bartholomew's Hospital, Barts Health NHS Trust, London, UK
| | - Ross J Hunter
- Barts Heart Centre, St Bartholomew's Hospital, Barts Health NHS Trust, London, UK
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20
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Aronis KN, Ali RL, Liang JA, Zhou S, Trayanova NA. Understanding AF Mechanisms Through Computational Modelling and Simulations. Arrhythm Electrophysiol Rev 2019; 8:210-219. [PMID: 31463059 PMCID: PMC6702471 DOI: 10.15420/aer.2019.28.2] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2019] [Accepted: 06/17/2019] [Indexed: 12/21/2022] Open
Abstract
AF is a progressive disease of the atria, involving complex mechanisms related to its initiation, maintenance and progression. Computational modelling provides a framework for integration of experimental and clinical findings, and has emerged as an essential part of mechanistic research in AF. The authors summarise recent advancements in development of multi-scale AF models and focus on the mechanistic links between alternations in atrial structure and electrophysiology with AF. Key AF mechanisms that have been explored using atrial modelling are pulmonary vein ectopy; atrial fibrosis and fibrosis distribution; atrial wall thickness heterogeneity; atrial adipose tissue infiltration; development of repolarisation alternans; cardiac ion channel mutations; and atrial stretch with mechano-electrical feedback. They review modelling approaches that capture variability at the cohort level and provide cohort-specific mechanistic insights. The authors conclude with a summary of future perspectives, as envisioned for the contributions of atrial modelling in the mechanistic understanding of AF.
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Affiliation(s)
- Konstantinos N Aronis
- Department of Biomedical Engineering and the Institute for Computational Medicine, Johns Hopkins UniversityBaltimore, MD, US
- Division of Cardiology, Johns Hopkins HospitalBaltimore, MD, US
| | - Rheeda L Ali
- Department of Biomedical Engineering and the Institute for Computational Medicine, Johns Hopkins UniversityBaltimore, MD, US
| | - Jialiu A Liang
- Department of Biomedical Engineering and the Institute for Computational Medicine, Johns Hopkins UniversityBaltimore, MD, US
| | - Shijie Zhou
- Department of Biomedical Engineering and the Institute for Computational Medicine, Johns Hopkins UniversityBaltimore, MD, US
| | - Natalia A Trayanova
- Department of Biomedical Engineering and the Institute for Computational Medicine, Johns Hopkins UniversityBaltimore, MD, US
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21
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Kim MY, Sikkel MB, Hunter RJ, Haywood GA, Tomlinson DR, Tayebjee MH, Ali RL, Cantwell CD, Gonna H, Sandler BC, Lim E, Furniss G, Panagopoulos D, Begg G, Dhillon G, Hill NJ, O'Neill J, Francis DP, Lim PB, Peters NS, Linton NWF, Kanagaratnam P. A novel approach to mapping the atrial ganglionated plexus network by generating a distribution probability atlas. J Cardiovasc Electrophysiol 2018; 29:1624-1634. [PMID: 30168232 PMCID: PMC6369684 DOI: 10.1111/jce.13723] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2018] [Revised: 08/16/2018] [Accepted: 08/23/2018] [Indexed: 11/27/2022]
Abstract
Introduction The ganglionated plexuses (GPs) of the intrinsic cardiac autonomic system are implicated in arrhythmogenesis. GP localization by stimulation of the epicardial fat pads to produce atrioventricular dissociating (AVD) effects is well described. We determined the anatomical distribution of the left atrial GPs that influence atrioventricular (AV) dissociation. Methods and Results High frequency stimulation was delivered through a Smart‐Touch catheter in the left atrium of patients undergoing atrial fibrillation (AF) ablation. Three dimensional locations of points tested throughout the entire chamber were recorded on the CARTO™ system. Impact on the AV conduction was categorized as ventricular asystole, bradycardia, or no effect. CARTO maps were exported, registered, and transformed onto a reference left atrial geometry using a custom software, enabling data from multiple patients to be overlaid. In 28 patients, 2108 locations were tested and 283 sites (13%) demonstrated (AVD‐GP) effects. There were 10 AVD‐GPs (interquartile range, 11.5) per patient. Eighty percent (226) produced asystole and 20% (57) showed bradycardia. The distribution of the two groups was very similar. Highest probability of AVD‐GPs (>20%) was identified in: inferoseptal portion (41%) and right inferior pulmonary vein base (30%) of the posterior wall, right superior pulmonary vein antrum (31%). Conclusion It is feasible to map the entire left atrium for AVD‐GPs before AF ablation. Aggregated data from multiple patients, producing a distribution probability atlas of AVD‐GPs, identified three regions with a higher likelihood for finding AVD‐GPs and these matched the histological descriptions. This approach could be used to better characterize the autonomic network.
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Affiliation(s)
- Min-Young Kim
- Myocardial Function Section, Imperial Centre for Translational and Experimental Medicine, Imperial College London, London, UK.,Imperial Centre for Cardiac Engineering, Imperial College London, London, UK
| | - Markus B Sikkel
- Myocardial Function Section, Imperial Centre for Translational and Experimental Medicine, Imperial College London, London, UK.,Imperial Centre for Cardiac Engineering, Imperial College London, London, UK.,Department of Cardiology, Imperial College Healthcare NHS Trust, London, UK
| | - Ross J Hunter
- Department of Cardiology, The Barts Heart Centre, St Bartholomew's Hospital, Barts Health NHS Trust, London, UK
| | - Guy A Haywood
- Department of Cardiology, Derriford Hospital, Plymouth Hospitals NHS Trust, Plymouth, UK
| | - David R Tomlinson
- Department of Cardiology, Derriford Hospital, Plymouth Hospitals NHS Trust, Plymouth, UK
| | - Muzahir H Tayebjee
- Department of Cardiology, Leeds General Infirmary, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Rheeda L Ali
- Myocardial Function Section, Imperial Centre for Translational and Experimental Medicine, Imperial College London, London, UK.,Imperial Centre for Cardiac Engineering, Imperial College London, London, UK
| | - Chris D Cantwell
- Myocardial Function Section, Imperial Centre for Translational and Experimental Medicine, Imperial College London, London, UK.,Imperial Centre for Cardiac Engineering, Imperial College London, London, UK
| | - Hanney Gonna
- Myocardial Function Section, Imperial Centre for Translational and Experimental Medicine, Imperial College London, London, UK.,Imperial Centre for Cardiac Engineering, Imperial College London, London, UK
| | - Belinda C Sandler
- Myocardial Function Section, Imperial Centre for Translational and Experimental Medicine, Imperial College London, London, UK.,Imperial Centre for Cardiac Engineering, Imperial College London, London, UK
| | - Elaine Lim
- Imperial Centre for Cardiac Engineering, Imperial College London, London, UK.,Department of Cardiology, Imperial College Healthcare NHS Trust, London, UK
| | - Guy Furniss
- Department of Cardiology, Derriford Hospital, Plymouth Hospitals NHS Trust, Plymouth, UK
| | - Dimitrios Panagopoulos
- Department of Cardiology, Derriford Hospital, Plymouth Hospitals NHS Trust, Plymouth, UK
| | - Gordon Begg
- Department of Cardiology, Derriford Hospital, Plymouth Hospitals NHS Trust, Plymouth, UK
| | - Gurpreet Dhillon
- Department of Cardiology, The Barts Heart Centre, St Bartholomew's Hospital, Barts Health NHS Trust, London, UK
| | - Nicola J Hill
- Department of Cardiology, Leeds General Infirmary, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - James O'Neill
- Department of Cardiology, Leeds General Infirmary, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Darrel P Francis
- Myocardial Function Section, Imperial Centre for Translational and Experimental Medicine, Imperial College London, London, UK.,Imperial Centre for Cardiac Engineering, Imperial College London, London, UK.,Department of Cardiology, Imperial College Healthcare NHS Trust, London, UK
| | - Phang Boon Lim
- Myocardial Function Section, Imperial Centre for Translational and Experimental Medicine, Imperial College London, London, UK.,Imperial Centre for Cardiac Engineering, Imperial College London, London, UK.,Department of Cardiology, Imperial College Healthcare NHS Trust, London, UK
| | - Nicholas S Peters
- Myocardial Function Section, Imperial Centre for Translational and Experimental Medicine, Imperial College London, London, UK.,Imperial Centre for Cardiac Engineering, Imperial College London, London, UK.,Department of Cardiology, Imperial College Healthcare NHS Trust, London, UK
| | - Nick W F Linton
- Myocardial Function Section, Imperial Centre for Translational and Experimental Medicine, Imperial College London, London, UK.,Imperial Centre for Cardiac Engineering, Imperial College London, London, UK.,Department of Cardiology, Imperial College Healthcare NHS Trust, London, UK
| | - Prapa Kanagaratnam
- Myocardial Function Section, Imperial Centre for Translational and Experimental Medicine, Imperial College London, London, UK.,Imperial Centre for Cardiac Engineering, Imperial College London, London, UK.,Department of Cardiology, Imperial College Healthcare NHS Trust, London, UK
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