1
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van Schie MS, Talib S, Knops P, Taverne YJHJ, de Groot NMS. Conduction Velocity and Anisotropic Properties of Fibrillation Waves During Acutely Induced and Long-Standing Persistent AF. JACC Clin Electrophysiol 2024; 10:1592-1604. [PMID: 38752952 DOI: 10.1016/j.jacep.2024.02.001] [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] [Received: 10/25/2023] [Revised: 02/01/2024] [Accepted: 02/04/2024] [Indexed: 08/02/2024]
Abstract
BACKGROUND Quantified features of local conduction heterogeneity due to pathological alterations of myocardial tissue could serve as a marker for the degree of electrical remodeling and hence be used to determine the stage of atrial fibrillation (AF). OBJECTIVES In this study, the authors investigated whether local directional heterogeneity (LDH) and anisotropy ratio, derived from estimated local conduction velocities (CVs) during AF, are suitable electrical parameters to stage AF. METHODS Epicardial mapping (244-electrode array, interelectrode distance 2.25 mm) of the right atrium was performed during acute atrial fibrillation (AAF) (n = 25, 32 ± 11 years of age) and during long-standing persistent atrial fibrillation (LSPAF) (n = 23, 64 ± 9 years of age). Episodes of 9 ± 4 seconds of AF were analyzed. Local CV vectors were constructed to assess the degree of anisotropy. Directions and magnitudes of individual vectors were compared with surrounding vectors to identify LDH. RESULTS Compared with the entire AAF group, LSPAF was characterized by slower conduction (71.5 ± 6.8 cm/s vs 67.6 ± 5.6 cm/s; P = 0.037) with a larger dispersion (1.59 ± 0.21 vs 1.95 ± 0.17; P < 0.001) and temporal variability (32.0 ± 4.7 cm/s vs 38.5 ± 3.3 cm/s; P < 0.001). Also, LSPAF was characterized by more LDH (19.6% ± 4.4% vs 26.0% ± 3.4%; P < 0.001) and a higher degree of anisotropy (1.38 ± 0.07 vs 1.51 ± 0.14; P < 0.001). Compared with the most complex type of AAF (type III), LSPAF was still associated with a larger CV dispersion, higher temporal variability of CV, and larger amount of LDH. CONCLUSIONS Increasing AF complexity was associated with increased spatiotemporal variability of local CV vectors, local conduction heterogeneity, and anisotropy ratio. By using these novel parameters, LSPAF could potentially be discriminated from the most complex type of AAF. These observations may indicate pathological alterations of myocardial tissue underlying progression of AF.
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Affiliation(s)
- Mathijs S van Schie
- Department of Cardiology, Erasmus Medical Center, Rotterdam, the Netherlands
| | - Shmaila Talib
- Department of Cardiology, Haga Teaching Hospital, The Hague, the Netherlands
| | - Paul Knops
- Department of Cardiology, Erasmus Medical Center, Rotterdam, the Netherlands
| | - Yannick J H J Taverne
- Department of Cardiothoracic Surgery, Erasmus Medical Center, Rotterdam, the Netherlands
| | - Natasja M S de Groot
- Department of Cardiology, Erasmus Medical Center, Rotterdam, the Netherlands; Department of Microelectronics, Delft University of Technology, Delft, the Netherlands.
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Kassar A, Akoum N, Boyle PM. Navigating the Stormy Sea of Anisotropy: How Electroanatomic Properties Influence Complex Propagation in Atrial Fibrillation. JACC Clin Electrophysiol 2024; 10:1605-1607. [PMID: 38752953 DOI: 10.1016/j.jacep.2024.03.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2024] [Accepted: 03/09/2024] [Indexed: 08/02/2024]
Affiliation(s)
- Ahmad Kassar
- Electrophysiology Section, Division of Cardiology, University of Washington, Seattle, Washington, USA
| | - Nazem Akoum
- Electrophysiology Section, Division of Cardiology, University of Washington, Seattle, Washington, USA; Department of Bioengineering, University of Washington, Seattle, Washington, USA
| | - Patrick M Boyle
- Department of Bioengineering, University of Washington, Seattle, Washington, USA; Center for Cardiovascular Biology, University of Washington, Seattle, Washington, USA; Institute for Stem Cell and Regenerative Medicine, University of Washington, Seattle, Washington, USA.
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3
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Ayagama T, Charles PD, Bose SJ, Boland B, Priestman DA, Aston D, Berridge G, Fischer R, Cribbs AP, Song Q, Mirams GR, Amponsah K, Heather L, Galione A, Herring N, Kramer H, Capel RA, Platt FM, Schotten U, Verheule S, Burton RA. Compartmentalization proteomics revealed endolysosomal protein network changes in a goat model of atrial fibrillation. iScience 2024; 27:109609. [PMID: 38827406 PMCID: PMC11141153 DOI: 10.1016/j.isci.2024.109609] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Revised: 02/07/2024] [Accepted: 03/25/2024] [Indexed: 06/04/2024] Open
Abstract
Endolysosomes (EL) are known for their role in regulating both intracellular trafficking and proteostasis. EL facilitate the elimination of damaged membranes, protein aggregates, membranous organelles and play an important role in calcium signaling. The specific role of EL in cardiac atrial fibrillation (AF) is not well understood. We isolated atrial EL organelles from AF goat biopsies and conducted a comprehensive integrated omics analysis to study the EL-specific proteins and pathways. We also performed electron tomography, protein and enzyme assays on these biopsies. Our results revealed the upregulation of the AMPK pathway and the expression of EL-specific proteins that were not found in whole tissue lysates, including GAA, DYNLRB1, CLTB, SIRT3, CCT2, and muscle-specific HSPB2. We also observed structural anomalies, such as autophagic-vacuole formation, irregularly shaped mitochondria, and glycogen deposition. Our results provide molecular information suggesting EL play a role in AF disease process over extended time frames.
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Affiliation(s)
- Thamali Ayagama
- Department of Pharmacology, University of Oxford, Oxford, UK
| | | | - Samuel J. Bose
- Department of Pharmacology, University of Oxford, Oxford, UK
| | - Barry Boland
- Department of Pharmacology and Therapeutics, University College Cork, Cork, Ireland
| | | | - Daniel Aston
- Department of Anaesthesia and Critical Care, Royal Papworth Hospital NHS Foundation Trust, Papworth Road, Cambridge CB2 0AY, UK
| | | | - Roman Fischer
- Target Discovery Institute, University of Oxford, Oxford, UK
| | - Adam P. Cribbs
- Nuffield Department of Orthopaedics Rheumatology and Musculoskeletal Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Botnar Research Centre, University of Oxford, Headington OX3 7LD, UK
| | - Qianqian Song
- Department of Pharmacology, University of Oxford, Oxford, UK
| | - Gary R. Mirams
- Centre for Mathematical Medicine & Biology, Mathematical Sciences, University of Nottingham, Nottingham NG7 2RD, UK
| | - Kwabena Amponsah
- Centre for Mathematical Medicine & Biology, Mathematical Sciences, University of Nottingham, Nottingham NG7 2RD, UK
| | - Lisa Heather
- Department of Physiology, Anatomy and Genetics, , University of Oxford, South Park Road, Oxford OX1 3PT, UK
| | - Antony Galione
- Department of Pharmacology, University of Oxford, Oxford, UK
| | - Neil Herring
- Department of Physiology, Anatomy and Genetics, , University of Oxford, South Park Road, Oxford OX1 3PT, UK
| | - Holger Kramer
- Mass spectrometry Facility, The MRC Laboratory of Molecular Biology, Francis Crick Avenue, Cambridge CB2 0QH, UK
| | | | | | - Ulrich Schotten
- Departments of Physiology and Cardiology, Cardiovascular Research Institute Maastricht, Maastricht University, Maastricht, the Netherlands
| | - Sander Verheule
- Departments of Physiology and Cardiology, Cardiovascular Research Institute Maastricht, Maastricht University, Maastricht, the Netherlands
| | - Rebecca A.B. Burton
- Department of Pharmacology, University of Oxford, Oxford, UK
- University of Liverpool, Department of Pharmacology and Therapeutics, Institute of Systems, Molecular and Integrative Biology, Liverpool, UK
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4
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Nyuta E, Takemoto M, Antoku Y, Mito T, Sakai T, Takiguchi T, Ikeda S, Koga T, Tsuchihashi T. Role of Sleep-Disordered Breathing and Epicardial Connections in the Recurrence of Atrial Fibrillation. Int Heart J 2024; 65:414-426. [PMID: 38749745 DOI: 10.1536/ihj.23-653] [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] [Indexed: 06/04/2024]
Abstract
The presence of epicardial connections (ECs) between the pulmonary veins (PVs) and atrium may contribute to atrial fibrillation (AF) recurrence. This study aimed to determine the impact of sleep-disordered breathing (SDB) on the presence of ECs and the interplay between SDB and ECs on AF recurrence.We retrospectively reviewed 400 consecutive non-valvular AF patients. Among them, 235 patients exhibiting a 3% oxygen desaturation index (ODI) of ≥ 10 events/hour underwent polysomnography to evaluate the SDB severity, measured by the apnea-hypopnea index (AHI). To facilitate the ablation of AF and ECs, a high-density mapping catheter (HDMC) was employed. AF recurrence was evaluated over a 12-month period post-AF ablation.The key findings included: 1) 63% of AF patients with ECs had SDB with an AHI ≥ 20 events/hour. 2) Despite achieving complete PV isolations and precise EC ablation using an HDMC, SDB presence was associated with an increased AF recurrence. 3) Continuous positive airway pressure therapy for SDB improved AF recurrence among the AF patients with both ECs and SDB (57% versus 73%; P = 0.016). 4) AHI (odds ratio [OR] = 1.91, ≥ 28.4 events/hour) and left atrial volume (LAV) (OR = 1.42, ≥ 128.3 mL) were independent predictors of the presence of ECs, and AHI (OR = 1.44, ≥ 27.8 events/hour) was an independent predictor of the presence of AF recurrence.It is essential for physicians to recognise the potential complexity of ECs and SDB in AF patients. Thus, screening and treating SDB in AF patients presenting with ECs might play a pivotal role in suppressing AF recurrence.
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Affiliation(s)
- Eiji Nyuta
- Cardiovascular Centre, Steel Memorial Yawata Hospital
| | | | | | | | - Togo Sakai
- Cardiovascular Centre, Steel Memorial Yawata Hospital
| | | | - Shota Ikeda
- Cardiovascular Centre, Steel Memorial Yawata Hospital
| | - Tokushi Koga
- Cardiovascular Centre, Steel Memorial Yawata Hospital
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5
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Zhang L, van Schie MS, Knops P, Taverne YJHJ, de Groot NMS. A novel diagnostic tool to identify atrial endo-epicardial asynchrony using signal fingerprinting. Hellenic J Cardiol 2024; 75:9-20. [PMID: 37482189 DOI: 10.1016/j.hjc.2023.07.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Revised: 06/04/2023] [Accepted: 07/18/2023] [Indexed: 07/25/2023] Open
Abstract
OBJECTIVE Patients with persistent atrial fibrillation (AF) have more electrical endo-epicardial asynchrony (EEA) during sinus rhythm (SR) than patients without AF. Prior mapping studies indicated that particularly unipolar, endo- and/or epicardial electrogram (EGM) morphology may be indicators of EEA. This study aim to develop a novel method for estimating the degree of EEA by using unipolar EGM characteristics recorded from either the endo- and/or epicardium. METHODS Simultaneous endo-epicardial mapping during sinus rhythm was performed in 86 patients. EGM characteristics, including unipolar voltages, low-voltage areas (LVAs), potential types (single, short/long double and fractionated potentials: SP, SDP, LDP and FP) and fractionation duration (FD) of double potentials (DP) and FP were compared between EEA and non-EEA areas. Asynchrony Fingerprinting Scores (AFS) containing quantified EGM characteristics were constructed to estimate the degree of EEA. RESULTS Endo- and epicardial sites of EEA areas are characterized by lower unipolar voltages, a higher number of LDPs and FPs and longer DP and FP durations. Patients with AF have lower potential voltages in EEA areas, along with alterations in the potential types. The EE-AFS, containing the proportion of endocardial LVAs and FD of epicardial DPs, had the highest predictive value for determining the degree of EEA (AUC: 0.913). Endo- and epi-AFS separately also showed good predictive values (AUC: 0.901 and 0.830 respectively). CONCLUSIONS EGM characteristics can be used to identify EEA areas. AFS can be utilized as a novel diagnostic tool for accurately estimating the degree of EEA. These characteristics potentially indicate AF related arrhythmogenic substrates.
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Affiliation(s)
- Lu Zhang
- Department of Cardiology, Erasmus Medical Center, Rotterdam, the Netherlands
| | - Mathijs S van Schie
- Department of Cardiology, Erasmus Medical Center, Rotterdam, the Netherlands
| | - Paul Knops
- Department of Cardiology, Erasmus Medical Center, Rotterdam, the Netherlands
| | - Yannick J H J Taverne
- Translational Cardiothoracic Surgery Research Lab, Department of Cardiothoracic Surgery, Erasmus Medical Center, Rotterdam, the Netherlands
| | - Natasja M S de Groot
- Department of Cardiology, Erasmus Medical Center, Rotterdam, the Netherlands; Department of Microelectronics, Signal Processing Systems, Faculty of Electrical Engineering, Mathematics and Computer Sciences, Delft University of Technology, Delft, the Netherlands.
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6
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Lother A, Kohl P. The heterocellular heart: identities, interactions, and implications for cardiology. Basic Res Cardiol 2023; 118:30. [PMID: 37495826 PMCID: PMC10371928 DOI: 10.1007/s00395-023-01000-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Revised: 07/17/2023] [Accepted: 07/17/2023] [Indexed: 07/28/2023]
Abstract
The heterocellular nature of the heart has been receiving increasing attention in recent years. In addition to cardiomyocytes as the prototypical cell type of the heart, non-myocytes such as endothelial cells, fibroblasts, or immune cells are coming more into focus. The rise of single-cell sequencing technologies enables identification of ever more subtle differences and has reignited the question of what defines a cell's identity. Here we provide an overview of the major cardiac cell types, describe their roles in homeostasis, and outline recent findings on non-canonical functions that may be of relevance for cardiology. We highlight modes of biochemical and biophysical interactions between different cardiac cell types and discuss the potential implications of the heterocellular nature of the heart for basic research and therapeutic interventions.
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Affiliation(s)
- Achim Lother
- Institute of Experimental and Clinical Pharmacology and Toxicology, Faculty of Medicine, University of Freiburg, Albertstr. 25, 79104, Freiburg, Germany.
- Interdisciplinary Medical Intensive Care, Faculty of Medicine, Medical Center-University of Freiburg, University of Freiburg, Freiburg, Germany.
| | - Peter Kohl
- Institute for Experimental Cardiovascular Medicine, Faculty of Medicine, University Heart Center, University of Freiburg, Freiburg, Germany
- CIBSS Centre for Integrative Biological Signalling Studies, University of Freiburg, Freiburg, Germany
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7
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Kamali R, Kwan E, Regouski M, Bunch TJ, Dosdall DJ, Hsu E, Macleod RS, Polejaeva I, Ranjan R. Contribution of atrial myofiber architecture to atrial fibrillation. PLoS One 2023; 18:e0279974. [PMID: 36719871 PMCID: PMC9888724 DOI: 10.1371/journal.pone.0279974] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Accepted: 12/19/2022] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND The role of fiber orientation on a global chamber level in sustaining atrial fibrillation (AF) is unknown. The goal of this study was to correlate the fiber direction derived from Diffusion Tensor Imaging (DTI) with AF inducibility. METHODS Transgenic goats with cardiac-specific overexpression of constitutively active TGF-β1 (n = 14) underwent AF inducibility testing by rapid pacing in the left atrium. We chose a minimum of 10 minutes of sustained AF as a cut-off for AF inducibility. Explanted hearts underwent DTI to determine the fiber direction. Using tractography data, we clustered, visualized, and quantified the fiber helix angles in 8 different regions of the left atrial wall using two reference vectors defined based on anatomical landmarks. RESULTS Sustained AF was induced in 7 out of 14 goats. The mean helix fiber angles in 7 out of 8 selected regions were statistically different (P-Value < 0.05) in the AF inducible group. The average fractional anisotropy (FA) and the mean diffusivity (MD) were similar in the two groups with FA of 0.32±0.08 and MD of 8.54±1.72 mm2/s in the non-inducible group and FA of 0.31±0.05 (P-value = 0.90) and MD of 8.68±1.60 mm2/s (P-value = 0.88) in the inducible group. CONCLUSIONS DTI based fiber direction shows significant variability across subjects with a significant difference between animals that are AF inducible versus animals that are not inducible. Fiber direction might be contributing to the initiation and sustaining of AF, and its role needs to be investigated further.
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Affiliation(s)
- Roya Kamali
- Department of Bioengineering, University of Utah, Salt Lake City, Utah, United States of America
- Cardiovascular Medicine, University of Utah, Salt Lake City, Utah, United States of America
- Nora Eccles Harrison Cardiovascular Research and Training Institute, Salt Lake City, Utah, United States of America
| | - Eugene Kwan
- Department of Bioengineering, University of Utah, Salt Lake City, Utah, United States of America
- Cardiovascular Medicine, University of Utah, Salt Lake City, Utah, United States of America
- Nora Eccles Harrison Cardiovascular Research and Training Institute, Salt Lake City, Utah, United States of America
| | - Misha Regouski
- Department of Animal, Dairy and Veterinary Sciences, Utah State University, Logan, Utah, United States of America
| | - T. Jared Bunch
- Cardiovascular Medicine, University of Utah, Salt Lake City, Utah, United States of America
| | - Derek J. Dosdall
- Department of Bioengineering, University of Utah, Salt Lake City, Utah, United States of America
- Cardiovascular Medicine, University of Utah, Salt Lake City, Utah, United States of America
- Nora Eccles Harrison Cardiovascular Research and Training Institute, Salt Lake City, Utah, United States of America
- Department of Surgery, University of Utah, Salt Lake City, Utah, United States of America
| | - Ed Hsu
- Department of Bioengineering, University of Utah, Salt Lake City, Utah, United States of America
| | - Rob S. Macleod
- Department of Bioengineering, University of Utah, Salt Lake City, Utah, United States of America
| | - Irina Polejaeva
- Department of Animal, Dairy and Veterinary Sciences, Utah State University, Logan, Utah, United States of America
| | - Ravi Ranjan
- Department of Bioengineering, University of Utah, Salt Lake City, Utah, United States of America
- Cardiovascular Medicine, University of Utah, Salt Lake City, Utah, United States of America
- Nora Eccles Harrison Cardiovascular Research and Training Institute, Salt Lake City, Utah, United States of America
- * E-mail:
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8
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Cryoballoon ablation of persistent atrial fibrillation for de novo pulmonary vein isolation: a single-center follow-up study. J Geriatr Cardiol 2022; 19:725-733. [PMID: 36338279 PMCID: PMC9618841 DOI: 10.11909/j.issn.1671-5411.2022.10.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
BACKGROUND Pulmonary vein isolation (PVI) alone for persistent atrial fibrillation (PersAF) remains controversial. The characteristics of cryoballoon ablation (CBA) to treat PersAF and the blanking period recurrence are underreported. METHODS This study retrospectively analyzed patients with PersAF undergoing second-generation CBA for de novo PVI. The post-procedural efficacy and survival analysis were compared between patients with different PersAF durations. The multivariate Cox regression analysis was used to detect the risk factors for recurrence. Early and long-term recurrence were analyzed relative to each other. RESULTS A total of 329 patients were enrolled, with a median PersAF duration of 4.0 months (interquartile range: 2.0-12.0 months); 257 patients (78.1%) were male. Kaplan-Meier analysis of freedom from atrial fibrillation recurrence at 12, 24, and 30 months showed 71.0%, 58.5%, and 54.9%, respectively. Early PersAF had a relatively favorable survival rate and a narrow P-wave duration of restoring sinus rhythm compared with that of PersAF lasting more than three months (P < 0.05). The multivariate Cox regression analysis revealed that PersAF duration and left atrial anteroposterior diameter ≥ 42 mm were the risk factors for atrial fibrillation recurrence after CBA [hazard ratio (HR) = 1.89, 95% CI: 1.01-1.4, P = 0.042; HR = 3.6, 95% CI: 2.4-5.4, P < 0.001, respectively]. The blanking period recurrence predicted the long-term recurrence (P < 0.0001). CONCLUSIONS CBA of PersAF had safety and efficacy to reach de novo PVI. The PersAF duration and left atrial size were risk factors for atrial fibrillation recurrence after CBA. Blanking period recurrence was associated with long-term recurrence.
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9
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Scarano Pereira JP, Owen E, Martinino A, Akmal K, Abouelazayem M, Graham Y, Weiner S, Sakran N, Dekker LR, Parmar C, Pouwels S. Epicardial adipose tissue, obesity and the occurrence of atrial fibrillation: an overview of pathophysiology and treatment methods. Expert Rev Cardiovasc Ther 2022; 20:307-322. [PMID: 35443854 DOI: 10.1080/14779072.2022.2067144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
INTRODUCTION Obesity is a chronic disease, which has significant health consequences and is a staggering burden to health care systems. Obesity can have harmful effects on the cardiovascular system, including heart failure, hypertension, coronary heart disease, and atrial fibrillation (AF). One of the possible substrates might be epicardial adipose tissue (EAT), which can be the link between AF and obesity. EAT is a fat deposit located between the myocardium and the visceral pericardium. Numerous studies have demonstrated that EAT plays a pivotal role in this relationship regarding atrial fibrillation. AREAS COVERED This review will focus on the role of obesity and the occurrence of atrial fibrillation (AF) and examine the connection between these and epicardial adipose tissue (EAT). The first part of this review will explain the pathophysiology of EAT and its association with the occurrence of AF. Secondly, we will review bariatric and metabolic surgery and its effects on EAT and AF. EXPERT COMMENTARY In this review, the epidemiology, pathophysiology, and treatments methods of AF are explained. Secondly the effects on EAT were elucidated. Due to the complex pathophysiological link between EAT, AF, and obesity, it is still uncertain which treatment strategy is superior.
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Affiliation(s)
| | - Eloise Owen
- Faculty of Biology, Medicine and Health, University of Manchester, Manchester, United Kingdom
| | | | - Kiran Akmal
- Faculty of Medicine, Brighton and Sussex Medical School, Brighton, United Kingdom
| | - Mohamed Abouelazayem
- Department of Surgery, Royal Free London Hospitals NHS Foundation, London, United Kingdom
| | - Yitka Graham
- Faculty of Health Sciences and Wellbeing, University of Sunderland, Sunderland, United Kingdom.,Facultad de Psucologia, Universidad Anahuac Mexico, Mexico City, Mexico
| | - Sylvia Weiner
- Department of Bariatric and Metabolic Surgery, Krankenhaus Nordwest, Frankfurt am Main, Germany
| | - Nasser Sakran
- Department of Surgery, Holy Family Hospital, Nazareth, Israel.,Azrieli, Faculty of Medicine, Bar-Ilan University, Safed, Israel
| | - Lukas R Dekker
- Department of Cardiology, Catharina Hospital, Eindhoven, The Netherlands
| | - Chetan Parmar
- Department of Surgery, Whittington Health NHS Trust, London, United Kingdom
| | - Sjaak Pouwels
- Department of Intensive Care Medicine, Elisabeth-Tweesteden Hospital, Tilburg, The Netherlands
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10
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Maesen B, Verheule S, Zeemering S, La Meir M, Nijs J, Lumeij S, Lau DH, Granier M, Crijns HJ, Maessen JG, Dhein S, Schotten U. Endomysial fibrosis, rather than overall connective tissue content, is the main determinant of conduction disturbances in human atrial fibrillation. Europace 2022; 24:1015-1024. [PMID: 35348667 PMCID: PMC9282911 DOI: 10.1093/europace/euac026] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Accepted: 03/15/2022] [Indexed: 12/20/2022] Open
Abstract
Aims Although in persistent atrial fibrillation (AF) a complex AF substrate characterized by a high incidence of conduction block has been reported, relatively little is known about AF complexity in paroxysmal AF (pAF). Also, the relative contribution of various aspects of structural alterations to conduction disturbances is not clear. In particular, the contribution of endomysial fibrosis to conduction disturbances during progression of AF has not been studied yet. Methods and results During cardiac surgery, epicardial high-density mapping was performed in patients with acutely induced (aAF, n = 11), pAF (n = 12), and longstanding persistent AF (persAF, n = 9) on the right atrial (RA) wall, the posterior left atrial wall (pLA) and the LA appendage (LAA). In RA appendages, overall and endomysial (myocyte-to-myocyte distances) fibrosis and connexin 43 (Cx43) distribution were quantified. Unipolar AF electrogram analysis showed a more complex pattern with a larger number of narrower waves, more breakthroughs and a higher fractionation index (FI) in persAF compared with aAF and pAF, with no differences between aAF and pAF. The FI was consistently higher at the pLA compared with the RA. Structurally, Cx43 lateralization increased with AF progression (aAF = 7.5 ± 8.9%, pAF = 24.7 ± 11.1%, persAF = 35.1 ± 11.4%, P < 0.001). Endomysial but not overall fibrosis correlated with AF complexity (r = 0.57, P = 0.001; r = 0.23, P = 0.20; respectively). Conclusions Atrial fibrillation complexity is highly variable in patients with pAF, but not significantly higher than in patients with acutely induced AF, while in patients with persistent AF complexity is higher. Among the structural alterations studied, endomysial fibrosis, but not overall fibrosis, is the strongest determinant of AF complexity.
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Affiliation(s)
- Bart Maesen
- Department of Cardio-Thoracic Surgery, Maastricht University Medical Center, Maastricht, The Netherlands.,Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, Maastricht, The Netherlands
| | - Sander Verheule
- Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, Maastricht, The Netherlands.,Department of Physiology, Maastricht University, Universiteitssingel 50, PO Box 616, 6200MD Maastricht, The Netherlands
| | - Stef Zeemering
- Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, Maastricht, The Netherlands.,Department of Physiology, Maastricht University, Universiteitssingel 50, PO Box 616, 6200MD Maastricht, The Netherlands
| | - Mark La Meir
- Department of Cardiac Surgery, UZ Brussels, Brussels, Belgium
| | - Jan Nijs
- Department of Cardiac Surgery, UZ Brussels, Brussels, Belgium
| | - Stijn Lumeij
- Department of Physiology, Maastricht University, Universiteitssingel 50, PO Box 616, 6200MD Maastricht, The Netherlands
| | - Dennis H Lau
- Department of Physiology, Maastricht University, Universiteitssingel 50, PO Box 616, 6200MD Maastricht, The Netherlands
| | - Mathieu Granier
- Department of Physiology, Maastricht University, Universiteitssingel 50, PO Box 616, 6200MD Maastricht, The Netherlands
| | - Harry Jgm Crijns
- Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, Maastricht, The Netherlands.,Department of Cardiology, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Jos G Maessen
- Department of Cardio-Thoracic Surgery, Maastricht University Medical Center, Maastricht, The Netherlands.,Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, Maastricht, The Netherlands
| | - Stefan Dhein
- Department of Cardiac Surgery, Clinic for Cardiac Surgery, Heart Centre Leipzig, Leipzig, Germany
| | - Ulrich Schotten
- Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, Maastricht, The Netherlands.,Department of Physiology, Maastricht University, Universiteitssingel 50, PO Box 616, 6200MD Maastricht, The Netherlands
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11
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Saliani A, Irakoze É, Jacquemet V. Simulation of diffuse and stringy fibrosis in a bilayer interconnected cable model of the left atrium. Europace 2021; 23:i169-i177. [PMID: 33751082 DOI: 10.1093/europace/euab001] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Accepted: 01/04/2021] [Indexed: 11/13/2022] Open
Abstract
AIMS The aim of this study is to design a computer model of the left atrium for investigating fibre-orientation-dependent microstructure such as stringy fibrosis. METHODS AND RESULTS We developed an approach for automatic construction of bilayer interconnected cable models from left atrial geometry and epi- and endocardial fibre orientation. The model consisted of two layers (epi- and endocardium) of longitudinal and transverse cables intertwined-like fabric threads, with a spatial discretization of 100 µm. Model validation was performed by comparison with cubic volumetric models in normal conditions. Then, diffuse (n = 2904), stringy (n = 3600), and mixed fibrosis patterns (n = 6840) were randomly generated by uncoupling longitudinal and transverse connections in the interconnected cable model. Fibrosis density was varied from 0% to 40% and mean stringy obstacle length from 0.1 to 2 mm. Total activation time, apparent anisotropy ratio, and local activation time jitter were computed during normal rhythm in each pattern. Non-linear regression formulas were identified for expressing measured propagation parameters as a function of fibrosis density and obstacle length (stringy and mixed patterns). Longer obstacles (even below tissue space constant) were independently associated with prolonged activation times, increased anisotropy, and local fluctuations in activation times. This effect was increased by endo-epicardial dissociation and mitigated when fibrosis was limited to the epicardium. CONCLUSION Interconnected cable models enable the study of microstructure in organ-size models despite limitations in the description of transmural structures.
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Affiliation(s)
- Ariane Saliani
- Department of Pharmacology and Physiology, Institute of Biomedical Engineering, Université de Montréal, Montréal, QC H3T 1J4, Canada.,Research Center, Hôpital du Sacré-Cœur de Montréal, 5400 boul. Gouin Ouest, Montréal, QC H4J 1C5, Canada
| | - Éric Irakoze
- Department of Pharmacology and Physiology, Institute of Biomedical Engineering, Université de Montréal, Montréal, QC H3T 1J4, Canada.,Research Center, Hôpital du Sacré-Cœur de Montréal, 5400 boul. Gouin Ouest, Montréal, QC H4J 1C5, Canada
| | - Vincent Jacquemet
- Department of Pharmacology and Physiology, Institute of Biomedical Engineering, Université de Montréal, Montréal, QC H3T 1J4, Canada.,Research Center, Hôpital du Sacré-Cœur de Montréal, 5400 boul. Gouin Ouest, Montréal, QC H4J 1C5, Canada
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12
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Maesen B, Luermans JGLM, Bidar E, Chaldoupi SM, Gelsomino S, Maessen JG, Pison L, Meir ML. A hybrid approach to complex arrhythmias. Europace 2021; 23:ii28-ii33. [PMID: 33837755 DOI: 10.1093/europace/euab027] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2020] [Accepted: 01/20/2021] [Indexed: 12/16/2022] Open
Abstract
Despite many years of research, the different aspects of the mechanism of atrial fibrillation (AF) are still incompletely understood. And although the latest guidelines recommend catheter ablation with pulmonary vein isolation as a rhythm control strategy, long-term results in persistent and long-standing persistent AF are suboptimal. Historically, a mechanistic-based patient-tailored approach for the treatment of AF was impossible because of the lack real-time mapping techniques and advanced ablation tools. Therefore, surgeons created lesion sets based upon the anatomy of both atria and the safety of the incisions made by the knife. These complex open-heart procedures had to be performed through a sternotomy on the arrested heart and where therefore not generally adopted. The use of controlled energy sources such as cryothermy and radiofrequency where the first step to make the creation of these lesions less complex. With the development and improvement of electrophysiology techniques and catheters, this invasive and solely anatomical approach could again be partially redesigned. Now less invasive, it prepared the way for collaboration between electrophysiologists working on the endocardial side of the heart and cardiac surgeons providing epicardial access. The introduction of video-assisted technology and hybrid procedures has further increased the possibilities of new successful therapies. Now more than 40 years since the beginning of this exciting maze of AF procedures and still working towards a less aggressive and more comprehensive approach we give an overview of the history of the different minimally invasive surgical solutions and of the hybrid approach.
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Affiliation(s)
- Bart Maesen
- Department of Cardiothoracic Surgery, Maastricht University Medical Center, Maastricht, the Netherlands.,Cardiovascular Research Institute Maastricht, Maastricht University, Maastricht, the Netherlands
| | - Justin G L M Luermans
- Cardiovascular Research Institute Maastricht, Maastricht University, Maastricht, the Netherlands.,Department of Cardiology, Maastricht University Medical Center, Maastricht, the Netherlands
| | - Elham Bidar
- Department of Cardiothoracic Surgery, Maastricht University Medical Center, Maastricht, the Netherlands.,Cardiovascular Research Institute Maastricht, Maastricht University, Maastricht, the Netherlands
| | - Sevasti-Maria Chaldoupi
- Cardiovascular Research Institute Maastricht, Maastricht University, Maastricht, the Netherlands.,Department of Cardiology, Maastricht University Medical Center, Maastricht, the Netherlands
| | - Sandro Gelsomino
- Department of Cardiothoracic Surgery, Maastricht University Medical Center, Maastricht, the Netherlands
| | - Jos G Maessen
- Department of Cardiothoracic Surgery, Maastricht University Medical Center, Maastricht, the Netherlands.,Cardiovascular Research Institute Maastricht, Maastricht University, Maastricht, the Netherlands
| | | | - Mark La Meir
- Department of Cardiothoracic Surgery, Maastricht University Medical Center, Maastricht, the Netherlands.,Department of Cardiothoracic Surgery, UZ Brussels, Brussels, Belgium
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13
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van Rosmalen F, Maesen B, van Hunnik A, Hermans BJM, Bonizzi P, Bidar E, Nijs J, Maessen JG, Verheule S, Delhaas T, Schotten U, Zeemering S. Incidence, prevalence, and trajectories of repetitive conduction patterns in human atrial fibrillation. Europace 2021; 23:i123-i132. [PMID: 33751087 DOI: 10.1093/europace/euaa403] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Accepted: 12/11/2020] [Indexed: 11/12/2022] Open
Abstract
AIMS Repetitive conduction patterns in atrial fibrillation (AF) may reflect anatomical structures harbouring preferential conduction paths and indicate the presence of stationary sources for AF. Recently, we demonstrated a novel technique to detect repetitive patterns in high-density contact mapping of AF. As a first step towards repetitive pattern mapping to guide AF ablation, we determined the incidence, prevalence, and trajectories of repetitive conduction patterns in epicardial contact mapping of paroxysmal and persistent AF patients. METHODS AND RESULTS A 256-channel mapping array was used to record epicardial left and right AF electrograms in persistent AF (persAF, n = 9) and paroxysmal AF (pAF, n = 11) patients. Intervals containing repetitive conduction patterns were detected using recurrence plots. Activation movies, preferential conduction direction, and average activation sequence were used to characterize and classify conduction patterns. Repetitive patterns were identified in 33/40 recordings. Repetitive patterns were more prevalent in pAF compared with persAF [pAF: median 59%, inter-quartile range (41-72) vs. persAF: 39% (0-51), P < 0.01], larger [pAF: = 1.54 (1.15-1.96) vs. persAF: 1.16 (0.74-1.56) cm2, P < 0.001), and more stable [normalized preferentiality (0-1) pAF: 0.38 (0.25-0.50) vs. persAF: 0.23 (0-0.33), P < 0.01]. Most repetitive patterns were peripheral waves (87%), often with conduction block (69%), while breakthroughs (9%) and re-entries (2%) occurred less frequently. CONCLUSION High-density epicardial contact mapping in AF patients reveals frequent repetitive conduction patterns. In persistent AF patients, repetitive patterns were less frequent, smaller, and more variable than in paroxysmal AF patients. Future research should elucidate whether these patterns can help in finding AF ablation targets.
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Affiliation(s)
- Frank van Rosmalen
- Department of Biomedical Engineering, Cardiovascular Research Institute Maastricht, Maastricht University, Maastricht, The Netherlands
| | - Bart Maesen
- Department of Cardiothoracic Surgery, Maastricht University, Medical Center & Cardiovascular Research Institute Maastricht, Maastricht University, Maastricht, The Netherlands
| | - Arne van Hunnik
- Department of Physiology, Cardiovascular Research Institute Maastricht, Maastricht University, Maastricht, The Netherlands
| | - Ben J M Hermans
- Department of Physiology, Cardiovascular Research Institute Maastricht, Maastricht University, Maastricht, The Netherlands
| | - Pietro Bonizzi
- Department of Data Science and Knowledge Engineering, Maastricht University, Maastricht, The Netherlands
| | - Elham Bidar
- Department of Cardiothoracic Surgery, Maastricht University, Medical Center & Cardiovascular Research Institute Maastricht, Maastricht University, Maastricht, The Netherlands
| | - Jan Nijs
- Department of Cardiac Surgery, UZ Brussel, Brussels, Belgium
| | - Jos G Maessen
- Department of Cardiothoracic Surgery, Maastricht University, Medical Center & Cardiovascular Research Institute Maastricht, Maastricht University, Maastricht, The Netherlands
| | - Sander Verheule
- Department of Physiology, Cardiovascular Research Institute Maastricht, Maastricht University, Maastricht, The Netherlands
| | - Tammo Delhaas
- Department of Biomedical Engineering, Cardiovascular Research Institute Maastricht, Maastricht University, Maastricht, The Netherlands
| | - Ulrich Schotten
- Department of Physiology, Cardiovascular Research Institute Maastricht, Maastricht University, Maastricht, The Netherlands
| | - Stef Zeemering
- Department of Physiology, Cardiovascular Research Institute Maastricht, Maastricht University, Maastricht, The Netherlands
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14
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Smietana JJ, Pothineni NVK, Nazarian S. Thinking Outside the Box: Epicardial Mapping of Atypical Flutter. JACC Clin Electrophysiol 2021; 7:825-827. [PMID: 34167759 DOI: 10.1016/j.jacep.2021.02.015] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Revised: 02/23/2021] [Accepted: 02/25/2021] [Indexed: 10/21/2022]
Affiliation(s)
- Jeffrey J Smietana
- Electrophysiology Section of the Division of Cardiovascular Medicine, The Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Naga Venkata K Pothineni
- Electrophysiology Section of the Division of Cardiovascular Medicine, The Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Saman Nazarian
- Electrophysiology Section of the Division of Cardiovascular Medicine, The Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA.
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15
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Liang Z, Liu L, Cheng L, Wang Z, Zhang J, Yang W, Wang Y, Wu Y. New method and electrophysiological characteristics of LA posterior wall isolation in persistent atrial fibrillation. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2021; 44:1691-1700. [PMID: 33734464 DOI: 10.1111/pace.14220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Revised: 01/21/2021] [Accepted: 03/07/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND Left atrial posterior wall isolation (PWI) is commonly used with persistent atrial fibrillation (AF) ablation. However, potentials are often still recorded in the posterior wall after pulmonary vein isolation (PVI), roof linear ablation, and bottom linear ablation in clinical practice. We aimed to explore the methodological approach and electrophysiological characteristics of PWI. METHODS A total of 36 patients who attended our center with long-standing persistent AF were retrospectively analyzed. After routine PVI and roof and bottom linear ablation, complete PWI was confirmed in sinus rhythm by voltage mapping and high-output pacing. Otherwise, activation mapping and voltage mapping were used to guide ablation on the line or inside the posterior wall until bidirectional block was achieved. RESULTS The first-pass success rate of PWI was 39%. In the remaining 61% of patients with posterior wall electrograms, activation mapping in sinus rhythm showed that the earliest activation point was not on the ablation line but in a relatively dispersed focal area, possibly related to epicardial muscular sleeve insertion. Voltage mapping revealed a focal high-voltage area in the posterior wall matching the relatively dispersed earliest activation site, in which an average of five points of ablation achieved complete PWI without serious esophageal injury. The middle zone contained 80% of the additional posterior wall ablation points. CONCLUSIONS PWI was performed safely and effectively with an average of five additional ablation points in the posterior wall in 61% of patients under the guidance of voltage mapping.
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Affiliation(s)
- Zhuo Liang
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Lifeng Liu
- department of heart center, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Liting Cheng
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Zefeng Wang
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Junmeng Zhang
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Wenxue Yang
- Department of Cardiology, Shijiazhuang Great Wall Hospital of Integrated Traditional Chinese and Western Medicine, Shijiazhuang, China
| | - Yunlong Wang
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Yongquan Wu
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
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16
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Fenner MF, Gatta G, Sattler S, Kuiper M, Hesselkilde EM, Adler DMT, Smerup M, Schotten U, Sørensen U, Diness JG, Jespersen T, Verheule S, Van Hunnik A, Buhl R. Inhibition of Small-Conductance Calcium-Activated Potassium Current ( I K,Ca) Leads to Differential Atrial Electrophysiological Effects in a Horse Model of Persistent Atrial Fibrillation. Front Physiol 2021; 12:614483. [PMID: 33633584 PMCID: PMC7900437 DOI: 10.3389/fphys.2021.614483] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Accepted: 01/08/2021] [Indexed: 12/13/2022] Open
Abstract
Background Small-conductance Ca2+-activated K+ (KCa2) channels have been proposed as a possible atrial-selective target to pharmacologically terminate atrial fibrillation (AF) and to maintain sinus rhythm. However, it has been hypothesized that the importance of the KCa2 current—and thereby the efficacy of small-conductance Ca2+-activated K+ current (IK,Ca) inhibition—might be negatively related to AF duration and the extent of AF-induced remodeling. Experimental Approach and Methods To address the hypothesis of the efficacy of IK,Ca inhibition being dependent on AF duration, the anti-arrhythmic properties of the IK,Ca inhibitor NS8593 (5 mg/kg) and its influence on atrial conduction were studied using epicardial high-density contact mapping in horses with persistent AF. Eleven Standardbred mares with tachypacing-induced persistent AF (42 ± 5 days of AF) were studied in an open-chest experiment. Unipolar AF electrograms were recorded and isochronal high-density maps analyzed to allow for the reconstruction of wave patterns and changes in electrophysiological parameters, such as atrial conduction velocity and AF cycle length. Atrial anti-arrhythmic properties and adverse effects of NS8593 on ventricular electrophysiology were evaluated by continuous surface ECG monitoring. Results IK,Ca inhibition by NS8593 administered intravenously had divergent effects on right and left AF complexity and propagation properties in this equine model of persistent AF. Despite global prolongation of AF cycle length, a slowing of conduction in the right atrium led to increased anisotropy and electrical dissociation, thus increasing AF complexity. In contrast, there was no significant change in AF complexity in the LA, and cardioversion of AF was not achieved. Conclusions Intra-atrial heterogeneity in response to IK,Ca inhibition by NS8593 was observed. The investigated dose of NS8593 increased the AF cycle length but was not sufficient to induce cardioversion. In terms of propagation properties during AF, IK,Ca inhibition by NS8593 led to divergent effects in the right and left atrium. This divergent behavior may have impeded the cardioversion success.
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Affiliation(s)
- Merle Friederike Fenner
- Department of Veterinary Clinical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Taastrup, Denmark
| | - Giulia Gatta
- Department of Physiology, Cardiovascular Research Institute Maastricht, Maastricht, Netherlands
| | - Stefan Sattler
- Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Marion Kuiper
- Department of Physiology, Cardiovascular Research Institute Maastricht, Maastricht, Netherlands
| | - Eva Melis Hesselkilde
- Department of Veterinary Clinical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Taastrup, Denmark.,Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Ditte M T Adler
- Department of Veterinary Clinical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Taastrup, Denmark
| | - Morten Smerup
- Department of Cardiothoracic Surgery, The Heart Centre, Copenhagen University Hospital, Copenhagen, Denmark
| | - Ulrich Schotten
- Department of Physiology, Cardiovascular Research Institute Maastricht, Maastricht, Netherlands
| | | | | | - Thomas Jespersen
- Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Sander Verheule
- Department of Physiology, Cardiovascular Research Institute Maastricht, Maastricht, Netherlands
| | - Arne Van Hunnik
- Department of Physiology, Cardiovascular Research Institute Maastricht, Maastricht, Netherlands
| | - Rikke Buhl
- Department of Veterinary Clinical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Taastrup, Denmark
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17
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Kotadia I, Whitaker J, Roney C, Niederer S, O’Neill M, Bishop M, Wright M. Anisotropic Cardiac Conduction. Arrhythm Electrophysiol Rev 2020; 9:202-210. [PMID: 33437488 PMCID: PMC7788398 DOI: 10.15420/aer.2020.04] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2020] [Accepted: 10/09/2020] [Indexed: 01/06/2023] Open
Abstract
Anisotropy is the property of directional dependence. In cardiac tissue, conduction velocity is anisotropic and its orientation is determined by myocyte direction. Cell shape and size, excitability, myocardial fibrosis, gap junction distribution and function are all considered to contribute to anisotropic conduction. In disease states, anisotropic conduction may be enhanced, and is implicated, in the genesis of pathological arrhythmias. The principal mechanism responsible for enhanced anisotropy in disease remains uncertain. Possible contributors include changes in cellular excitability, changes in gap junction distribution or function and cellular uncoupling through interstitial fibrosis. It has recently been demonstrated that myocyte orientation may be identified using diffusion tensor magnetic resonance imaging in explanted hearts, and multisite pacing protocols have been proposed to estimate myocyte orientation and anisotropic conduction in vivo. These tools have the potential to contribute to the understanding of the role of myocyte disarray and anisotropic conduction in arrhythmic states.
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Affiliation(s)
- Irum Kotadia
- School of Biomedical Engineering and Imaging Sciences, King’s College, London, UK
- Guy’s and St Thomas’ NHS Foundation Trust, London, UK
| | - John Whitaker
- School of Biomedical Engineering and Imaging Sciences, King’s College, London, UK
- Guy’s and St Thomas’ NHS Foundation Trust, London, UK
| | - Caroline Roney
- School of Biomedical Engineering and Imaging Sciences, King’s College, London, UK
| | - Steven Niederer
- School of Biomedical Engineering and Imaging Sciences, King’s College, London, UK
| | - Mark O’Neill
- School of Biomedical Engineering and Imaging Sciences, King’s College, London, UK
- Guy’s and St Thomas’ NHS Foundation Trust, London, UK
| | - Martin Bishop
- School of Biomedical Engineering and Imaging Sciences, King’s College, London, UK
| | - Matthew Wright
- School of Biomedical Engineering and Imaging Sciences, King’s College, London, UK
- Guy’s and St Thomas’ NHS Foundation Trust, London, UK
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18
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Zeemering S, van Hunnik A, van Rosmalen F, Bonizzi P, Scaf B, Delhaas T, Verheule S, Schotten U. A Novel Tool for the Identification and Characterization of Repetitive Patterns in High-Density Contact Mapping of Atrial Fibrillation. Front Physiol 2020; 11:570118. [PMID: 33178041 PMCID: PMC7593698 DOI: 10.3389/fphys.2020.570118] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2020] [Accepted: 09/22/2020] [Indexed: 01/19/2023] Open
Abstract
Introduction Electrical contact mapping provides a detailed view of conduction patterns in the atria during atrial fibrillation (AF). Identification of repetitive wave front propagation mechanisms potentially initiating or sustaining AF might provide more insights into temporal and spatial distribution of candidate AF mechanism and identify targets for catheter ablation. We developed a novel tool based on recurrence plots to automatically identify and characterize repetitive conduction patterns in high-density contact mapping of AF. Materials and Methods Recurrence plots were constructed by first transforming atrial electrograms recorded by a multi-electrode array to activation-phase signals and then quantifying the degree of similarity between snapshots of the activation-phase in the electrode array. An AF cycle length dependent distance threshold was applied to discriminate between repetitive and non-repetitive snapshots. Intervals containing repetitive conduction patterns were detected in a recurrence plot as regions with a high recurrence rate. Intervals that contained similar repetitive patterns were then grouped into clusters. To demonstrate the ability to detect and quantify the incidence, duration and size of repetitive patterns, the tool was applied to left and right atrial recordings in a goat model of different duration of persistent AF [3 weeks AF (3 wkAF, n = 8) and 22 weeks AF (22 wkAF, n = 8)], using a 249-electrode mapping array (2.4 mm inter-electrode distance). Results Recurrence plots identified frequent recurrences of activation patterns in all recordings and indicated a strong correlation between recurrence plot threshold and AF cycle length. Prolonged AF duration was associated with shorter repetitive pattern duration [mean maximum duration 3 wkAF: 74 cycles, 95% confidence interval (54-94) vs. 22 wkAF: 41 cycles (21-62), p = 0.03], and smaller recurrent regions within repetitive patterns [3 wkAF 1.7 cm2 (1.0-2.3) vs. 22 wkAF 0.5 cm2 (0.0-1.2), p = 0.02]. Both breakthrough patterns and re-entry were identified as repetitive conduction patterns. Conclusion Recurrence plots provide a novel way to delineate high-density contact mapping of AF. Dominant repetitive conduction patterns were identified in a goat model of sustained AF. Application of the developed methodology using the new generation of multi-electrode catheters could identify additional targets for catheter ablation of AF.
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Affiliation(s)
- Stef Zeemering
- Department of Physiology, Maastricht University Medical Center, Cardiovascular Research Institute Maastricht, Maastricht, Netherlands
| | - Arne van Hunnik
- Department of Physiology, Maastricht University Medical Center, Cardiovascular Research Institute Maastricht, Maastricht, Netherlands
| | - Frank van Rosmalen
- Department of Biomedical Engineering, Maastricht University Medical Center, Cardiovascular Research Institute Maastricht, Maastricht, Netherlands
| | - Pietro Bonizzi
- Department of Data Science and Knowledge Engineering, Maastricht University, Maastricht, Netherlands
| | - Billy Scaf
- Department of Physiology, Maastricht University Medical Center, Cardiovascular Research Institute Maastricht, Maastricht, Netherlands
| | - Tammo Delhaas
- Department of Biomedical Engineering, Maastricht University Medical Center, Cardiovascular Research Institute Maastricht, Maastricht, Netherlands
| | - Sander Verheule
- Department of Physiology, Maastricht University Medical Center, Cardiovascular Research Institute Maastricht, Maastricht, Netherlands
| | - Ulrich Schotten
- Department of Physiology, Maastricht University Medical Center, Cardiovascular Research Institute Maastricht, Maastricht, Netherlands
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19
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Parameswaran R, Kalman JM, Royse A, Goldblatt J, Larobina M, Watts T, Walters TE, Nalliah CJ, Wong G, Al-Kaisey A, Douglas Anderson R, Voskoboinik A, Sugumar H, Chieng D, Sanders P, Kistler PM, Gerstenfeld EP, Lee G. Endocardial-Epicardial Phase Mapping of Prolonged Persistent Atrial Fibrillation Recordings. Circ Arrhythm Electrophysiol 2020; 13:e008512. [DOI: 10.1161/circep.120.008512] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background:
Endocardial-epicardial dissociation and focal breakthroughs in humans with atrial fibrillation (AF) have been recently demonstrated using activation mapping of short 10-second AF segments. In the current study, we used simultaneous endo-epi phase mapping to characterize endo-epi activation patterns on long segments of human persistent AF.
Methods:
Simultaneous intraoperative mapping of endo- and epicardial lateral right atrium wall was performed in patients with persistent AF using 2 high-density grid catheters (16 electrodes, 3 mm spacing). Filtered unipolar and bipolar electrograms of continuous 2-minute AF recordings and electrodes locations were exported for phase analyses. We defined endocardial-epicardial dissociation as phase difference of ≥20 ms between paired endo-epi electrodes. Wavefronts were classified as rotations, single wavefronts, focal waves, or disorganized activity as per standard criteria. Endo-Epi wavefront patterns were simultaneously compared on dynamic phase maps. Complex fractionated electrograms were defined as bipolar electrograms with ≥5 directional changes occupying at least 70% of sample duration.
Results:
Fourteen patients with persistent AF undergoing cardiac surgery were included. Endocardial-epicardial dissociation was seen in 50.3% of phase maps with significant temporal heterogeneity. Disorganized activity (Endo: 41.3% versus Epi: 46.8%,
P
=0.0194) and single wavefronts (Endo: 31.3% versus Epi: 28.1%,
P
=0.129) were the dominant patterns. Transient rotations (Endo: 22% versus Epi: 19.2%,
P
=0.169; mean duration: 590±140 ms) and nonsustained focal waves (Endo: 1.2% versus Epi: 1.6%,
P
=0.669) were also observed. Apparent transmural migration of rotational activations (n=6) from the epi- to the endocardium was seen in 2 patients. Electrogram fractionation was significantly higher in the epicardium than endocardium (61.2% versus 51.6%,
P
<0.0001).
Conclusions:
Simultaneous endo-epi phase mapping of prolonged human persistent AF recordings shows significant Endocardial-epicardial dissociation marked temporal heterogeneity, discordant and transitioning wavefronts patterns and complex fractionations. No sustained focal activity was observed. Such complex 3-dimensional interactions provide insight into why endocardial mapping alone may not fully characterize the AF mechanism and why endocardial ablation may not be sufficient.
Graphic Abstract:
A
graphic abstract
is available for this article.
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Affiliation(s)
- Ramanathan Parameswaran
- Department of Cardiology, Royal Melbourne Hospital (R.P., J.M.K., T.W., C.J.N., G.W., A.A.-K., R.D.A., G.L.)
- Department of Medicine, University of Melbourne (R.P., J.M.K., A.R., C.J.N., G.W., A.A.-K., R.D.A., A.V., H.S., D.C., P.M.K., G.L.)
- Heart Centre, Alfred Hospital (R.P., A.V., H.S., D.C., P.M.K.)
| | - Jonathan M. Kalman
- Department of Cardiology, Royal Melbourne Hospital (R.P., J.M.K., T.W., C.J.N., G.W., A.A.-K., R.D.A., G.L.)
- Department of Medicine, University of Melbourne (R.P., J.M.K., A.R., C.J.N., G.W., A.A.-K., R.D.A., A.V., H.S., D.C., P.M.K., G.L.)
| | - Alistair Royse
- Department of Medicine, University of Melbourne (R.P., J.M.K., A.R., C.J.N., G.W., A.A.-K., R.D.A., A.V., H.S., D.C., P.M.K., G.L.)
| | - John Goldblatt
- Department of Cardiothoracic Surgery, Royal Melbourne Hospital (A.R., J.G., M.L.)
| | - Marco Larobina
- Department of Cardiothoracic Surgery, Royal Melbourne Hospital (A.R., J.G., M.L.)
| | - Troy Watts
- Department of Cardiology, Royal Melbourne Hospital (R.P., J.M.K., T.W., C.J.N., G.W., A.A.-K., R.D.A., G.L.)
| | - Tomos E. Walters
- Section of Cardiac Electrophysiology, Division of Cardiology, Department of Medicine, University of California San Francisco (T.E.W., E.P.G)
| | - Chrishan J. Nalliah
- Department of Cardiology, Royal Melbourne Hospital (R.P., J.M.K., T.W., C.J.N., G.W., A.A.-K., R.D.A., G.L.)
- Department of Medicine, University of Melbourne (R.P., J.M.K., A.R., C.J.N., G.W., A.A.-K., R.D.A., A.V., H.S., D.C., P.M.K., G.L.)
| | - Geoffrey Wong
- Department of Cardiology, Royal Melbourne Hospital (R.P., J.M.K., T.W., C.J.N., G.W., A.A.-K., R.D.A., G.L.)
- Department of Medicine, University of Melbourne (R.P., J.M.K., A.R., C.J.N., G.W., A.A.-K., R.D.A., A.V., H.S., D.C., P.M.K., G.L.)
| | - Ahmed Al-Kaisey
- Department of Cardiology, Royal Melbourne Hospital (R.P., J.M.K., T.W., C.J.N., G.W., A.A.-K., R.D.A., G.L.)
- Department of Medicine, University of Melbourne (R.P., J.M.K., A.R., C.J.N., G.W., A.A.-K., R.D.A., A.V., H.S., D.C., P.M.K., G.L.)
| | - Robert Douglas Anderson
- Department of Cardiology, Royal Melbourne Hospital (R.P., J.M.K., T.W., C.J.N., G.W., A.A.-K., R.D.A., G.L.)
- Department of Medicine, University of Melbourne (R.P., J.M.K., A.R., C.J.N., G.W., A.A.-K., R.D.A., A.V., H.S., D.C., P.M.K., G.L.)
| | - Aleksandr Voskoboinik
- Department of Medicine, University of Melbourne (R.P., J.M.K., A.R., C.J.N., G.W., A.A.-K., R.D.A., A.V., H.S., D.C., P.M.K., G.L.)
- Heart Centre, Alfred Hospital (R.P., A.V., H.S., D.C., P.M.K.)
- Baker IDI Heart & Diabetes Institute, Melbourne (A.V., H.S., D.C., P.M.K.)
| | - Hariharan Sugumar
- Department of Medicine, University of Melbourne (R.P., J.M.K., A.R., C.J.N., G.W., A.A.-K., R.D.A., A.V., H.S., D.C., P.M.K., G.L.)
- Heart Centre, Alfred Hospital (R.P., A.V., H.S., D.C., P.M.K.)
- Baker IDI Heart & Diabetes Institute, Melbourne (A.V., H.S., D.C., P.M.K.)
| | - David Chieng
- Department of Medicine, University of Melbourne (R.P., J.M.K., A.R., C.J.N., G.W., A.A.-K., R.D.A., A.V., H.S., D.C., P.M.K., G.L.)
- Heart Centre, Alfred Hospital (R.P., A.V., H.S., D.C., P.M.K.)
- Baker IDI Heart & Diabetes Institute, Melbourne (A.V., H.S., D.C., P.M.K.)
| | - Prashanthan Sanders
- Centre for Heart Rhythm Disorders, South Australian Health & Medical Research Institute, University of Adelaide, Royal Adelaide Hospital, Australia (P.S.)
| | - Peter M. Kistler
- Department of Medicine, University of Melbourne (R.P., J.M.K., A.R., C.J.N., G.W., A.A.-K., R.D.A., A.V., H.S., D.C., P.M.K., G.L.)
- Heart Centre, Alfred Hospital (R.P., A.V., H.S., D.C., P.M.K.)
- Baker IDI Heart & Diabetes Institute, Melbourne (A.V., H.S., D.C., P.M.K.)
| | - Edward P. Gerstenfeld
- Section of Cardiac Electrophysiology, Division of Cardiology, Department of Medicine, University of California San Francisco (T.E.W., E.P.G)
| | - Geoffrey Lee
- Department of Cardiology, Royal Melbourne Hospital (R.P., J.M.K., T.W., C.J.N., G.W., A.A.-K., R.D.A., G.L.)
- Department of Medicine, University of Melbourne (R.P., J.M.K., A.R., C.J.N., G.W., A.A.-K., R.D.A., A.V., H.S., D.C., P.M.K., G.L.)
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20
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Acute hyperglycaemia is not associated with the development of atrial fibrillation in healthy pigs. Sci Rep 2020; 10:11881. [PMID: 32681085 PMCID: PMC7367844 DOI: 10.1038/s41598-020-68897-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2020] [Accepted: 07/03/2020] [Indexed: 01/13/2023] Open
Abstract
Development and progression of atrial fibrillation (AF) is driven by comorbidities such as arterial hypertension and diabetes mellitus. In animal models of chronic hyperglycaemia, progression of AF has been proposed to be triggered by oxidative stress, apoptosis and fibrosis. Acute glycosylation of CaMKII has been associated with increased susceptibility to arrhythmias in acute hyperglycaemia. However, the proarrhythmogenic effect of acute hyperglycaemia has not been investigated. Nine healthy, anesthetized pigs (54 ± 6 kg) were instrumented with electrophysiologic catheters and a multielectrode array on the epicardium of the left atrial anterior wall. Left and right atrial effective refractory periods (AERP), inducibility of AF and left atrial epicardial conduction velocities (CV) were measured at baseline (BL), increasing steps of blood glucose (200-500 mg/dL in steps of 100 mg/dL by glucose infusion) and repeated after normalisation of blood glucose levels (recovery). Serum electrolytes were kept constant during measurements by means of sodium and potassium infusion. There were no significant differences in AERP, CV or AF inducibility between BL and recovery. Heart rate remained constant regardless of blood glucose levels (BL: 103 ± 18 bpm, 500 mg/dL: 103 ± 18 bpm, r = 0.02, p = 0.346). Mean left as well as right AERP increased with higher glucose levels. CV increased with glucose levels (1.25 (1.04, 1.67) m/s at BL vs. 1.53 (1.22, 2.15) m/s at 500 mg/dL, r = 0.85, p = 0.034). Rate of AF inducibility in the left atrium remained constant throughout the whole protocol (AF episodes > 10 s: mean inducibility of 80% at BL vs. 69% at 500 mg/dL, p = 0.32, episodes > 30 s: 0% at BL vs. 0% at 500 mg/dL, p = 0.17). Our data imply that acute hyperglycaemia is associated with lower arrhythmogenic substrate and does not promote AF inducibility.
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21
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Schram-Serban C, Heida A, Roos-Serote MC, Knops P, Kik C, Brundel B, Bogers AJJC, de Groot NMS. Heterogeneity in Conduction Underlies Obesity-Related Atrial Fibrillation Vulnerability. Circ Arrhythm Electrophysiol 2020; 13:e008161. [PMID: 32301327 DOI: 10.1161/circep.119.008161] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
BACKGROUND Obese patients are more vulnerable to development of atrial fibrillation but pathophysiology underlying this relation is only partly understood. The aim of this study is to compare the severity and extensiveness of conduction disorders between obese patients and nonobese patients measured at a high-resolution scale. METHODS Patients (N=212) undergoing cardiac surgery (male:161, 63±11 years) underwent epicardial mapping of the right atrium, Bachmann bundle, and left atrium during sinus rhythm. Conduction delay (CD) was defined as interelectrode conduction time of 7 to 11 ms and conduction block (CB) as conduction time ≥12 ms. Prevalence of CD/CB, continuous CDCB (cCDCB), length of CD/CB/cCDCB lines, and severity of CB were analyzed. RESULTS In obese patients, the overall incidence of CD (3.1% versus 2.6%; P=0.002), CB (1.8% versus 1.2%; P<0.001), and cCDCB (2.6% versus 1.9%; P<0.001) was higher and CD (P=0.012) and cCDCB (P<0.001) lines are longer. There were more conduction disorders at Bachmann bundle and this area has a higher incidence of CD (4.4% versus 3.3%, P=0.002), CB (3.1% versus 1.6%, P<0.001), cCDCB (4.6% versus 2.7%, P<0.001) and longer CD (P<0.001) or cCDCB (P=0.017) lines. The severity of CB is also higher, particularly in the Bachmann bundle (P=0.008) and pulmonary vein (P=0.020) areas. In addition, obese patients have a higher incidence of early de-novo postoperative atrial fibrillation (P=0.003). Body mass index (P=0.037) and the overall amount of CB (P=0.012) were independent predictors for incidence of early postoperative atrial fibrillation. CONCLUSIONS Compared with nonobese patients, obese patients have higher incidences of conduction disorders, which are also more extensive and more severe. These differences in heterogeneity in conduction are already present during sinus rhythm and may explain the higher vulnerability to atrial fibrillation of obese patients.
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Affiliation(s)
- Corina Schram-Serban
- Department of Cardiology (C.S.-S., A.H., M.C.R.-S., P.K., N.M.S.d.G.), Erasmus University Medical Center, Rotterdam
| | - Annejet Heida
- Department of Cardiology (C.S.-S., A.H., M.C.R.-S., P.K., N.M.S.d.G.), Erasmus University Medical Center, Rotterdam
| | - Maarten C Roos-Serote
- Department of Cardiology (C.S.-S., A.H., M.C.R.-S., P.K., N.M.S.d.G.), Erasmus University Medical Center, Rotterdam
| | - Paul Knops
- Department of Cardiology (C.S.-S., A.H., M.C.R.-S., P.K., N.M.S.d.G.), Erasmus University Medical Center, Rotterdam
| | - Charles Kik
- Department of Cardio-Thoracic Surgery (C.K., A.J.J.C.B.), Erasmus University Medical Center, Rotterdam
| | - Bianca Brundel
- Department of Physiology, Amsterdam UMC, Vrije Universiteit Amsterdam (B.B.).,Cardiovascular Sciences, Amsterdam, The Netherlands (B.B.)
| | - Ad J J C Bogers
- Department of Cardio-Thoracic Surgery (C.K., A.J.J.C.B.), Erasmus University Medical Center, Rotterdam
| | - Natasja M S de Groot
- Department of Cardiology (C.S.-S., A.H., M.C.R.-S., P.K., N.M.S.d.G.), Erasmus University Medical Center, Rotterdam
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22
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Abstract
This review focusses on novel findings in atrial fibrillation mechanisms derived from mapping studies. Recent panoramic mapping techniques have identified 2 arrhythmic mechanisms of interest, namely, rotational (rotors) and ectopic focal activations as drivers of atrial fibrillation. Epicardial adipose tissue and fatty infiltration into the myocardium have been described as novel substrates for atrial fibrillation. There is increasing appreciation that the thin atrial walls harbor a complex 3-dimensional electrostructural substrate to contribute to atrial fibrillation sustenance. Further research is warranted to advance the field toward more targeted therapy.
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Affiliation(s)
- Dennis H Lau
- Department of Cardiology, Centre for Heart Rhythm Disorders, University of Adelaide, Royal Adelaide Hospital, 1 Port Road, Adelaide, South Australia 5000, Australia
| | - Dominik Linz
- Department of Cardiology, Centre for Heart Rhythm Disorders, University of Adelaide, Royal Adelaide Hospital, 1 Port Road, Adelaide, South Australia 5000, Australia
| | - Prashanthan Sanders
- Department of Cardiology, Centre for Heart Rhythm Disorders, University of Adelaide, Royal Adelaide Hospital, 1 Port Road, Adelaide, South Australia 5000, Australia.
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23
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Gan Y, Lye TH, Marboe CC, Hendon CP. Characterization of the human myocardium by optical coherence tomography. JOURNAL OF BIOPHOTONICS 2019; 12:e201900094. [PMID: 31400074 PMCID: PMC7456394 DOI: 10.1002/jbio.201900094] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/12/2019] [Revised: 06/25/2019] [Accepted: 08/08/2019] [Indexed: 05/21/2023]
Abstract
Imaging of cardiac tissue structure plays a critical role in the treatment and understanding of cardiovascular disease. Optical coherence tomography (OCT) offers the potential to provide valuable, high-resolution imaging of cardiac tissue. However, there is a lack of comprehensive OCT imaging data of the human heart, which could improve identification of structural substrates underlying cardiac abnormalities. The objective of this study was to provide qualitative and quantitative analysis of OCT image features throughout the human heart. Fifty human hearts were acquired, and tissues from all chambers were imaged with OCT. Histology was obtained to verify tissue composition. Statistical differences between OCT image features corresponding to different tissue types and chambers were estimated using analysis of variance. OCT imaging provided features that were able to distinguish structures such as thickened collagen, as well as adipose tissue and fibrotic myocardium. Statistically significant differences were found between atria and ventricles in attenuation coefficient, and between adipose and all other tissue types. This study provides an overview of OCT image features throughout the human heart, which can be used for guiding future applications such as OCT-integrated catheter-based treatments or ex vivo investigation of structural substrates.
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Affiliation(s)
- Yu Gan
- Department of Electrical Engineering, Columbia University, New York, New York
| | - Theresa H. Lye
- Department of Electrical Engineering, Columbia University, New York, New York
| | - Charles C. Marboe
- Department of Pathology and Cell Biology, Columbia University Medical Center, New York, New York
| | - Christine P. Hendon
- Department of Electrical Engineering, Columbia University, New York, New York
- Correspondence: Christine P. Hendon, Department of Electrical Engineering, Columbia University, 500 W 120th Street, New York, NY 10032.
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24
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Abstract
Ablation of AF through electrical isolation of the pulmonary veins is a well-established technique and a cornerstone in the ablation of AF, although there are a variety of techniques and ablation strategies now available. However, high numbers of patients are returning to hospital after ablation procedures such as pulmonary vein isolation (PVI). Scar tissue (as identified by contact voltage mapping) is found to be present in many of these patients, especially those with persistent AF and even those with paroxysmal AF. This scarring is associated with poor outcomes after PVI. Cardiac mapping is necessary to locate triggers and substrate so that an ablation strategy can be optimised. Multipolar mapping catheters offer more information regarding the status of the tissue than standard ablation catheters. A patient-tailored catheter ablation approach, targeting the patient-specific low voltage/fibrotic substrate can lead to improved outcomes.
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25
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Hendon CP, Lye TH, Yao X, Gan Y, Marboe CC. Optical coherence tomography imaging of cardiac substrates. Quant Imaging Med Surg 2019; 9:882-904. [PMID: 31281782 PMCID: PMC6571187 DOI: 10.21037/qims.2019.05.09] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2019] [Accepted: 05/06/2019] [Indexed: 01/02/2023]
Abstract
Cardiovascular disease is the leading cause of morbidity and mortality in the United States. Knowledge of a patient's heart structure will help to plan procedures, potentially identifying arrhythmia substrates, critical structures to avoid, detect transplant rejection, and reduce ambiguity when interpreting electrograms and functional measurements. Similarly, basic research of numerous cardiac diseases would greatly benefit from structural imaging at cellular scale. For both applications imaging on the scale of a myocyte is needed, which is approximately 100 µm × 10 µm. The use of optical coherence tomography (OCT) as a tool for characterizing cardiac tissue structure and function has been growing in the past two decades. We briefly review OCT principles and highlight important considerations when imaging cardiac muscle. In particular, image penetration, tissue birefringence, and light absorption by blood during in vivo imaging are important factors when imaging the heart with OCT. Within the article, we highlight applications of cardiac OCT imaging including imaging heart tissue structure in small animal models, quantification of myofiber organization, monitoring of radiofrequency ablation (RFA) lesion formation, structure-function analysis enabled by functional extensions of OCT and multimodal analysis and characterizing important substrates within the human heart. The review concludes with a summary and future outlook of OCT imaging the heart, which is promising with progress in optical catheter development, functional extensions of OCT, and real time image processing to enable dynamic imaging and real time tracking during therapeutic procedures.
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Affiliation(s)
| | | | | | - Yu Gan
- Columbia University, New York, NY, USA
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26
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Tissue-Specific Optical Mapping Models of Swine Atria Informed by Optical Coherence Tomography. Biophys J 2019; 114:1477-1489. [PMID: 29590604 PMCID: PMC5883619 DOI: 10.1016/j.bpj.2018.01.035] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2017] [Revised: 01/12/2018] [Accepted: 01/30/2018] [Indexed: 11/21/2022] Open
Abstract
Computational models and experimental optical mapping of cardiac electrophysiology serve as powerful tools to investigate the underlying mechanisms of arrhythmias. Modeling can also aid the interpretation of optical mapping signals, which may have different characteristics with respect to the underlying electrophysiological signals they represent. However, despite the prevalence of atrial arrhythmias such as atrial fibrillation, models of optical electrical mapping incorporating realistic structure of the atria are lacking. Therefore, we developed image-based models of atrial tissue using structural information extracted from optical coherence tomography (OCT), which can provide volumetric tissue characteristics in high resolution. OCT volumetric data of four swine atrial tissue samples were used to develop models incorporating tissue geometry, tissue-specific myofiber orientation, and ablation lesion regions. We demonstrated the use of these models through electrophysiology and photon scattering simulations. Changes in transmural electrical conduction were observed with the inclusion of OCT-derived, depth-resolved fiber orientation. Additionally, the amplitude of optical mapping signals were not found to correspond with lesion transmurality because of lesion geometry and electrical propagation occurring beyond excitation light penetration. This work established a framework for the development of tissue-specific models of atrial tissue derived from OCT imaging data, which can be useful in future investigations of electrophysiology and optical mapping signals with respect to realistic atrial tissue structure.
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27
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Garcia F, Enriquez A, Arroyo A, Supple G, Marchlinski F, Saenz L. Roof-dependent atrial flutter with an epicardial component: Role of the septopulmonary bundle. J Cardiovasc Electrophysiol 2019; 30:1159-1163. [DOI: 10.1111/jce.13885] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2019] [Revised: 02/08/2019] [Accepted: 02/16/2019] [Indexed: 11/29/2022]
Affiliation(s)
- Fermin Garcia
- Section of Cardiac Electrophysiology, Department of Medicine; Hospital of the University of Pennsylvania; Philadelphia PA
| | - Andres Enriquez
- Division of Cardiology; Queen's University; Kingston Ontario Canada
| | - Alonso Arroyo
- International Arrhythmia Center, CardioInfantil Foundation; Bogotá Colombia
| | - Gregory Supple
- Section of Cardiac Electrophysiology, Department of Medicine; Hospital of the University of Pennsylvania; Philadelphia PA
| | - Francis Marchlinski
- Section of Cardiac Electrophysiology, Department of Medicine; Hospital of the University of Pennsylvania; Philadelphia PA
| | - Luis Saenz
- International Arrhythmia Center, CardioInfantil Foundation; Bogotá Colombia
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28
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Vroomen M, Olsthoorn JR, Maesen B, L’Espoir V, La Meir M, Das M, Maessen JG, Crijns HJGM, Verheule S, Pison L. Quantification of epicardial adipose tissue in patients undergoing hybrid ablation for atrial fibrillation. Eur J Cardiothorac Surg 2019; 56:79-86. [DOI: 10.1093/ejcts/ezy472] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2018] [Revised: 12/02/2018] [Accepted: 12/13/2018] [Indexed: 01/10/2023] Open
Abstract
Abstract
OBJECTIVES
Epicardial adipose tissue volume (EAT-V) has been linked to atrial fibrillation (AF) recurrences after catheter ablation. We retrospectively studied the association between atrial EAT-V and outcome after hybrid AF ablation (epicardial surgical and endocardial catheter ablation).
METHODS
On preoperative cardiac computed tomography angiography scans, the left atrium and right atrium were manually delineated using the open source ImageJ. With custom-made automated software, the number of pixels in the regions of interest on each slice was calculated. On the basis of the Hounsfield units, pixel size and slice thickness, EAT-V was computed and normalized in relation to the body surface area (BSA) and the myocardial tissue volume.
RESULTS
Eighty-five patients were included. Left atrial and right atrial EAT-V normalized to BSA were not significantly different between paroxysmal and persistent AF [0.84 (0.51–1.50) vs 0.81 (0.57–1.18), 1.74 (1.02–2.56) vs 1.55 (1.26–2.18), all P = 0.9], neither between the acute conduction block and no acute conduction block in the epicardial box lesion [0.92 (0.55–1.39) vs 0.72 (0.55–1.24), P = 0.5, right atrium not applicable], nor between the sinus rhythm and arrhythmia recurrence after 12 months [0.88 (0.55–1.48) vs 0.63 (0.47–1.10), 1.61 (1.11–2.50) vs 1.55 (1.20–2.20), all P > 0.1]. Left atrial EAT-V normalized to myocardial tissue volume was not different between the groups.
CONCLUSIONS
This study could neither confirm that EAT-V was predictive of recurrence of supraventricular arrhythmias in patients undergoing a hybrid AF ablation, nor that EAT-V was different between patients with paroxysmal AF and persistent and long-standing persistent AF. This suggests that EAT-V might not affect the outcome in surgical ablation procedures and therefore should not influence preoperative or intraoperative decision-making.
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Affiliation(s)
- Mindy Vroomen
- Department of Cardiology, Maastricht University Medical Center, Maastricht, Netherlands
- Cardiovascular Research Institute Maastricht, Maastricht, Netherlands
| | - Jules R Olsthoorn
- Department of Cardiothoracic Surgery, Maastricht University Medical Center, Maastricht, Netherlands
| | - Bart Maesen
- Cardiovascular Research Institute Maastricht, Maastricht, Netherlands
- Department of Cardiothoracic Surgery, Maastricht University Medical Center, Maastricht, Netherlands
| | - Vladimir L’Espoir
- Department of Cardiothoracic Surgery, Maastricht University Medical Center, Maastricht, Netherlands
| | - Mark La Meir
- Department of Cardiothoracic Surgery, Maastricht University Medical Center, Maastricht, Netherlands
| | - Marco Das
- Cardiovascular Research Institute Maastricht, Maastricht, Netherlands
- Department of Radiology, Maastricht University Medical Center, Maastricht, Netherlands
| | - Jos G Maessen
- Cardiovascular Research Institute Maastricht, Maastricht, Netherlands
- Department of Cardiothoracic Surgery, Maastricht University Medical Center, Maastricht, Netherlands
| | - Harry J G M Crijns
- Department of Cardiology, Maastricht University Medical Center, Maastricht, Netherlands
- Cardiovascular Research Institute Maastricht, Maastricht, Netherlands
| | - Sander Verheule
- Cardiovascular Research Institute Maastricht, Maastricht, Netherlands
- Department of Physiology, Maastricht University Medical Center, Maastricht, Netherlands
| | - Laurent Pison
- Department of Cardiology, Maastricht University Medical Center, Maastricht, Netherlands
- Cardiovascular Research Institute Maastricht, Maastricht, Netherlands
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29
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Lewis M, Whang W, Biviano A, Hickey K, Garan H, Rosenbaum M. Predictors and rates of recurrence of atrial arrhythmias following catheter ablation in adults with congenital heart disease. CONGENIT HEART DIS 2018; 14:207-212. [PMID: 30451375 DOI: 10.1111/chd.12695] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2018] [Accepted: 09/12/2018] [Indexed: 11/28/2022]
Abstract
BACKGROUND Catheter ablation is commonly performed to treat atrial arrhythmias in adult congenital heart disease (ACHD). Despite the frequency of ablations in the ACHD population, predictors of recurrence remain poorly defined. OBJECTIVE We sought to determine predictors of arrhythmia recurrence in ACHD patients following catheter ablation for atrial arrhythmias. METHODS We performed a retrospective study of all catheter ablations for atrial arrhythmias performed in ACHD patients between January 12, 2005 and February 11, 2015 at our institution. Prespecified exposures of interest and time from ablation to recurrence were determined via chart review. RESULTS Among 124 patients (mean age: 45 years) who underwent catheter ablation, 96 (77%) were treated for macro-reentrant atrial tachycardia, 10 (7%) for focal atrial tachycardia, 9 (7%) for atrial fibrillation, 7 (6%) for atrioventricular nodal reentrant tachycardia, and 2 (2%) for atrioventricular reentrant tachycardia. 15 (12%) required transseptal/transbaffle puncture. Fifty-one percent of patients recurred with a median time to recurrence of 1639 days. By univariate and multivariable analysis, body mass index (BMI) and Fontan status were the only variables associated with recurrence. Dose-dependent effect was observed with overweight (HR = 2.37, P = .012), obese (HR = 2.67, P = .009), and morbidly obese (HR = 4.23, P = .003) patients demonstrating an increasing risk for arrhythmia recurrence postablation. There was no significant different in recurrence rates by gender, age, non-Fontan diagnosis, or need for transseptal puncture. CONCLUSIONS In our cohort of ACHD patients, BMI was a significant risk factor for arrhythmia recurrence postablation, independent of Fontan status. These findings may help guide treatment decisions for persistent arrhythmias in the ACHD population.
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Affiliation(s)
- Matthew Lewis
- Division of Cardiology, Department of Medicine, Schneeweiss Adult Congenital Heart Center, Columbia University Medical Center, New York, New York
| | - William Whang
- Division of Cardiology, Department of Medicine, Columbia University Medical Center, Electrophysiology Service, New York, New York
| | - Angelo Biviano
- Division of Cardiology, Department of Medicine, Columbia University Medical Center, Electrophysiology Service, New York, New York
| | - Kathleen Hickey
- Division of Cardiology, Department of Medicine, Columbia University Medical Center, Electrophysiology Service, New York, New York
| | - Hasan Garan
- Division of Cardiology, Department of Medicine, Columbia University Medical Center, Electrophysiology Service, New York, New York
| | - Marlon Rosenbaum
- Division of Cardiology, Department of Medicine, Schneeweiss Adult Congenital Heart Center, Columbia University Medical Center, New York, New York
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30
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Stiles MK, Sanders P, Lau DH. Targeting the Substrate in Ablation of Persistent Atrial Fibrillation: Recent Lessons and Future Directions. Front Physiol 2018; 9:1158. [PMID: 30279660 PMCID: PMC6154526 DOI: 10.3389/fphys.2018.01158] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2018] [Accepted: 08/02/2018] [Indexed: 12/16/2022] Open
Abstract
While isolation of the pulmonary veins is firmly established as effective treatment for the majority of paroxysmal atrial fibrillation (AF) patients, there is recognition that patients with persistent AF have substrate for perpetuation of arrhythmia existing outside of the pulmonary veins. Various computational approaches have been used to identify targets for effective ablation of persistent AF. This paper aims to discuss the clinical aspects of computational approaches that aim to identify critical sites for treatment. Various analyses of electrogram characteristics have been performed with this aim. Leading techniques for electrogram analysis are Complex Fractionated Atrial Electrograms (CFAE) and Dominant Frequency (DF). These techniques have been the subject of clinical trials of which the results are discussed. Evaluation of the activation patterns of atria in AF has been another avenue of research. Focal Impulse and Rotor Modulation (FIRM) mapping and forms of Body Surface Mapping aim to characterize multiple atrial wavelets, macro-reentry and focal sources which have been proposed as basic mechanisms perpetuating AF. Both invasive and non-invasive activation mapping techniques are reviewed. The presence of atrial fibrosis causes non-uniform anisotropic impulse propagation. Therefore, identification of fibrosis by imaging techniques is an avenue of potential research. The leading contender for imaging-based techniques is Cardiac Magnetic Resonance (CMR). As this technology advances, improvements in resolution and scar identification have positioned CMR as the mode of choice for analysis of atrial structure. AF has been demonstrated to be associated with obesity, inactivity and diseases of modern life. An opportunity exists for detailed computational analysis of the impact of risk factor modification on atrial substrate. This ranges from microstructural investigation through to examination at a population level via registries and public health interventions. Computational analysis of atrial substrate has moved from basic science toward clinical application. Future directions and potential limitations of such analyses are examined in this review.
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Affiliation(s)
- Martin K Stiles
- Waikato Clinical School, University of Auckland, Hamilton, New Zealand.,Department of Cardiology, Waikato District Health Board, Hamilton, New Zealand
| | - Prashanthan Sanders
- Centre for Heart Rhythm Disorders (CHRD), South Australian Health and Medical Research Institute (SAHMRI), The University of Adelaide and Royal Adelaide Hospital, Adelaide, SA, Australia
| | - Dennis H Lau
- Centre for Heart Rhythm Disorders (CHRD), South Australian Health and Medical Research Institute (SAHMRI), The University of Adelaide and Royal Adelaide Hospital, Adelaide, SA, Australia
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31
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Gharaviri A, Verheule S, Eckstein J, Potse M, Kuklik P, Kuijpers NHL, Schotten U. How disruption of endo-epicardial electrical connections enhances endo-epicardial conduction during atrial fibrillation. Europace 2018; 19:308-318. [PMID: 28175261 DOI: 10.1093/europace/euv445] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2015] [Accepted: 08/11/2015] [Indexed: 11/12/2022] Open
Abstract
Aims Loss of side-to-side electrical connections between atrial muscle bundles is thought to underlie conduction disturbances predisposing to atrial fibrillation (AF). Putatively, disruption of electrical connections occurs not only within the epicardial layer but also between the epicardial layer and the endocardial bundle network, thus impeding transmural conductions (‘breakthroughs’). However, both clinical and experimental studies have shown an enhancement of breakthroughs during later stages of AF. We tested the hypothesis that endo-epicardial uncoupling enhances endo-epicardial electrical dyssynchrony, breakthrough rate (BTR), and AF stability. Methods and Results In a novel dual-layer computer model of the human atria, 100% connectivity between the two layers served as healthy control. Atrial structural remodelling was simulated by reducing the number of connections between the layers from 96 to 6 randomly chosen locations. With progressive elimination of connections, AF stability increased. Reduction in the number of connections from 96 to 24 resulted in an increase in endo-epicardial dyssynchrony from 6.6 ± 1.9 to 24.6 ± 1.3%, with a concomitant increase in BTR. A further reduction to 12 and 6 resulted in more pronounced endo-epicardial dyssynchrony of 34.4 ± 1.15 and 40.2 ± 0.52% but with BTR reduction. This biphasic relationship between endo-epicardial coupling and BTR was found independently from whether AF was maintained by re-entry or by ectopic focal discharges. Conclusion Loss of endo-epicardial coupling increases AF stability. There is a biphasic relation between endo-epicardial coupling and BTR. While at high degrees of endo-epicardial connectivity, the BTR is limited by the endo-epicardial synchronicity, at low degrees of connectivity, it is limited by the number of endo-epicardial connections.
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Affiliation(s)
- Ali Gharaviri
- Department of Physiology and Maastricht Centre of Systems Biology, Maastricht University, PO Box 616, Maastricht 6200 MD, The Netherlands
| | - Sander Verheule
- Department of Physiology and Maastricht Centre of Systems Biology, Maastricht University, PO Box 616, Maastricht 6200 MD, The Netherlands
| | - Jens Eckstein
- Department of Physiology and Maastricht Centre of Systems Biology, Maastricht University, PO Box 616, Maastricht 6200 MD, The Netherlands.,Department of Internal Medicine, University Hospital Basel, Basel, Switzerland
| | - Mark Potse
- Department of Biomedical Engineering, Maastricht University, Maastricht, The Netherlands.,Institute of Computational Science, Faculty of Informatics, Università della Svizzera italiana, Lugano, Switzerland
| | - Pawel Kuklik
- Department of Physiology and Maastricht Centre of Systems Biology, Maastricht University, PO Box 616, Maastricht 6200 MD, The Netherlands
| | - Nico H L Kuijpers
- Department of Biomedical Engineering, Maastricht University, Maastricht, The Netherlands
| | - Ulrich Schotten
- Department of Physiology and Maastricht Centre of Systems Biology, Maastricht University, PO Box 616, Maastricht 6200 MD, The Netherlands
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Muneretto C, Bisleri G, Rosati F, Krakor R, Giroletti L, Di Bacco L, Repossini A, Moltrasio M, Curnis A, Tondo C, Polvani G. European prospective multicentre study of hybrid thoracoscopic and transcatheter ablation of persistent atrial fibrillation: the HISTORIC-AF trial. Eur J Cardiothorac Surg 2018; 52:740-745. [PMID: 29156015 DOI: 10.1093/ejcts/ezx162] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2016] [Accepted: 02/26/2017] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES The HISTORIC-AF trial is a prospective, multicentre, single-arm study designed to evaluate the outcomes of a staged endoscopic and transcatheter ablation in patients with stand-alone, persistent or long-standing persistent atrial fibrillation (AF). METHODS From 2012 to 2015, 100 consecutive patients were enrolled and underwent thoracoscopic left atrial epicardial isolation ('box lesion') followed by transcatheter ablation in case of AF recurrency. The safety end point was the composite outcome of freedom from major adverse events at 30-days, while efficacy end points were: (i) primary: freedom from AF and stable sinus rhythm following isolated thoracospic ablation >60% and (ii) secondary: freedom from AF and stable sinus rhythm >80% following hybrid ablation (as per HRS criteria). RESULTS No death occurred and surgical thoracoscopic procedure was successfully completed in all patients. Survival free from major adverse events at 30 days was 94%: there were 3 permanent pacemaker implants, 2 episodes of stroke and 1 revision for bleeding. At discharge, 87% of patients were in sinus rhythm. A staged transcatheter ablation was carried out in all patients with AF recurrences at the end of 3 months blanking period (17% of patients). At 12-months follow-up, a stable restoration of sinus rhythm was achieved in 75% and 88% of patients following isolated thoracoscopic ablation and hybrid ablation, respectively. CONCLUSIONS The HISTORIC-AF trial showed that thoracoscopic isolated surgical ablation reached both the safety and the efficacy end points. Hybrid ablation steadily improved rhythm outcomes and may be considered in the future as the treatment of choice for patients with persistent and long-standing persistent AF. ClinicalTrials.gov Identifier NCT01622907.
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Affiliation(s)
- Claudio Muneretto
- Division of Cardiac Surgery and Cardiology, University of Brescia Medical School, Brescia, Italy
| | - Gianluigi Bisleri
- Division of Cardiac Surgery, Queen's University, Kingston General Hospital, Kingston, Canada
| | - Fabrizio Rosati
- Division of Cardiac Surgery and Cardiology, University of Brescia Medical School, Brescia, Italy
| | - Ralf Krakor
- Division of Cardiovascular Surgery, THG Staedtisches Klinikum, Dortmund, Germany
| | - Laura Giroletti
- Division of Cardiac Surgery and Cardiology, University of Brescia Medical School, Brescia, Italy
| | - Lorenzo Di Bacco
- Division of Cardiac Surgery and Cardiology, University of Brescia Medical School, Brescia, Italy
| | - Alberto Repossini
- Division of Cardiac Surgery and Cardiology, University of Brescia Medical School, Brescia, Italy
| | - Massimo Moltrasio
- Division of Cardiac Surgery and Cardiology, University of Milan, Milan, Italy
| | - Antonio Curnis
- Division of Cardiac Surgery and Cardiology, University of Brescia Medical School, Brescia, Italy
| | - Claudio Tondo
- Division of Cardiac Surgery and Cardiology, University of Milan, Milan, Italy
| | - Gianluca Polvani
- Division of Cardiac Surgery and Cardiology, University of Milan, Milan, Italy
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33
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Fastl TE, Tobon-Gomez C, Crozier A, Whitaker J, Rajani R, McCarthy KP, Sanchez-Quintana D, Ho SY, O'Neill MD, Plank G, Bishop MJ, Niederer SA. Personalized computational modeling of left atrial geometry and transmural myofiber architecture. Med Image Anal 2018; 47:180-190. [PMID: 29753182 PMCID: PMC6277816 DOI: 10.1016/j.media.2018.04.001] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2017] [Revised: 03/27/2018] [Accepted: 04/03/2018] [Indexed: 01/15/2023]
Abstract
Atrial fibrillation (AF) is a supraventricular tachyarrhythmia characterized by complete absence of coordinated atrial contraction and is associated with an increased morbidity and mortality. Personalized computational modeling provides a novel framework for integrating and interpreting the role of atrial electrophysiology (EP) including the underlying anatomy and microstructure in the development and sustenance of AF. Coronary computed tomography angiography data were segmented using a statistics-based approach and the smoothed voxel representations were discretized into high-resolution tetrahedral finite element (FE) meshes. To estimate the complex left atrial myofiber architecture, individual fiber fields were generated according to morphological data on the endo- and epicardial surfaces based on local solutions of Laplace’s equation and transmurally interpolated to tetrahedral elements. The influence of variable transmural microstructures was quantified through EP simulations on 3 patients using 5 different fiber interpolation functions. Personalized geometrical models included the heterogeneous thickness distribution of the left atrial myocardium and subsequent discretization led to high-fidelity tetrahedral FE meshes. The novel algorithm for automated incorporation of the left atrial fiber architecture provided a realistic estimate of the atrial microstructure and was able to qualitatively capture all important fiber bundles. Consistent maximum local activation times were predicted in EP simulations using individual transmural fiber interpolation functions for each patient suggesting a negligible effect of the transmural myofiber architecture on EP. The established modeling pipeline provides a robust framework for the rapid development of personalized model cohorts accounting for detailed anatomy and microstructure and facilitates simulations of atrial EP.
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Affiliation(s)
- Thomas E Fastl
- Department of Biomedical Engineering, King's College London, London, United Kingdom.
| | - Catalina Tobon-Gomez
- Department of Biomedical Engineering, King's College London, London, United Kingdom
| | - Andrew Crozier
- Institute of Biophysics, Medical University of Graz, Graz, Austria
| | - John Whitaker
- Department of Biomedical Engineering, King's College London, London, United Kingdom; Department of Cardiology, Guy's and St Thomas' Hospitals, London, United Kingdom
| | - Ronak Rajani
- Department of Biomedical Engineering, King's College London, London, United Kingdom; Department of Cardiology, Guy's and St Thomas' Hospitals, London, United Kingdom
| | - Karen P McCarthy
- Cardiac Morphology Unit, Royal Brompton Hospital, London, United Kingdom
| | | | - Siew Y Ho
- Cardiac Morphology Unit, Royal Brompton Hospital, London, United Kingdom
| | - Mark D O'Neill
- Department of Biomedical Engineering, King's College London, London, United Kingdom; Department of Cardiology, Guy's and St Thomas' Hospitals, London, United Kingdom
| | - Gernot Plank
- Institute of Biophysics, Medical University of Graz, Graz, Austria
| | - Martin J Bishop
- Department of Biomedical Engineering, King's College London, London, United Kingdom
| | - Steven A Niederer
- Department of Biomedical Engineering, King's College London, London, United Kingdom
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34
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Piorkowski C, Kronborg M, Hourdain J, Piorkowski J, Kirstein B, Neudeck S, Wechselberger S, Päßler E, Löwen A, El-Armouche A, Mayer J, Ulbrich S, Pu L, Richter U, Gaspar T, Huo Y. Endo-/Epicardial Catheter Ablation of Atrial Fibrillation. Circ Arrhythm Electrophysiol 2018; 11:e005748. [DOI: 10.1161/circep.117.005748] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2017] [Accepted: 12/12/2017] [Indexed: 12/14/2022]
Affiliation(s)
- Christopher Piorkowski
- From the Department of Electrophysiology, Heart Center (C.P., J.H., J.P., B.K., S.N., S.W., J.M., S.U., L.P.,U.R., T.G., Y.H.) and Department of Pharmacology and Toxicology (A.E.-A.), University of Technology Dresden, Germany; Department of Cardiology, Aarhus University Hospital, Denmark (M.K.); and Steinbeis Research Institute-Electrophysiology and Cardiac Devices, Dresden, Germany (E.P., A.L.)
| | - Mads Kronborg
- From the Department of Electrophysiology, Heart Center (C.P., J.H., J.P., B.K., S.N., S.W., J.M., S.U., L.P.,U.R., T.G., Y.H.) and Department of Pharmacology and Toxicology (A.E.-A.), University of Technology Dresden, Germany; Department of Cardiology, Aarhus University Hospital, Denmark (M.K.); and Steinbeis Research Institute-Electrophysiology and Cardiac Devices, Dresden, Germany (E.P., A.L.)
| | - Jerome Hourdain
- From the Department of Electrophysiology, Heart Center (C.P., J.H., J.P., B.K., S.N., S.W., J.M., S.U., L.P.,U.R., T.G., Y.H.) and Department of Pharmacology and Toxicology (A.E.-A.), University of Technology Dresden, Germany; Department of Cardiology, Aarhus University Hospital, Denmark (M.K.); and Steinbeis Research Institute-Electrophysiology and Cardiac Devices, Dresden, Germany (E.P., A.L.)
| | - Judith Piorkowski
- From the Department of Electrophysiology, Heart Center (C.P., J.H., J.P., B.K., S.N., S.W., J.M., S.U., L.P.,U.R., T.G., Y.H.) and Department of Pharmacology and Toxicology (A.E.-A.), University of Technology Dresden, Germany; Department of Cardiology, Aarhus University Hospital, Denmark (M.K.); and Steinbeis Research Institute-Electrophysiology and Cardiac Devices, Dresden, Germany (E.P., A.L.)
| | - Bettina Kirstein
- From the Department of Electrophysiology, Heart Center (C.P., J.H., J.P., B.K., S.N., S.W., J.M., S.U., L.P.,U.R., T.G., Y.H.) and Department of Pharmacology and Toxicology (A.E.-A.), University of Technology Dresden, Germany; Department of Cardiology, Aarhus University Hospital, Denmark (M.K.); and Steinbeis Research Institute-Electrophysiology and Cardiac Devices, Dresden, Germany (E.P., A.L.)
| | - Sebastian Neudeck
- From the Department of Electrophysiology, Heart Center (C.P., J.H., J.P., B.K., S.N., S.W., J.M., S.U., L.P.,U.R., T.G., Y.H.) and Department of Pharmacology and Toxicology (A.E.-A.), University of Technology Dresden, Germany; Department of Cardiology, Aarhus University Hospital, Denmark (M.K.); and Steinbeis Research Institute-Electrophysiology and Cardiac Devices, Dresden, Germany (E.P., A.L.)
| | - Simon Wechselberger
- From the Department of Electrophysiology, Heart Center (C.P., J.H., J.P., B.K., S.N., S.W., J.M., S.U., L.P.,U.R., T.G., Y.H.) and Department of Pharmacology and Toxicology (A.E.-A.), University of Technology Dresden, Germany; Department of Cardiology, Aarhus University Hospital, Denmark (M.K.); and Steinbeis Research Institute-Electrophysiology and Cardiac Devices, Dresden, Germany (E.P., A.L.)
| | - Ellen Päßler
- From the Department of Electrophysiology, Heart Center (C.P., J.H., J.P., B.K., S.N., S.W., J.M., S.U., L.P.,U.R., T.G., Y.H.) and Department of Pharmacology and Toxicology (A.E.-A.), University of Technology Dresden, Germany; Department of Cardiology, Aarhus University Hospital, Denmark (M.K.); and Steinbeis Research Institute-Electrophysiology and Cardiac Devices, Dresden, Germany (E.P., A.L.)
| | - Anastasia Löwen
- From the Department of Electrophysiology, Heart Center (C.P., J.H., J.P., B.K., S.N., S.W., J.M., S.U., L.P.,U.R., T.G., Y.H.) and Department of Pharmacology and Toxicology (A.E.-A.), University of Technology Dresden, Germany; Department of Cardiology, Aarhus University Hospital, Denmark (M.K.); and Steinbeis Research Institute-Electrophysiology and Cardiac Devices, Dresden, Germany (E.P., A.L.)
| | - Ali El-Armouche
- From the Department of Electrophysiology, Heart Center (C.P., J.H., J.P., B.K., S.N., S.W., J.M., S.U., L.P.,U.R., T.G., Y.H.) and Department of Pharmacology and Toxicology (A.E.-A.), University of Technology Dresden, Germany; Department of Cardiology, Aarhus University Hospital, Denmark (M.K.); and Steinbeis Research Institute-Electrophysiology and Cardiac Devices, Dresden, Germany (E.P., A.L.)
| | - Julia Mayer
- From the Department of Electrophysiology, Heart Center (C.P., J.H., J.P., B.K., S.N., S.W., J.M., S.U., L.P.,U.R., T.G., Y.H.) and Department of Pharmacology and Toxicology (A.E.-A.), University of Technology Dresden, Germany; Department of Cardiology, Aarhus University Hospital, Denmark (M.K.); and Steinbeis Research Institute-Electrophysiology and Cardiac Devices, Dresden, Germany (E.P., A.L.)
| | - Stefan Ulbrich
- From the Department of Electrophysiology, Heart Center (C.P., J.H., J.P., B.K., S.N., S.W., J.M., S.U., L.P.,U.R., T.G., Y.H.) and Department of Pharmacology and Toxicology (A.E.-A.), University of Technology Dresden, Germany; Department of Cardiology, Aarhus University Hospital, Denmark (M.K.); and Steinbeis Research Institute-Electrophysiology and Cardiac Devices, Dresden, Germany (E.P., A.L.)
| | - Liying Pu
- From the Department of Electrophysiology, Heart Center (C.P., J.H., J.P., B.K., S.N., S.W., J.M., S.U., L.P.,U.R., T.G., Y.H.) and Department of Pharmacology and Toxicology (A.E.-A.), University of Technology Dresden, Germany; Department of Cardiology, Aarhus University Hospital, Denmark (M.K.); and Steinbeis Research Institute-Electrophysiology and Cardiac Devices, Dresden, Germany (E.P., A.L.)
| | - Utz Richter
- From the Department of Electrophysiology, Heart Center (C.P., J.H., J.P., B.K., S.N., S.W., J.M., S.U., L.P.,U.R., T.G., Y.H.) and Department of Pharmacology and Toxicology (A.E.-A.), University of Technology Dresden, Germany; Department of Cardiology, Aarhus University Hospital, Denmark (M.K.); and Steinbeis Research Institute-Electrophysiology and Cardiac Devices, Dresden, Germany (E.P., A.L.)
| | - Thomas Gaspar
- From the Department of Electrophysiology, Heart Center (C.P., J.H., J.P., B.K., S.N., S.W., J.M., S.U., L.P.,U.R., T.G., Y.H.) and Department of Pharmacology and Toxicology (A.E.-A.), University of Technology Dresden, Germany; Department of Cardiology, Aarhus University Hospital, Denmark (M.K.); and Steinbeis Research Institute-Electrophysiology and Cardiac Devices, Dresden, Germany (E.P., A.L.)
| | - Yan Huo
- From the Department of Electrophysiology, Heart Center (C.P., J.H., J.P., B.K., S.N., S.W., J.M., S.U., L.P.,U.R., T.G., Y.H.) and Department of Pharmacology and Toxicology (A.E.-A.), University of Technology Dresden, Germany; Department of Cardiology, Aarhus University Hospital, Denmark (M.K.); and Steinbeis Research Institute-Electrophysiology and Cardiac Devices, Dresden, Germany (E.P., A.L.)
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35
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Schmidt EJ, Halperin HR. MRI use for atrial tissue characterization in arrhythmias and for EP procedure guidance. Int J Cardiovasc Imaging 2018; 34:81-95. [PMID: 28593399 PMCID: PMC5889521 DOI: 10.1007/s10554-017-1179-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2017] [Accepted: 05/24/2017] [Indexed: 12/19/2022]
Abstract
We review the utilization of magnetic resonance imaging methods for classifying atrial tissue properties that act as a substrate for common cardiac arrhythmias, such as atrial fibrillation. We then review state-of-the-art methods for mapping this substrate as a predicate for treatment, as well as methods used to ablate the electrical pathways that cause arrhythmia and restore patients to sinus rhythm.
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Affiliation(s)
- Ehud J Schmidt
- Cardiology, Johns Hopkins University School of Medicine, Baltimore, MD, 21205, USA.
| | - Henry R Halperin
- Cardiology, Johns Hopkins University School of Medicine, Baltimore, MD, 21205, USA
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36
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Csige I, Ujvárosy D, Szabó Z, Lőrincz I, Paragh G, Harangi M, Somodi S. The Impact of Obesity on the Cardiovascular System. J Diabetes Res 2018; 2018:3407306. [PMID: 30525052 PMCID: PMC6247580 DOI: 10.1155/2018/3407306] [Citation(s) in RCA: 230] [Impact Index Per Article: 38.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2018] [Revised: 09/12/2018] [Accepted: 09/27/2018] [Indexed: 12/11/2022] Open
Abstract
Obesity is a growing health problem worldwide. It is associated with an increased cardiovascular risk on the one hand of obesity itself and on the other hand of associated medical conditions (hypertension, diabetes, insulin resistance, and sleep apnoea syndrome). Obesity has an important role in atherosclerosis and coronary artery disease. Obesity leads to structural and functional changes of the heart, which causes heart failure. The altered myocardial structure increases the risk of atrial fibrillation and sudden cardiac death. However, obesity also has a protective effect on the clinical outcome of underlying cardiovascular disease, the phenomenon called obesity paradox. The improved cardiac imaging techniques allow the early detection of altered structure and function of the heart in obese patients. In this review, we attempt to summarize the relationship between obesity and cardiovascular diseases and outline the underlying mechanisms. The demonstrated new techniques of cardiac diagnostic procedures allow for the early detection and treatment of subclinical medical conditions and, therefore, the prevention of cardiovascular events.
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Affiliation(s)
- Imre Csige
- Department of Emergency Medicine, Faculty of Medicine, University of Debrecen, Hungary
| | - Dóra Ujvárosy
- Department of Emergency Medicine, Faculty of Medicine, University of Debrecen, Hungary
| | - Zoltán Szabó
- Department of Emergency Medicine, Faculty of Medicine, University of Debrecen, Hungary
| | - István Lőrincz
- Department of Emergency Medicine, Faculty of Medicine, University of Debrecen, Hungary
| | - György Paragh
- Division of Metabolism, Department of Internal Medicine, Faculty of Medicine, University of Debrecen, Hungary
| | - Mariann Harangi
- Division of Metabolism, Department of Internal Medicine, Faculty of Medicine, University of Debrecen, Hungary
| | - Sándor Somodi
- Division of Metabolism, Department of Internal Medicine, Faculty of Medicine, University of Debrecen, Hungary
- Division of Clinical Pharmacology, Faculty of Pharmacy, University of Debrecen, Hungary
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37
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Saini A, Huizar JF, Tan A, Koneru JN, Ellenbogen KA, Kaszala K. Scar Homogenization in Atrial Fibrillation Ablation: Evolution and Practice. J Atr Fibrillation 2017; 10:1645. [PMID: 29250241 DOI: 10.4022/jafib.1645] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2017] [Revised: 07/19/2017] [Accepted: 09/14/2017] [Indexed: 11/10/2022]
Abstract
Atrial fibrillation (AF) ablation has emerged as the preferred rhythm control strategy for symptomatic paroxysmal AF refractory or intolerant to at least one class I or III antiarrhythmic medication. Since the initial observation by Haissaguerre and colleagues, of pulmonary vein triggers initiating atrial fibrillation (AF), pulmonary vein isolation (PVI) has become the cornerstone for paroxysmal AF ablation therapy.
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Affiliation(s)
- Aditya Saini
- Division of Cardiology, Hunter Holmes McGuire VAMC and Virginia Commonwealth University, Richmond, VA
| | - Jose F Huizar
- Division of Cardiology, Hunter Holmes McGuire VAMC and Virginia Commonwealth University, Richmond, VA
| | - Alex Tan
- Division of Cardiology, Hunter Holmes McGuire VAMC and Virginia Commonwealth University, Richmond, VA
| | - Jayanthi N Koneru
- Division of Cardiology, Hunter Holmes McGuire VAMC and Virginia Commonwealth University, Richmond, VA
| | - Kenneth A Ellenbogen
- Division of Cardiology, Hunter Holmes McGuire VAMC and Virginia Commonwealth University, Richmond, VA
| | - Karoly Kaszala
- Division of Cardiology, Hunter Holmes McGuire VAMC and Virginia Commonwealth University, Richmond, VA
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38
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Song JS, Wi J, Lee HJ, Hwang M, Lim B, Kim TH, Uhm J, Joung B, Lee M, Seo JW, Pak HN. Role of atrial wall thickness in wave-dynamics of atrial fibrillation. PLoS One 2017; 12:e0182174. [PMID: 28827810 PMCID: PMC5565105 DOI: 10.1371/journal.pone.0182174] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2017] [Accepted: 07/13/2017] [Indexed: 01/13/2023] Open
Abstract
Background/Aims Atrial anatomy and thickness may affect the electrical wave-dynamics of atrial fibrillation (AF). We explored the relationship between left atrial (LA) wall thickness (LAWT) or LA geometry and AF wave-dynamics. Methods We included 15 patients with persistent AF (age, 62.3 ± 11.9 years) who underwent AF catheter ablation. We measured the LAWT, LA endocardial curvature, and SD-curvature (surface bumpiness) from preprocedural computed tomography images. We compared those anatomical characteristics with electrophysiologic parameters such as dominant frequency (DF), Shannon entropy (ShEn), or complex fractionated atrial electrogram (CFAE)-cycle length (CL), calculated from intracardiac bipolar electrograms (300–500 points, 5 s), acquired during ablation procedures. Results 1. LAWT (excluding fat) varied widely among patients, locations, and types of AF. LAWT was inversely correlated with LA volume (r = -0.565, p = 0.028) and positively correlated with SD-curvature (r = 0.272, p < 0.001). 2. LAWT was positively correlated with ShEn (r = 0.233, p < 0.001) and negatively correlated with CFAE-CL (r = -0.107, p = 0.038). 3. In the multivariate linear regression analyses for AF wave-dynamics parameters, DF (β = -0.29 [95% CI -0.44–-0.14], p < 0.001), ShEn (β = 0.19 [95% CI 0.12–0.25], p < 0.001), and CFAE-CL (β = 7.49 [95% CI 0.65–14.34], p = 0.032) were independently associated with LAWT. Conclusion Regional LAWT is associated with LA structural features, and has significant correlations with the wave-dynamics parameters associated with electrical wavebreaks or rotors in patients with persistent AF.
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Affiliation(s)
- Jun-Seop Song
- Yonsei University Health System, Seoul, Republic of Korea
| | - Jin Wi
- Yonsei University Health System, Seoul, Republic of Korea
| | - Hye-Jeong Lee
- Yonsei University Health System, Seoul, Republic of Korea
| | - Minki Hwang
- Yonsei University Health System, Seoul, Republic of Korea
| | - Byounghyun Lim
- Yonsei University Health System, Seoul, Republic of Korea
| | - Tae-Hoon Kim
- Yonsei University Health System, Seoul, Republic of Korea
| | - Jae‐Sun Uhm
- Yonsei University Health System, Seoul, Republic of Korea
| | - Boyoung Joung
- Yonsei University Health System, Seoul, Republic of Korea
| | | | - Jeong-Wook Seo
- Department of Pathology, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Hui-Nam Pak
- Yonsei University Health System, Seoul, Republic of Korea
- * E-mail:
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Lau DH, Linz D, Schotten U, Mahajan R, Sanders P, Kalman JM. Pathophysiology of Paroxysmal and Persistent Atrial Fibrillation: Rotors, Foci and Fibrosis. Heart Lung Circ 2017; 26:887-893. [PMID: 28610723 DOI: 10.1016/j.hlc.2017.05.119] [Citation(s) in RCA: 97] [Impact Index Per Article: 13.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2017] [Accepted: 05/15/2017] [Indexed: 12/12/2022]
Abstract
Recent advances in our understanding of the mechanisms underlying atrial fibrillation (AF) have further underscored the complex pathophysiological basis of the arrhythmia. It has become apparent that the current clinical classification of AF does not reflect the severity of the underlying atrial disease. Atrial fibrosis has been identified as the key structural change in different substrates that are responsible for the perpetuation of AF. Three-dimensional electroanatomical mapping and late gadolinium-enhanced magnetic resonance imaging are novel modalities that can be used to facilitate identification and quantitation of atrial fibrosis for improved delineation of the AF substrate. Advances in AF mapping technology using endocardial 'panaromic' basket-type catheter and non-invasive body surface electrodes have facilitated the identification of two major arrhythmic mechanisms of interest, namely rotational ('rotors') and ectopic focal activations ('foci'). Ongoing research on these potential drivers of AF may provide guidance to more mechanistic based therapies to improve outcomes for this complex arrhythmia in the future. Here, we aim to review the differences in AF substrate in those with paroxysmal and more persistent forms of the arrhythmia by evaluating fibrosis, rotors and foci, towards improved AF substrate classification and individualised substrate based therapies.
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Affiliation(s)
- Dennis H Lau
- Centre for Heart Rhythm Disorders, South Australian Health and Medical Research Institute, University of Adelaide and Royal Adelaide Hospital, Adelaide, SA, Australia.
| | - Dominik Linz
- Centre for Heart Rhythm Disorders, South Australian Health and Medical Research Institute, University of Adelaide and Royal Adelaide Hospital, Adelaide, SA, Australia; Pathophysiology of Atrial Fibrillation, University Hospital of Saarland, Homburg/Saar, Germany
| | - Ulrich Schotten
- Department of Physiology, Maastricht University, Cardiovascular Research Institute Maastricht (CARIM), The Netherlands
| | - Rajiv Mahajan
- Centre for Heart Rhythm Disorders, South Australian Health and Medical Research Institute, University of Adelaide and Royal Adelaide Hospital, Adelaide, SA, Australia
| | - Prashanthan Sanders
- Centre for Heart Rhythm Disorders, South Australian Health and Medical Research Institute, University of Adelaide and Royal Adelaide Hospital, Adelaide, SA, Australia
| | - Jonathan M Kalman
- Department of Cardiology, Royal Melbourne Hospital and Department of Medicine, The University of Melbourne, Melbourne, Vic, Australia
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40
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Thanigaimani S, Lau DH, Agbaedeng T, Elliott AD, Mahajan R, Sanders P. Molecular mechanisms of atrial fibrosis: implications for the clinic. Expert Rev Cardiovasc Ther 2017; 15:247-256. [DOI: 10.1080/14779072.2017.1299005] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Affiliation(s)
- Shivshankar Thanigaimani
- Centre for Heart Rhythm Disorders, South Australian Health and Medical Research Institute, University of Adelaide and Royal Adelaide Hospital, Adelaide, Australia
| | - Dennis H Lau
- Centre for Heart Rhythm Disorders, South Australian Health and Medical Research Institute, University of Adelaide and Royal Adelaide Hospital, Adelaide, Australia
| | - Thomas Agbaedeng
- Centre for Heart Rhythm Disorders, South Australian Health and Medical Research Institute, University of Adelaide and Royal Adelaide Hospital, Adelaide, Australia
| | - Adrian D. Elliott
- Centre for Heart Rhythm Disorders, South Australian Health and Medical Research Institute, University of Adelaide and Royal Adelaide Hospital, Adelaide, Australia
| | - Rajiv Mahajan
- Centre for Heart Rhythm Disorders, South Australian Health and Medical Research Institute, University of Adelaide and Royal Adelaide Hospital, Adelaide, Australia
| | - Prashanthan Sanders
- Centre for Heart Rhythm Disorders, South Australian Health and Medical Research Institute, University of Adelaide and Royal Adelaide Hospital, Adelaide, Australia
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41
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Afzal MR, Samanta A, Chatta J, Ansari B, Atherton S, Sabzwari S, Turagam M, Lakkireddy D, Houmsse M. Adjunctive ablation strategies improve the efficacy of pulmonary vein isolation in non-paroxysmal atrial fibrillation: a systematic review and meta-analysis. Expert Rev Cardiovasc Ther 2017; 15:227-235. [DOI: 10.1080/14779072.2017.1294064] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Muhammad R. Afzal
- Division of Cardiovascular Medicine, Department of Internal Medicine, Electrophysiology Section, Ross Heart Hospital, The Wexner Medical Center at the Ohio State University Medical Center, Columbus, OH, USA
| | - Anweshan Samanta
- Division of Cardiovascular Medicine, University of Kansas Medical Center, Kansas City, KS, USA
| | - Jawaria Chatta
- Division of Cardiovascular Medicine, University of Kansas Medical Center, Kansas City, KS, USA
| | - Brihh Ansari
- Division of Cardiovascular Medicine, University of Kansas Medical Center, Kansas City, KS, USA
| | - Sam Atherton
- Division of Cardiovascular Medicine, University of Kansas Medical Center, Kansas City, KS, USA
| | - Syed Sabzwari
- Division of Cardiovascular Medicine, University of Kansas Medical Center, Kansas City, KS, USA
| | - Mohit Turagam
- Division of Cardiovascular Medicine, University of Kansas Medical Center, Kansas City, KS, USA
| | - Dhanunjaya Lakkireddy
- Division of Cardiovascular Medicine, University of Kansas Medical Center, Kansas City, KS, USA
| | - Mahmoud Houmsse
- Division of Cardiovascular Medicine, Department of Internal Medicine, Electrophysiology Section, Ross Heart Hospital, The Wexner Medical Center at the Ohio State University Medical Center, Columbus, OH, USA
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42
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Pashakhanloo F, Herzka DA, Ashikaga H, Mori S, Gai N, Bluemke DA, Trayanova NA, McVeigh ER. Myofiber Architecture of the Human Atria as Revealed by Submillimeter Diffusion Tensor Imaging. Circ Arrhythm Electrophysiol 2016; 9:e004133. [PMID: 27071829 DOI: 10.1161/circep.116.004133] [Citation(s) in RCA: 112] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2016] [Accepted: 03/15/2016] [Indexed: 11/16/2022]
Abstract
BACKGROUND Accurate knowledge of the human atrial fibrous structure is paramount in understanding the mechanisms of atrial electric function in health and disease. Thus far, such knowledge has been acquired from destructive sectioning, and there is a paucity of data about atrial fiber architecture variability in the human population. METHODS AND RESULTS In this study, we have developed a customized 3-dimensional diffusion tensor magnetic resonance imaging sequence on a clinical scanner that makes it possible to image an entire intact human heart specimen ex vivo at submillimeter resolution. The data from 8 human atrial specimens obtained with this technique present complete maps of the fibrous organization of the human atria. The findings demonstrate that the main features of atrial anatomy are mostly preserved across subjects although the exact location and orientation of atrial bundles vary. Using the full tractography data, we were able to cluster, visualize, and characterize the distinct major bundles in the human atria. Furthermore, quantitative characterization of the fiber angles across the atrial wall revealed that the transmural fiber angle distribution is heterogeneous throughout different regions of the atria. CONCLUSIONS The application of submillimeter diffusion tensor magnetic resonance imaging provides an unprecedented level of information on both human atrial structure, as well as its intersubject variability. The high resolution and fidelity of this data could enhance our understanding of structural contributions to atrial rhythm and pump disorders and lead to improvements in their targeted treatment.
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Affiliation(s)
- Farhad Pashakhanloo
- From the Departments of Biomedical Engineering (F.P., D.A.H., N.A.T., E.R.M.), Medicine (H.A.), and Radiology (S.M., E.R.M), Johns Hopkins University, Baltimore, MD; Radiology and Imaging Sciences, National Institutes of Health Clinical Center, Bethesda, MD (N.G, D.A.B.); and Departments of Bioengineering, Medicine, and Radiology, University of California, San Diego (E.R.M.)
| | - Daniel A Herzka
- From the Departments of Biomedical Engineering (F.P., D.A.H., N.A.T., E.R.M.), Medicine (H.A.), and Radiology (S.M., E.R.M), Johns Hopkins University, Baltimore, MD; Radiology and Imaging Sciences, National Institutes of Health Clinical Center, Bethesda, MD (N.G, D.A.B.); and Departments of Bioengineering, Medicine, and Radiology, University of California, San Diego (E.R.M.)
| | - Hiroshi Ashikaga
- From the Departments of Biomedical Engineering (F.P., D.A.H., N.A.T., E.R.M.), Medicine (H.A.), and Radiology (S.M., E.R.M), Johns Hopkins University, Baltimore, MD; Radiology and Imaging Sciences, National Institutes of Health Clinical Center, Bethesda, MD (N.G, D.A.B.); and Departments of Bioengineering, Medicine, and Radiology, University of California, San Diego (E.R.M.)
| | - Susumu Mori
- From the Departments of Biomedical Engineering (F.P., D.A.H., N.A.T., E.R.M.), Medicine (H.A.), and Radiology (S.M., E.R.M), Johns Hopkins University, Baltimore, MD; Radiology and Imaging Sciences, National Institutes of Health Clinical Center, Bethesda, MD (N.G, D.A.B.); and Departments of Bioengineering, Medicine, and Radiology, University of California, San Diego (E.R.M.)
| | - Neville Gai
- From the Departments of Biomedical Engineering (F.P., D.A.H., N.A.T., E.R.M.), Medicine (H.A.), and Radiology (S.M., E.R.M), Johns Hopkins University, Baltimore, MD; Radiology and Imaging Sciences, National Institutes of Health Clinical Center, Bethesda, MD (N.G, D.A.B.); and Departments of Bioengineering, Medicine, and Radiology, University of California, San Diego (E.R.M.)
| | - David A Bluemke
- From the Departments of Biomedical Engineering (F.P., D.A.H., N.A.T., E.R.M.), Medicine (H.A.), and Radiology (S.M., E.R.M), Johns Hopkins University, Baltimore, MD; Radiology and Imaging Sciences, National Institutes of Health Clinical Center, Bethesda, MD (N.G, D.A.B.); and Departments of Bioengineering, Medicine, and Radiology, University of California, San Diego (E.R.M.)
| | - Natalia A Trayanova
- From the Departments of Biomedical Engineering (F.P., D.A.H., N.A.T., E.R.M.), Medicine (H.A.), and Radiology (S.M., E.R.M), Johns Hopkins University, Baltimore, MD; Radiology and Imaging Sciences, National Institutes of Health Clinical Center, Bethesda, MD (N.G, D.A.B.); and Departments of Bioengineering, Medicine, and Radiology, University of California, San Diego (E.R.M.)
| | - Elliot R McVeigh
- From the Departments of Biomedical Engineering (F.P., D.A.H., N.A.T., E.R.M.), Medicine (H.A.), and Radiology (S.M., E.R.M), Johns Hopkins University, Baltimore, MD; Radiology and Imaging Sciences, National Institutes of Health Clinical Center, Bethesda, MD (N.G, D.A.B.); and Departments of Bioengineering, Medicine, and Radiology, University of California, San Diego (E.R.M.).
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43
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Goette A, Kalman JM, Aguinaga L, Akar J, Cabrera JA, Chen SA, Chugh SS, Corradi D, D'Avila A, Dobrev D, Fenelon G, Gonzalez M, Hatem SN, Helm R, Hindricks G, Ho SY, Hoit B, Jalife J, Kim YH, Lip GYH, Ma CS, Marcus GM, Murray K, Nogami A, Sanders P, Uribe W, Van Wagoner DR, Nattel S. EHRA/HRS/APHRS/SOLAECE expert consensus on Atrial cardiomyopathies: Definition, characterisation, and clinical implication. J Arrhythm 2016; 32:247-78. [PMID: 27588148 PMCID: PMC4996910 DOI: 10.1016/j.joa.2016.05.002] [Citation(s) in RCA: 84] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Affiliation(s)
- Andreas Goette
- Departement of Cardiology and Intensive Care Medicine, St. Vincenz-Hospital Paderborn, Working Group: Molecular Electrophysiology, University Hospital Magdeburg, Germany
| | - Jonathan M Kalman
- University of Melbourne, Royal Melbourne Hospital, Melbourne, VIC, Australia
| | | | | | | | | | - Sumeet S Chugh
- The Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | | | | | - Dobromir Dobrev
- Institute of Pharmacology, West German Heart and Vascular Center, University Duisburg-Essen, Essen, Germany
| | | | - Mario Gonzalez
- Penn State Heart and Vascular Institute, Penn State University, Hershey, PA, USA
| | - Stephane N Hatem
- Department of Cardiology, Assistance Publique - Hô pitaux de Paris, Pitié-Salpêtrière Hospital, Sorbonne University, INSERM UMR_S1166, Institute of Cardiometabolism and Nutrition-ICAN, Paris, France
| | - Robert Helm
- Boston University School of Medicine, Boston Medical Center, Boston, MA, USA
| | | | - Siew Yen Ho
- Royal Brompton Hospital and Imperial College London, London, UK
| | - Brian Hoit
- UH Case Medical Center, Cleveland, OH, USA
| | | | | | | | | | | | | | | | - Prashanthan Sanders
- Centre for Heart Rhythm Disorders, South Australian Health and Medical Research Institute, University of Adelaide and Royal Adelaide Hospital, Adelaide, Australia
| | - William Uribe
- Electrophysiology Deparment at Centros Especializados de San Vicente Fundació n and Clínica CES. Universidad CES, Universidad Pontificia Bolivariana (UPB), Medellin, Colombia
| | | | - Stanley Nattel
- Université de Montréal, Montreal Heart Institute Research Center and McGill University, Montreal, Quebec, Canada; Institute of Pharmacology, West German Heart and Vascular Center, Faculty of Medicine, University Duisburg-Essen, Essen, Germany
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44
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Goette A, Kalman JM, Aguinaga L, Akar J, Cabrera JA, Chen SA, Chugh SS, Corradi D, D'Avila A, Dobrev D, Fenelon G, Gonzalez M, Hatem SN, Helm R, Hindricks G, Ho SY, Hoit B, Jalife J, Kim YH, Lip GYH, Ma CS, Marcus GM, Murray K, Nogami A, Sanders P, Uribe W, Van Wagoner DR, Nattel S. EHRA/HRS/APHRS/SOLAECE expert consensus on atrial cardiomyopathies: definition, characterization, and clinical implication. Europace 2016; 18:1455-1490. [PMID: 27402624 DOI: 10.1093/europace/euw161] [Citation(s) in RCA: 429] [Impact Index Per Article: 53.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Affiliation(s)
- Andreas Goette
- Departement of Cardiology and Intensive Care Medicine, St. Vincenz-Hospital Paderborn, Working Group: Molecular Electrophysiology, University Hospital Magdeburg, Germany
| | - Jonathan M Kalman
- University of Melbourne, Royal Melbourne Hospital, Melbourne, VIC, Australia
| | | | | | | | | | - Sumeet S Chugh
- The Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | | | | | - Dobromir Dobrev
- Institute of Pharmacology, West German Heart and Vascular Center, University Duisburg-Essen, Essen, Germany
| | | | - Mario Gonzalez
- Penn State Heart and Vascular Institute, Penn State University, Hershey, PA, USA
| | - Stephane N Hatem
- Department of Cardiology, Assistance Publique - Hôpitaux de Paris, Pitié-Salpêtrière Hospital; Sorbonne University; INSERM UMR_S1166; Institute of Cardiometabolism and Nutrition-ICAN, Paris, France
| | - Robert Helm
- Boston University School of Medicine, Boston Medical Center, Boston, MA, USA
| | | | - Siew Yen Ho
- Royal Brompton Hospital and Imperial College London, London, UK
| | - Brian Hoit
- UH Case Medical Center, Cleveland, OH, USA
| | | | | | | | | | | | | | | | - Prashanthan Sanders
- Centre for Heart Rhythm Disorders, South Australian Health and Medical Research Institute, University of Adelaide and Royal Adelaide Hospital, Adelaide, Australia
| | - William Uribe
- Electrophysiology Deparment at Centros Especializados de San Vicente Fundación and Clínica CES. Universidad CES, Universidad Pontificia Bolivariana (UPB), Medellin, Colombia
| | | | - Stanley Nattel
- Université de Montréal, Montreal Heart Institute Research Center and McGill University, Montreal, Quebec, Canada .,Institute of Pharmacology, West German Heart and Vascular Center, Faculty of Medicine, University Duisburg-Essen, Essen, Germany
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45
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EHRA/HRS/APHRS/SOLAECE expert consensus on atrial cardiomyopathies: Definition, characterization, and clinical implication. Heart Rhythm 2016; 14:e3-e40. [PMID: 27320515 DOI: 10.1016/j.hrthm.2016.05.028] [Citation(s) in RCA: 214] [Impact Index Per Article: 26.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2016] [Indexed: 12/21/2022]
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46
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Schotten U, Dobrev D, Platonov PG, Kottkamp H, Hindricks G. Current controversies in determining the main mechanisms of atrial fibrillation. J Intern Med 2016; 279:428-38. [PMID: 26991914 DOI: 10.1111/joim.12492] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
Despite considerable basic research into the mechanisms of atrial fibrillation (AF), not much progress has been made in the prognosis of patients with AF. With the exception of anticoagulant therapy, current treatments for AF still do not improve major cardiovascular outcomes. This may be due partly to the diverse aetiology of AF with increasingly more factors found to contribute to the arrhythmia. In addition, a strong increase has been seen in the technological complexity of the methods used to quantify the main pathophysiological alterations underlying the initiation and progression of AF. Because of the lack of standardization of the technological approaches currently used, the perception of basic mechanisms of AF varies widely in the scientific community. Areas of debate include the role of Ca(2+) -handling alterations associated with AF, the contribution and noninvasive assessment of the degree of atrial fibrosis, and the best techniques to identify electrophysiological drivers of AF. In this review, we will summarize the state of the art of these controversial topics and describe the diverse approaches to investigating and the scientific opinions on leading AF mechanisms. Finally, we will highlight the need for transparency in scientific reporting and standardization of terminology, assumptions, algorithms and experimental conditions used for the development of better AF therapies.
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Affiliation(s)
- U Schotten
- Cardiovascular Research Institute Maastricht, Maastricht Centre of Systems Biology, Maastricht University, Maastricht, The Netherlands
| | - D Dobrev
- Institute of Pharmacology, West German Heart and Vascular Center, School of Medicine, University Duisburg-Essen, Essen, Germany
| | - P G Platonov
- Center for Integrative Electrocardiology at Lund University (CIEL), Arrhythmia Clinic, Skåne University Hospital, Lund, Sweden
| | - H Kottkamp
- Department of Rhythmology, Klinik Hirslanden, Zürich, Switzerland
| | - G Hindricks
- Department of Cardiac Electrophysiology, Heart Center, University of Leipzig, Leipzig, Germany
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Haemers P, Hamdi H, Guedj K, Suffee N, Farahmand P, Popovic N, Claus P, LePrince P, Nicoletti A, Jalife J, Wolke C, Lendeckel U, Jaïs P, Willems R, Hatem SN. Atrial fibrillation is associated with the fibrotic remodelling of adipose tissue in the subepicardium of human and sheep atria. Eur Heart J 2015; 38:53-61. [DOI: 10.1093/eurheartj/ehv625] [Citation(s) in RCA: 154] [Impact Index Per Article: 17.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2015] [Revised: 09/12/2015] [Accepted: 10/27/2015] [Indexed: 11/15/2022] Open
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Lau DH, Schotten U, Mahajan R, Antic NA, Hatem SN, Pathak RK, Hendriks JML, Kalman JM, Sanders P. Novel mechanisms in the pathogenesis of atrial fibrillation: practical applications. Eur Heart J 2015; 37:1573-81. [DOI: 10.1093/eurheartj/ehv375] [Citation(s) in RCA: 101] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2015] [Accepted: 07/21/2015] [Indexed: 12/21/2022] Open
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49
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Ferrer A, Sebastián R, Sánchez-Quintana D, Rodríguez JF, Godoy EJ, Martínez L, Saiz J. Detailed Anatomical and Electrophysiological Models of Human Atria and Torso for the Simulation of Atrial Activation. PLoS One 2015; 10:e0141573. [PMID: 26523732 PMCID: PMC4629897 DOI: 10.1371/journal.pone.0141573] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2015] [Accepted: 10/09/2015] [Indexed: 01/24/2023] Open
Abstract
Atrial arrhythmias, and specifically atrial fibrillation (AF), induce rapid and irregular activation patterns that appear on the torso surface as abnormal P-waves in electrocardiograms and body surface potential maps (BSPM). In recent years both P-waves and the BSPM have been used to identify the mechanisms underlying AF, such as localizing ectopic foci or high-frequency rotors. However, the relationship between the activation of the different areas of the atria and the characteristics of the BSPM and P-wave signals are still far from being completely understood. In this work we developed a multi-scale framework, which combines a highly-detailed 3D atrial model and a torso model to study the relationship between atrial activation and surface signals in sinus rhythm. Using this multi scale model, it was revealed that the best places for recording P-waves are the frontal upper right and the frontal and rear left quadrants of the torso. Our results also suggest that only nine regions (of the twenty-one structures in which the atrial surface was divided) make a significant contribution to the BSPM and determine the main P-wave characteristics.
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Affiliation(s)
- Ana Ferrer
- Centro de Investigación e Innovación en Bioingeniería (Ci2B), Universitat Politècnica de València, Valencia, Spain
- * E-mail:
| | - Rafael Sebastián
- Computational Multiscale Physiology Lab (CoMMLab), Department of Computer Science, Universitat de Valencia, Valencia, Spain
| | - Damián Sánchez-Quintana
- Department of Anatomy and Cell Biology, Faculty of Medicine, Universidad de Extremadura, Badajoz, Spain
| | - José F. Rodríguez
- Applied Mechanics and Bioengineering Group (AMB), Universidad de Zaragoza, Zaragoza, Spain, and Dipartimento di Chimica, Materiali e Ingegneria Chimica “Giulio Natta”, Politecnico di Milano, Milano, Italy
| | - Eduardo J. Godoy
- Centro de Investigación e Innovación en Bioingeniería (Ci2B), Universitat Politècnica de València, Valencia, Spain
| | - Laura Martínez
- Centro de Investigación e Innovación en Bioingeniería (Ci2B), Universitat Politècnica de València, Valencia, Spain
| | - Javier Saiz
- Centro de Investigación e Innovación en Bioingeniería (Ci2B), Universitat Politècnica de València, Valencia, Spain
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50
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Tao H, Shi KH, Yang JJ, Li J. Epigenetic mechanisms in atrial fibrillation: New insights and future directions. Trends Cardiovasc Med 2015; 26:306-18. [PMID: 26475117 DOI: 10.1016/j.tcm.2015.08.006] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2015] [Revised: 08/23/2015] [Accepted: 08/28/2015] [Indexed: 11/28/2022]
Abstract
Atrial fibrillation (AF) is the most common sustained arrhythmia. AF is a complex disease that results from genetic and environmental factors and their interactions. In recent years, numerous studies have shown that epigenetic mechanisms significantly participate in AF pathogenesis. Even though a poor understanding of the molecular and electrophysiologic mechanisms of AF, accumulated evidence has suggested that the relevance of epigenetic changes in the development of AF. The aim of this review is to describe the present knowledge about the epigenetic regulatory features significantly participates in AF, and look ahead on new perspectives of epigenetic mechanisms research. Epigenetic regulatory features such as DNA methylation, histone modification, and microRNA influence gene expression by epigenetic mechanisms and by directly binding to various factor response elements in the target gene promoters. Given the role of epigenetic alterations in regulating genes, there is potential for the integration of factors-induced epigenetic alterations as informative factors in the risk assessment process. In this review, new insight into the epigenetic mechanisms in AF pathogenesis is discussed, with special emphasis on DNA methylation, histone modification, and microRNA. Further studies are needed to reveal the potential targets of epigenetic mechanisms, and it can be developed as a therapeutic target for AF.
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Affiliation(s)
- Hui Tao
- Department of Cardiothoracic Surgery, The Second Hospital of Anhui Medical University, Hefei, China; Cardiovascular Research Center, Anhui Medical University, Hefei, China
| | - Kai-Hu Shi
- Department of Cardiothoracic Surgery, The Second Hospital of Anhui Medical University, Hefei, China; Cardiovascular Research Center, Anhui Medical University, Hefei, China.
| | - Jing-Jing Yang
- Department of Pharmacology, The Second Hospital of Anhui Medical University, Hefei, China.
| | - Jun Li
- School of Pharmacy, Anhui Medical University, Hefei, China
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