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Silva Cunha P, Laranjo S, Monteiro S, Almeida IG, Mendonça T, Fontes I, Ferreira RC, Almeida AG, Didenko M, Oliveira MM. Left Atrial Wall Thickness Estimated by Cardiac CT: Implications for Catheter Ablation of Atrial Fibrillation. J Clin Med 2024; 13:5379. [PMID: 39336866 PMCID: PMC11432590 DOI: 10.3390/jcm13185379] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2024] [Revised: 08/28/2024] [Accepted: 09/02/2024] [Indexed: 09/30/2024] Open
Abstract
Atrial wall thickness (AWT) is a significant factor in understanding the pathological physiological substrate of atrial fibrillation, with a potentially substantial impact on the outcomes of catheter ablation procedures. Precise measurements of the AWT may provide valuable insights for categorising patients with AF and planning targeted interventions. Objectives: The purpose of this study was to evaluate the characteristics of the left atrium (LA) using non-invasive multidetector computed tomography (MDCT) scans and subsequent three-dimensional (3D) image post-processing using novel software designed to calculate atrial thickness dimensions and mass. Methods: We retrospectively analysed 128 consecutive patients (33.6% females; mean age 55.6 ± 11.2 years) referred for AF ablation (37 with persistent AF and 91 with paroxysmal AF) who underwent preprocedural MDCT. The images were post-processed and analysed using the ADAS software (Galgo Medical), automatically calculating the LA volume and regional wall thickness. In addition, the software employed a regional semi-automatic LA parcellation feature that divided the atrial wall into 12 segments, generating atrial wall thickness (AWT) maps per segment for each patient. Results: This study demonstrated considerable variability in the average thickness of LA walls, with the anterior segments being the thickest across the cohort. Distinct sex-specific differences were observed, with males exhibiting greater anterior and septal wall thickness than females. No significant associations were identified between the average AWT and body mass index, LA volume, or sphericity. Survival analysis conducted over 24 months revealed a meaningful relationship between mean anterior wall thickness and recurrence-free survival, with increased thickness associated with a lower likelihood of AF-free survival. No such relationship was observed for the indexed LA volume. Conclusions: The variability in AWT and its association with recurrence-free survival following AF ablation suggest that AWT should be considered when stratifying patients for AF management and ablation strategies. These findings underscore the need for personalised treatment approaches and further research on the interplay of the structural properties of the left atrium as factors that can serve as important prognostic markers in AF treatment.
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Affiliation(s)
- Pedro Silva Cunha
- Cardiology Service, Arrhythmology, Pacing and Electrophysiology Unit, Hospital Santa Marta, 1169-024 Lisbon, Portugal; (S.L.)
- Instituto de Fisiologia, Faculdade de Medicina, University of Lisbon, 1649-004 Lisbon, Portugal
- Comprehensive Health Research Center, NOVA Medical School, Faculdade de Ciências Médicas, NMS, FCM, Universidade NOVA de Lisboa, 1169-056 Lisbon, Portugal
| | - Sérgio Laranjo
- Cardiology Service, Arrhythmology, Pacing and Electrophysiology Unit, Hospital Santa Marta, 1169-024 Lisbon, Portugal; (S.L.)
- Comprehensive Health Research Center, NOVA Medical School, Faculdade de Ciências Médicas, NMS, FCM, Universidade NOVA de Lisboa, 1169-056 Lisbon, Portugal
- Departamento de Fisiologia, NOVA Medical School, Faculdade de Ciências Médicas, NMS, FCM, Universidade NOVA de Lisboa, 1099-085 Lisbon, Portugal
| | - Sofia Monteiro
- Cardiology Service, Arrhythmology, Pacing and Electrophysiology Unit, Hospital Santa Marta, 1169-024 Lisbon, Portugal; (S.L.)
- Instituto de Telecomunicações, Instituto Superior Técnico, 3810-193 Aveiro, Portugal
| | - Inês Grácio Almeida
- Cardiology Service, Arrhythmology, Pacing and Electrophysiology Unit, Hospital Santa Marta, 1169-024 Lisbon, Portugal; (S.L.)
- Imagiology Department, Hospital Santa Marta, 1169-024 Lisbon, Portugal
| | - Tiago Mendonça
- Cardiology Service, Arrhythmology, Pacing and Electrophysiology Unit, Hospital Santa Marta, 1169-024 Lisbon, Portugal; (S.L.)
- Imagiology Department, Hospital Santa Marta, 1169-024 Lisbon, Portugal
| | - Iládia Fontes
- Imagiology Department, Hospital Santa Marta, 1169-024 Lisbon, Portugal
| | - Rui Cruz Ferreira
- Cardiology Service, Arrhythmology, Pacing and Electrophysiology Unit, Hospital Santa Marta, 1169-024 Lisbon, Portugal; (S.L.)
| | - Ana G. Almeida
- CCUL@RISE, Faculdade de Medicina, Universidade de Lisboa, 1649-028 Lisbon, Portugal
| | - Maxim Didenko
- Heart and Diabetes Center NRW, University Clinic of the Ruhr University Bochum, 44789 Bochum, Germany
| | - Mário Martins Oliveira
- Cardiology Service, Arrhythmology, Pacing and Electrophysiology Unit, Hospital Santa Marta, 1169-024 Lisbon, Portugal; (S.L.)
- Instituto de Fisiologia, Faculdade de Medicina, University of Lisbon, 1649-004 Lisbon, Portugal
- Comprehensive Health Research Center, NOVA Medical School, Faculdade de Ciências Médicas, NMS, FCM, Universidade NOVA de Lisboa, 1169-056 Lisbon, Portugal
- CCUL@RISE, Faculdade de Medicina, Universidade de Lisboa, 1649-028 Lisbon, Portugal
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2
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Ye Z, Ramdat Misier NL, van Schie MS, Xiang H, Knops P, Kluin J, Taverne YJHJ, de Groot NMS. Identification of Critical Slowing of Conduction Using Unipolar Atrial Voltage and Fractionation Mapping. JACC Clin Electrophysiol 2024; 10:1971-1981. [PMID: 39023486 DOI: 10.1016/j.jacep.2024.04.036] [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: 12/26/2023] [Revised: 04/22/2024] [Accepted: 04/27/2024] [Indexed: 07/20/2024]
Abstract
BACKGROUND Ablation strategies targeting fractionated or low-voltage potentials have been widely used in patients with persistent types of atrial fibrillation (AF). However, recent studies have questioned their role in effectively representing sites of conduction slowing, and thus arrhythmogenic substrates. OBJECTIVES The authors studied the relationship between local conduction velocity (CV) and the occurrence of fractionated and/or low-voltage potentials in order to identify areas with critically slowing of conduction. METHODS Intraoperative epicardial mapping was performed during sinus rhythm. Unipolar potentials with an amplitude <1.0 mV were initially classified as low-voltage and potentials with ≥3 deflections as fractionation. A range of thresholds were also explored. Local CV was computed using discrete velocity vectors. RESULTS A total of 319 patients were included. Fractionated, low-voltage potentials were rare, accounting for only 0.36% (Q1-Q3: 0.15%-0.78%) of all atrial sites. Local CV at sites with fractionated, low-voltage potentials (46.0 cm/s [Q1-Q3: 22.6-72.7 cm/s]) was lowest compared with sites with either low-voltage, nonfractionated potentials (64.5 cm/s [Q1-Q3: 34.8-99.4 cm/s]) or fractionated, high-voltage potentials (65.9 cm/s [Q1-Q3: 41.7-92.8 cm/s]; P < 0.001). Slow conduction areas (CV <50 cm/s) could be most accurately identified by using a low voltage threshold (<1 mV) and a minimum of 3 deflections (positive predictive value: 54.2%-70.7%), although the overall sensitivity remained low (0.1%-1.9%). CONCLUSIONS Sites with fractionated, low-voltage potentials have substantially slower local CV compared with sites with either low-voltage, nonfractionated potentials or fractionated, high-voltage potentials. However, the strong inverse relationship between the positive predictive value and sensitivity of a combined voltage and fractionation threshold for slowed conduction is likely to complicate the use of these signal-based ablation approaches in AF patients.
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Affiliation(s)
- Ziliang Ye
- Department of Cardiology, Erasmus Medical Center, Rotterdam, the Netherlands
| | | | - Mathijs S van Schie
- Department of Cardiology, Erasmus Medical Center, Rotterdam, the Netherlands
| | - Hongxian Xiang
- Department of Cardiology, Erasmus Medical Center, Rotterdam, the Netherlands
| | - Paul Knops
- Department of Cardiology, Erasmus Medical Center, Rotterdam, the Netherlands
| | - Jolanda Kluin
- Department of Cardiothoracic Surgery, 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, Signal Processing Systems, Faculty of Electrical Engineering, Mathematics and Computer Sciences, Delft University of Technology, Delft, the Netherlands.
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3
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Sakata K, Bradley RP, Prakosa A, Yamamoto CAP, Yusuf Ali S, Loeffler S, Kholmovski EG, Kumar Sinha S, Marine JE, Calkins H, Spragg DD, Trayanova NA. Optimizing the Distribution of Ablation Lesions to Prevent Postablation Atrial Tachycardia: A Personalized Digital-Twin Study. JACC Clin Electrophysiol 2024:S2405-500X(24)00651-0. [PMID: 39243255 DOI: 10.1016/j.jacep.2024.07.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2024] [Revised: 07/02/2024] [Accepted: 07/03/2024] [Indexed: 09/09/2024]
Abstract
BACKGROUND Although targeting atrial fibrillation (AF) drivers and substrates has been used as an effective adjunctive ablation strategy for patients with persistent AF (PsAF), it can result in iatrogenic scar-related atrial tachycardia (iAT) requiring additional ablation. Personalized atrial digital twins (DTs) have been used preprocedurally to devise ablation targeting that eliminate the fibrotic substrate arrhythmogenic propensity and could potentially be used to predict and prevent postablation iAT. OBJECTIVES In this study, the authors sought to explore possible alternative configurations of ablation lesions that could prevent iAT occurrence with the use of biatrial DTs of prospectively enrolled PsAF patients. METHODS Biatrial DTs were generated from late gadolinium enhancement-magnetic resonance images of 37 consecutive PsAF patients, and the fibrotic substrate locations in the DT capable of sustaining reentries were determined. These locations were ablated in DTs by representing a single compound region of ablation with normal power (SSA), and postablation iAT occurrence was determined. At locations of iAT, ablation at the same DT target was repeated, but applying multiple lesions of reduced-strength (MRA) instead of SSA. RESULTS Eighty-three locations in the fibrotic substrates of 28 personalized biatrial DTs were capable of sustaining reentries and were thus targeted for SSA ablation. Of these ablations, 45 resulted in iAT. Repeating the ablation at these targets with MRA instead of SSA resulted in the prevention of iAT occurrence at 15 locations (18% reduction in the rate of iAT occurrence). CONCLUSIONS Personalized atrial DTs enable preprocedure prediction of iAT occurrence after ablation in the fibrotic substrate. It also suggests MRA could be a potential strategy for preventing postablation AT.
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Affiliation(s)
- Kensuke Sakata
- Alliance for Cardiovascular Diagnostic and Treatment Innovation, Johns Hopkins University, Baltimore, Maryland, USA
| | - Ryan P Bradley
- Alliance for Cardiovascular Diagnostic and Treatment Innovation, Johns Hopkins University, Baltimore, Maryland, USA; Research Computing, Lehigh University, Bethlehem, Pennsylvania, USA
| | - Adityo Prakosa
- Alliance for Cardiovascular Diagnostic and Treatment Innovation, Johns Hopkins University, Baltimore, Maryland, USA
| | - Carolyna A P Yamamoto
- Department of Biomedical Engineering, Johns Hopkins University, Baltimore, Maryland, USA
| | - Syed Yusuf Ali
- Department of Biomedical Engineering, Johns Hopkins University, Baltimore, Maryland, USA
| | - Shane Loeffler
- Alliance for Cardiovascular Diagnostic and Treatment Innovation, Johns Hopkins University, Baltimore, Maryland, USA
| | - Eugene G Kholmovski
- Alliance for Cardiovascular Diagnostic and Treatment Innovation, Johns Hopkins University, Baltimore, Maryland, USA; Department of Biomedical Engineering, Johns Hopkins University, Baltimore, Maryland, USA
| | - Sunil Kumar Sinha
- Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Joseph E Marine
- Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Hugh Calkins
- Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - David D Spragg
- Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Natalia A Trayanova
- Alliance for Cardiovascular Diagnostic and Treatment Innovation, Johns Hopkins University, Baltimore, Maryland, USA; Department of Biomedical Engineering, Johns Hopkins University, Baltimore, Maryland, USA.
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4
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Trayanova NA, Lyon A, Shade J, Heijman J. Computational modeling of cardiac electrophysiology and arrhythmogenesis: toward clinical translation. Physiol Rev 2024; 104:1265-1333. [PMID: 38153307 PMCID: PMC11381036 DOI: 10.1152/physrev.00017.2023] [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: 04/05/2023] [Revised: 12/19/2023] [Accepted: 12/21/2023] [Indexed: 12/29/2023] Open
Abstract
The complexity of cardiac electrophysiology, involving dynamic changes in numerous components across multiple spatial (from ion channel to organ) and temporal (from milliseconds to days) scales, makes an intuitive or empirical analysis of cardiac arrhythmogenesis challenging. Multiscale mechanistic computational models of cardiac electrophysiology provide precise control over individual parameters, and their reproducibility enables a thorough assessment of arrhythmia mechanisms. This review provides a comprehensive analysis of models of cardiac electrophysiology and arrhythmias, from the single cell to the organ level, and how they can be leveraged to better understand rhythm disorders in cardiac disease and to improve heart patient care. Key issues related to model development based on experimental data are discussed, and major families of human cardiomyocyte models and their applications are highlighted. An overview of organ-level computational modeling of cardiac electrophysiology and its clinical applications in personalized arrhythmia risk assessment and patient-specific therapy of atrial and ventricular arrhythmias is provided. The advancements presented here highlight how patient-specific computational models of the heart reconstructed from patient data have achieved success in predicting risk of sudden cardiac death and guiding optimal treatments of heart rhythm disorders. Finally, an outlook toward potential future advances, including the combination of mechanistic modeling and machine learning/artificial intelligence, is provided. As the field of cardiology is embarking on a journey toward precision medicine, personalized modeling of the heart is expected to become a key technology to guide pharmaceutical therapy, deployment of devices, and surgical interventions.
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Affiliation(s)
- Natalia A Trayanova
- Department of Biomedical Engineering, Johns Hopkins University, Baltimore, Maryland, United States
- Alliance for Cardiovascular Diagnostic and Treatment Innovation, Johns Hopkins University, Baltimore, Maryland, United States
| | - Aurore Lyon
- Department of Biomedical Engineering, CARIM School for Cardiovascular Diseases, Maastricht University, Maastricht, The Netherlands
- Division of Heart and Lungs, Department of Medical Physiology, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Julie Shade
- Department of Biomedical Engineering, Johns Hopkins University, Baltimore, Maryland, United States
- Alliance for Cardiovascular Diagnostic and Treatment Innovation, Johns Hopkins University, Baltimore, Maryland, United States
| | - Jordi Heijman
- Department of Cardiology, CARIM School for Cardiovascular Diseases, Maastricht University, Maastricht, The Netherlands
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5
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Sakata K, Bradley RP, Prakosa A, Yamamoto CAP, Ali SY, Loeffler S, Tice BM, Boyle PM, Kholmovski EG, Yadav R, Sinha SK, Marine JE, Calkins H, Spragg DD, Trayanova NA. Assessing the arrhythmogenic propensity of fibrotic substrate using digital twins to inform a mechanisms-based atrial fibrillation ablation strategy. NATURE CARDIOVASCULAR RESEARCH 2024; 3:857-868. [PMID: 39157719 PMCID: PMC11329066 DOI: 10.1038/s44161-024-00489-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Accepted: 05/15/2024] [Indexed: 08/20/2024]
Abstract
Atrial fibrillation (AF), the most common heart rhythm disorder, may cause stroke and heart failure. For patients with persistent AF with fibrosis proliferation, the standard AF treatment-pulmonary vein isolation-has poor outcomes, necessitating redo procedures, owing to insufficient understanding of what constitutes good targets in fibrotic substrates. Here we present a prospective clinical and personalized digital twin study that characterizes the arrhythmogenic properties of persistent AF substrates and uncovers locations possessing rotor-attracting capabilities. Among these, a portion needs to be ablated to render the substrate not inducible for rotors, but the rest (37%) lose rotor-attracting capabilities when another location is ablated. Leveraging digital twin mechanistic insights, we suggest ablation targets that eliminate arrhythmia propensity with minimum lesions while also minimizing the risk of iatrogenic tachycardia and AF recurrence. Our findings provide further evidence regarding the appropriate substrate ablation targets in persistent AF, opening the door for effective strategies to mitigate patients' AF burden.
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Affiliation(s)
- Kensuke Sakata
- Alliance for Cardiovascular Diagnostic and Treatment Innovation, Johns Hopkins University, Baltimore, MD, USA
| | - Ryan P. Bradley
- Alliance for Cardiovascular Diagnostic and Treatment Innovation, Johns Hopkins University, Baltimore, MD, USA
- Research Computing, Lehigh University, Bethlehem, PA, USA
| | - Adityo Prakosa
- Alliance for Cardiovascular Diagnostic and Treatment Innovation, Johns Hopkins University, Baltimore, MD, USA
| | | | - Syed Yusuf Ali
- Department of Biomedical Engineering, Johns Hopkins University, Baltimore, MD, USA
| | - Shane Loeffler
- Alliance for Cardiovascular Diagnostic and Treatment Innovation, Johns Hopkins University, Baltimore, MD, USA
| | - Brock M. Tice
- Alliance for Cardiovascular Diagnostic and Treatment Innovation, Johns Hopkins University, Baltimore, MD, USA
| | - Patrick M. Boyle
- Center for Cardiovascular Biology, University of Washington, Seattle, WA, USA
- Institute for Stem Cell and Regenerative Medicine, University of Washington, Seattle, WA, USA
| | - Eugene G. Kholmovski
- Alliance for Cardiovascular Diagnostic and Treatment Innovation, Johns Hopkins University, Baltimore, MD, USA
- Department of Biomedical Engineering, Johns Hopkins University, Baltimore, MD, USA
| | - Ritu Yadav
- Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Sunil Kumar Sinha
- Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Joseph E. Marine
- Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Hugh Calkins
- Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - David D. Spragg
- Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Natalia A. Trayanova
- Alliance for Cardiovascular Diagnostic and Treatment Innovation, Johns Hopkins University, Baltimore, MD, USA
- Department of Biomedical Engineering, Johns Hopkins University, Baltimore, MD, USA
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6
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Brunet J, Cook AC, Walsh CL, Cranley J, Tafforeau P, Engel K, Arthurs O, Berruyer C, Burke O’Leary E, Bellier A, Torii R, Werlein C, Jonigk DD, Ackermann M, Dollman K, Lee PD, Atzen S. Multidimensional Analysis of the Adult Human Heart in Health and Disease Using Hierarchical Phase-Contrast Tomography. Radiology 2024; 312:e232731. [PMID: 39012246 PMCID: PMC11303834 DOI: 10.1148/radiol.232731] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2023] [Revised: 05/02/2024] [Accepted: 05/07/2024] [Indexed: 07/17/2024]
Abstract
Background Current clinical imaging modalities such as CT and MRI provide resolution adequate to diagnose cardiovascular diseases but cannot depict detailed structural features in the heart across length scales. Hierarchical phase-contrast tomography (HiP-CT) uses fourth-generation synchrotron sources with improved x-ray brilliance and high energies to provide micron-resolution imaging of intact adult organs with unprecedented detail. Purpose To evaluate the capability of HiP-CT to depict the macro- to microanatomy of structurally normal and abnormal adult human hearts ex vivo. Materials and Methods Between February 2021 and September 2023, two adult human donor hearts were obtained, fixed in formalin, and prepared using a mixture of crushed agar in a 70% ethanol solution. One heart was from a 63-year-old White male without known cardiac disease, and the other was from an 87-year-old White female with a history of multiple known cardiovascular pathologies including ischemic heart disease, hypertension, and atrial fibrillation. Nondestructive ex vivo imaging of these hearts without exogenous contrast agent was performed using HiP-CT at the European Synchrotron Radiation Facility. Results HiP-CT demonstrated the capacity for high-spatial-resolution, multiscale cardiac imaging ex vivo, revealing histologic-level detail of the myocardium, valves, coronary arteries, and cardiac conduction system across length scales. Virtual sectioning of the cardiac conduction system provided information on fatty infiltration, vascular supply, and pathways between the cardiac nodes and adjacent structures. HiP-CT achieved resolutions ranging from gross (isotropic voxels of approximately 20 µm) to microscopic (approximately 6.4-µm voxel size) to cellular (approximately 2.3-µm voxel size) in scale. The potential for quantitative assessment of features in health and disease was demonstrated. Conclusion HiP-CT provided high-spatial-resolution, three-dimensional images of structurally normal and diseased ex vivo adult human hearts. Whole-heart image volumes were obtained with isotropic voxels of approximately 20 µm, and local regions of interest were obtained with resolution down to 2.3-6.4 µm without the need for sectioning, destructive techniques, or exogenous contrast agents. Published under a CC BY 4.0 license Supplemental material is available for this article. See also the editorial by Bluemke and Pourmorteza in this issue.
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Affiliation(s)
- Joseph Brunet
- From the Department of Mechanical Engineering, University College
London, London, England (J.B., C.L.W., C.B., E.B.O.L., R.T., P.D.L.); European
Synchrotron Radiation Facility, 71 Av des Martyrs, 38000 Grenoble, France (J.B.,
P.T., C.B., K.D.); UCL Institute of Cardiovascular Science, London, England
(A.C.C.); Wellcome Sanger Institute, Hinxton, England (J.C.); Siemenst
Healthineers, Erlangen, Germany (K.E.); Department of Radiology, Great Ormond
Street Hospital for Children NHS Foundation Trust, London, England (O.A.);
Laboratoire d’Anatomie des Alpes Françaises, Université
Grenoble Alpes, Grenoble, France (A.B.); Institute of Pathology, Hannover
Medical School, Hannover, Germany (C.W.); Biomedical Research in Endstage and
Obstructive Lung Disease Hannover, German Center for Lung Research (DZL),
Hannover, Germany (D.D.J.); Institute of Pathology, Faculty of Medicine, RWTH
Aachen University, Aachen, Germany (D.D.J., M.A.); Institute of Pathology and
Molecular Pathology, Helios University Clinic Wuppertal, Universität
Witten/Herdecke, Wuppertal, Germany (M.A.); Institute of Functional and Clinical
Anatomy, University Medical Center of the Johannes Gutenberg–University
Mainz, Mainz, Germany (M.A.); and Research Complex at Harwell, Didcot, England
(P.D.L.)
| | - Andrew C. Cook
- From the Department of Mechanical Engineering, University College
London, London, England (J.B., C.L.W., C.B., E.B.O.L., R.T., P.D.L.); European
Synchrotron Radiation Facility, 71 Av des Martyrs, 38000 Grenoble, France (J.B.,
P.T., C.B., K.D.); UCL Institute of Cardiovascular Science, London, England
(A.C.C.); Wellcome Sanger Institute, Hinxton, England (J.C.); Siemenst
Healthineers, Erlangen, Germany (K.E.); Department of Radiology, Great Ormond
Street Hospital for Children NHS Foundation Trust, London, England (O.A.);
Laboratoire d’Anatomie des Alpes Françaises, Université
Grenoble Alpes, Grenoble, France (A.B.); Institute of Pathology, Hannover
Medical School, Hannover, Germany (C.W.); Biomedical Research in Endstage and
Obstructive Lung Disease Hannover, German Center for Lung Research (DZL),
Hannover, Germany (D.D.J.); Institute of Pathology, Faculty of Medicine, RWTH
Aachen University, Aachen, Germany (D.D.J., M.A.); Institute of Pathology and
Molecular Pathology, Helios University Clinic Wuppertal, Universität
Witten/Herdecke, Wuppertal, Germany (M.A.); Institute of Functional and Clinical
Anatomy, University Medical Center of the Johannes Gutenberg–University
Mainz, Mainz, Germany (M.A.); and Research Complex at Harwell, Didcot, England
(P.D.L.)
| | - Claire L. Walsh
- From the Department of Mechanical Engineering, University College
London, London, England (J.B., C.L.W., C.B., E.B.O.L., R.T., P.D.L.); European
Synchrotron Radiation Facility, 71 Av des Martyrs, 38000 Grenoble, France (J.B.,
P.T., C.B., K.D.); UCL Institute of Cardiovascular Science, London, England
(A.C.C.); Wellcome Sanger Institute, Hinxton, England (J.C.); Siemenst
Healthineers, Erlangen, Germany (K.E.); Department of Radiology, Great Ormond
Street Hospital for Children NHS Foundation Trust, London, England (O.A.);
Laboratoire d’Anatomie des Alpes Françaises, Université
Grenoble Alpes, Grenoble, France (A.B.); Institute of Pathology, Hannover
Medical School, Hannover, Germany (C.W.); Biomedical Research in Endstage and
Obstructive Lung Disease Hannover, German Center for Lung Research (DZL),
Hannover, Germany (D.D.J.); Institute of Pathology, Faculty of Medicine, RWTH
Aachen University, Aachen, Germany (D.D.J., M.A.); Institute of Pathology and
Molecular Pathology, Helios University Clinic Wuppertal, Universität
Witten/Herdecke, Wuppertal, Germany (M.A.); Institute of Functional and Clinical
Anatomy, University Medical Center of the Johannes Gutenberg–University
Mainz, Mainz, Germany (M.A.); and Research Complex at Harwell, Didcot, England
(P.D.L.)
| | - James Cranley
- From the Department of Mechanical Engineering, University College
London, London, England (J.B., C.L.W., C.B., E.B.O.L., R.T., P.D.L.); European
Synchrotron Radiation Facility, 71 Av des Martyrs, 38000 Grenoble, France (J.B.,
P.T., C.B., K.D.); UCL Institute of Cardiovascular Science, London, England
(A.C.C.); Wellcome Sanger Institute, Hinxton, England (J.C.); Siemenst
Healthineers, Erlangen, Germany (K.E.); Department of Radiology, Great Ormond
Street Hospital for Children NHS Foundation Trust, London, England (O.A.);
Laboratoire d’Anatomie des Alpes Françaises, Université
Grenoble Alpes, Grenoble, France (A.B.); Institute of Pathology, Hannover
Medical School, Hannover, Germany (C.W.); Biomedical Research in Endstage and
Obstructive Lung Disease Hannover, German Center for Lung Research (DZL),
Hannover, Germany (D.D.J.); Institute of Pathology, Faculty of Medicine, RWTH
Aachen University, Aachen, Germany (D.D.J., M.A.); Institute of Pathology and
Molecular Pathology, Helios University Clinic Wuppertal, Universität
Witten/Herdecke, Wuppertal, Germany (M.A.); Institute of Functional and Clinical
Anatomy, University Medical Center of the Johannes Gutenberg–University
Mainz, Mainz, Germany (M.A.); and Research Complex at Harwell, Didcot, England
(P.D.L.)
| | - Paul Tafforeau
- From the Department of Mechanical Engineering, University College
London, London, England (J.B., C.L.W., C.B., E.B.O.L., R.T., P.D.L.); European
Synchrotron Radiation Facility, 71 Av des Martyrs, 38000 Grenoble, France (J.B.,
P.T., C.B., K.D.); UCL Institute of Cardiovascular Science, London, England
(A.C.C.); Wellcome Sanger Institute, Hinxton, England (J.C.); Siemenst
Healthineers, Erlangen, Germany (K.E.); Department of Radiology, Great Ormond
Street Hospital for Children NHS Foundation Trust, London, England (O.A.);
Laboratoire d’Anatomie des Alpes Françaises, Université
Grenoble Alpes, Grenoble, France (A.B.); Institute of Pathology, Hannover
Medical School, Hannover, Germany (C.W.); Biomedical Research in Endstage and
Obstructive Lung Disease Hannover, German Center for Lung Research (DZL),
Hannover, Germany (D.D.J.); Institute of Pathology, Faculty of Medicine, RWTH
Aachen University, Aachen, Germany (D.D.J., M.A.); Institute of Pathology and
Molecular Pathology, Helios University Clinic Wuppertal, Universität
Witten/Herdecke, Wuppertal, Germany (M.A.); Institute of Functional and Clinical
Anatomy, University Medical Center of the Johannes Gutenberg–University
Mainz, Mainz, Germany (M.A.); and Research Complex at Harwell, Didcot, England
(P.D.L.)
| | - Klaus Engel
- From the Department of Mechanical Engineering, University College
London, London, England (J.B., C.L.W., C.B., E.B.O.L., R.T., P.D.L.); European
Synchrotron Radiation Facility, 71 Av des Martyrs, 38000 Grenoble, France (J.B.,
P.T., C.B., K.D.); UCL Institute of Cardiovascular Science, London, England
(A.C.C.); Wellcome Sanger Institute, Hinxton, England (J.C.); Siemenst
Healthineers, Erlangen, Germany (K.E.); Department of Radiology, Great Ormond
Street Hospital for Children NHS Foundation Trust, London, England (O.A.);
Laboratoire d’Anatomie des Alpes Françaises, Université
Grenoble Alpes, Grenoble, France (A.B.); Institute of Pathology, Hannover
Medical School, Hannover, Germany (C.W.); Biomedical Research in Endstage and
Obstructive Lung Disease Hannover, German Center for Lung Research (DZL),
Hannover, Germany (D.D.J.); Institute of Pathology, Faculty of Medicine, RWTH
Aachen University, Aachen, Germany (D.D.J., M.A.); Institute of Pathology and
Molecular Pathology, Helios University Clinic Wuppertal, Universität
Witten/Herdecke, Wuppertal, Germany (M.A.); Institute of Functional and Clinical
Anatomy, University Medical Center of the Johannes Gutenberg–University
Mainz, Mainz, Germany (M.A.); and Research Complex at Harwell, Didcot, England
(P.D.L.)
| | - Owen Arthurs
- From the Department of Mechanical Engineering, University College
London, London, England (J.B., C.L.W., C.B., E.B.O.L., R.T., P.D.L.); European
Synchrotron Radiation Facility, 71 Av des Martyrs, 38000 Grenoble, France (J.B.,
P.T., C.B., K.D.); UCL Institute of Cardiovascular Science, London, England
(A.C.C.); Wellcome Sanger Institute, Hinxton, England (J.C.); Siemenst
Healthineers, Erlangen, Germany (K.E.); Department of Radiology, Great Ormond
Street Hospital for Children NHS Foundation Trust, London, England (O.A.);
Laboratoire d’Anatomie des Alpes Françaises, Université
Grenoble Alpes, Grenoble, France (A.B.); Institute of Pathology, Hannover
Medical School, Hannover, Germany (C.W.); Biomedical Research in Endstage and
Obstructive Lung Disease Hannover, German Center for Lung Research (DZL),
Hannover, Germany (D.D.J.); Institute of Pathology, Faculty of Medicine, RWTH
Aachen University, Aachen, Germany (D.D.J., M.A.); Institute of Pathology and
Molecular Pathology, Helios University Clinic Wuppertal, Universität
Witten/Herdecke, Wuppertal, Germany (M.A.); Institute of Functional and Clinical
Anatomy, University Medical Center of the Johannes Gutenberg–University
Mainz, Mainz, Germany (M.A.); and Research Complex at Harwell, Didcot, England
(P.D.L.)
| | - Camille Berruyer
- From the Department of Mechanical Engineering, University College
London, London, England (J.B., C.L.W., C.B., E.B.O.L., R.T., P.D.L.); European
Synchrotron Radiation Facility, 71 Av des Martyrs, 38000 Grenoble, France (J.B.,
P.T., C.B., K.D.); UCL Institute of Cardiovascular Science, London, England
(A.C.C.); Wellcome Sanger Institute, Hinxton, England (J.C.); Siemenst
Healthineers, Erlangen, Germany (K.E.); Department of Radiology, Great Ormond
Street Hospital for Children NHS Foundation Trust, London, England (O.A.);
Laboratoire d’Anatomie des Alpes Françaises, Université
Grenoble Alpes, Grenoble, France (A.B.); Institute of Pathology, Hannover
Medical School, Hannover, Germany (C.W.); Biomedical Research in Endstage and
Obstructive Lung Disease Hannover, German Center for Lung Research (DZL),
Hannover, Germany (D.D.J.); Institute of Pathology, Faculty of Medicine, RWTH
Aachen University, Aachen, Germany (D.D.J., M.A.); Institute of Pathology and
Molecular Pathology, Helios University Clinic Wuppertal, Universität
Witten/Herdecke, Wuppertal, Germany (M.A.); Institute of Functional and Clinical
Anatomy, University Medical Center of the Johannes Gutenberg–University
Mainz, Mainz, Germany (M.A.); and Research Complex at Harwell, Didcot, England
(P.D.L.)
| | - Emer Burke O’Leary
- From the Department of Mechanical Engineering, University College
London, London, England (J.B., C.L.W., C.B., E.B.O.L., R.T., P.D.L.); European
Synchrotron Radiation Facility, 71 Av des Martyrs, 38000 Grenoble, France (J.B.,
P.T., C.B., K.D.); UCL Institute of Cardiovascular Science, London, England
(A.C.C.); Wellcome Sanger Institute, Hinxton, England (J.C.); Siemenst
Healthineers, Erlangen, Germany (K.E.); Department of Radiology, Great Ormond
Street Hospital for Children NHS Foundation Trust, London, England (O.A.);
Laboratoire d’Anatomie des Alpes Françaises, Université
Grenoble Alpes, Grenoble, France (A.B.); Institute of Pathology, Hannover
Medical School, Hannover, Germany (C.W.); Biomedical Research in Endstage and
Obstructive Lung Disease Hannover, German Center for Lung Research (DZL),
Hannover, Germany (D.D.J.); Institute of Pathology, Faculty of Medicine, RWTH
Aachen University, Aachen, Germany (D.D.J., M.A.); Institute of Pathology and
Molecular Pathology, Helios University Clinic Wuppertal, Universität
Witten/Herdecke, Wuppertal, Germany (M.A.); Institute of Functional and Clinical
Anatomy, University Medical Center of the Johannes Gutenberg–University
Mainz, Mainz, Germany (M.A.); and Research Complex at Harwell, Didcot, England
(P.D.L.)
| | - Alexandre Bellier
- From the Department of Mechanical Engineering, University College
London, London, England (J.B., C.L.W., C.B., E.B.O.L., R.T., P.D.L.); European
Synchrotron Radiation Facility, 71 Av des Martyrs, 38000 Grenoble, France (J.B.,
P.T., C.B., K.D.); UCL Institute of Cardiovascular Science, London, England
(A.C.C.); Wellcome Sanger Institute, Hinxton, England (J.C.); Siemenst
Healthineers, Erlangen, Germany (K.E.); Department of Radiology, Great Ormond
Street Hospital for Children NHS Foundation Trust, London, England (O.A.);
Laboratoire d’Anatomie des Alpes Françaises, Université
Grenoble Alpes, Grenoble, France (A.B.); Institute of Pathology, Hannover
Medical School, Hannover, Germany (C.W.); Biomedical Research in Endstage and
Obstructive Lung Disease Hannover, German Center for Lung Research (DZL),
Hannover, Germany (D.D.J.); Institute of Pathology, Faculty of Medicine, RWTH
Aachen University, Aachen, Germany (D.D.J., M.A.); Institute of Pathology and
Molecular Pathology, Helios University Clinic Wuppertal, Universität
Witten/Herdecke, Wuppertal, Germany (M.A.); Institute of Functional and Clinical
Anatomy, University Medical Center of the Johannes Gutenberg–University
Mainz, Mainz, Germany (M.A.); and Research Complex at Harwell, Didcot, England
(P.D.L.)
| | - Ryo Torii
- From the Department of Mechanical Engineering, University College
London, London, England (J.B., C.L.W., C.B., E.B.O.L., R.T., P.D.L.); European
Synchrotron Radiation Facility, 71 Av des Martyrs, 38000 Grenoble, France (J.B.,
P.T., C.B., K.D.); UCL Institute of Cardiovascular Science, London, England
(A.C.C.); Wellcome Sanger Institute, Hinxton, England (J.C.); Siemenst
Healthineers, Erlangen, Germany (K.E.); Department of Radiology, Great Ormond
Street Hospital for Children NHS Foundation Trust, London, England (O.A.);
Laboratoire d’Anatomie des Alpes Françaises, Université
Grenoble Alpes, Grenoble, France (A.B.); Institute of Pathology, Hannover
Medical School, Hannover, Germany (C.W.); Biomedical Research in Endstage and
Obstructive Lung Disease Hannover, German Center for Lung Research (DZL),
Hannover, Germany (D.D.J.); Institute of Pathology, Faculty of Medicine, RWTH
Aachen University, Aachen, Germany (D.D.J., M.A.); Institute of Pathology and
Molecular Pathology, Helios University Clinic Wuppertal, Universität
Witten/Herdecke, Wuppertal, Germany (M.A.); Institute of Functional and Clinical
Anatomy, University Medical Center of the Johannes Gutenberg–University
Mainz, Mainz, Germany (M.A.); and Research Complex at Harwell, Didcot, England
(P.D.L.)
| | - Christopher Werlein
- From the Department of Mechanical Engineering, University College
London, London, England (J.B., C.L.W., C.B., E.B.O.L., R.T., P.D.L.); European
Synchrotron Radiation Facility, 71 Av des Martyrs, 38000 Grenoble, France (J.B.,
P.T., C.B., K.D.); UCL Institute of Cardiovascular Science, London, England
(A.C.C.); Wellcome Sanger Institute, Hinxton, England (J.C.); Siemenst
Healthineers, Erlangen, Germany (K.E.); Department of Radiology, Great Ormond
Street Hospital for Children NHS Foundation Trust, London, England (O.A.);
Laboratoire d’Anatomie des Alpes Françaises, Université
Grenoble Alpes, Grenoble, France (A.B.); Institute of Pathology, Hannover
Medical School, Hannover, Germany (C.W.); Biomedical Research in Endstage and
Obstructive Lung Disease Hannover, German Center for Lung Research (DZL),
Hannover, Germany (D.D.J.); Institute of Pathology, Faculty of Medicine, RWTH
Aachen University, Aachen, Germany (D.D.J., M.A.); Institute of Pathology and
Molecular Pathology, Helios University Clinic Wuppertal, Universität
Witten/Herdecke, Wuppertal, Germany (M.A.); Institute of Functional and Clinical
Anatomy, University Medical Center of the Johannes Gutenberg–University
Mainz, Mainz, Germany (M.A.); and Research Complex at Harwell, Didcot, England
(P.D.L.)
| | - Danny D. Jonigk
- From the Department of Mechanical Engineering, University College
London, London, England (J.B., C.L.W., C.B., E.B.O.L., R.T., P.D.L.); European
Synchrotron Radiation Facility, 71 Av des Martyrs, 38000 Grenoble, France (J.B.,
P.T., C.B., K.D.); UCL Institute of Cardiovascular Science, London, England
(A.C.C.); Wellcome Sanger Institute, Hinxton, England (J.C.); Siemenst
Healthineers, Erlangen, Germany (K.E.); Department of Radiology, Great Ormond
Street Hospital for Children NHS Foundation Trust, London, England (O.A.);
Laboratoire d’Anatomie des Alpes Françaises, Université
Grenoble Alpes, Grenoble, France (A.B.); Institute of Pathology, Hannover
Medical School, Hannover, Germany (C.W.); Biomedical Research in Endstage and
Obstructive Lung Disease Hannover, German Center for Lung Research (DZL),
Hannover, Germany (D.D.J.); Institute of Pathology, Faculty of Medicine, RWTH
Aachen University, Aachen, Germany (D.D.J., M.A.); Institute of Pathology and
Molecular Pathology, Helios University Clinic Wuppertal, Universität
Witten/Herdecke, Wuppertal, Germany (M.A.); Institute of Functional and Clinical
Anatomy, University Medical Center of the Johannes Gutenberg–University
Mainz, Mainz, Germany (M.A.); and Research Complex at Harwell, Didcot, England
(P.D.L.)
| | - Maximilian Ackermann
- From the Department of Mechanical Engineering, University College
London, London, England (J.B., C.L.W., C.B., E.B.O.L., R.T., P.D.L.); European
Synchrotron Radiation Facility, 71 Av des Martyrs, 38000 Grenoble, France (J.B.,
P.T., C.B., K.D.); UCL Institute of Cardiovascular Science, London, England
(A.C.C.); Wellcome Sanger Institute, Hinxton, England (J.C.); Siemenst
Healthineers, Erlangen, Germany (K.E.); Department of Radiology, Great Ormond
Street Hospital for Children NHS Foundation Trust, London, England (O.A.);
Laboratoire d’Anatomie des Alpes Françaises, Université
Grenoble Alpes, Grenoble, France (A.B.); Institute of Pathology, Hannover
Medical School, Hannover, Germany (C.W.); Biomedical Research in Endstage and
Obstructive Lung Disease Hannover, German Center for Lung Research (DZL),
Hannover, Germany (D.D.J.); Institute of Pathology, Faculty of Medicine, RWTH
Aachen University, Aachen, Germany (D.D.J., M.A.); Institute of Pathology and
Molecular Pathology, Helios University Clinic Wuppertal, Universität
Witten/Herdecke, Wuppertal, Germany (M.A.); Institute of Functional and Clinical
Anatomy, University Medical Center of the Johannes Gutenberg–University
Mainz, Mainz, Germany (M.A.); and Research Complex at Harwell, Didcot, England
(P.D.L.)
| | - Kathleen Dollman
- From the Department of Mechanical Engineering, University College
London, London, England (J.B., C.L.W., C.B., E.B.O.L., R.T., P.D.L.); European
Synchrotron Radiation Facility, 71 Av des Martyrs, 38000 Grenoble, France (J.B.,
P.T., C.B., K.D.); UCL Institute of Cardiovascular Science, London, England
(A.C.C.); Wellcome Sanger Institute, Hinxton, England (J.C.); Siemenst
Healthineers, Erlangen, Germany (K.E.); Department of Radiology, Great Ormond
Street Hospital for Children NHS Foundation Trust, London, England (O.A.);
Laboratoire d’Anatomie des Alpes Françaises, Université
Grenoble Alpes, Grenoble, France (A.B.); Institute of Pathology, Hannover
Medical School, Hannover, Germany (C.W.); Biomedical Research in Endstage and
Obstructive Lung Disease Hannover, German Center for Lung Research (DZL),
Hannover, Germany (D.D.J.); Institute of Pathology, Faculty of Medicine, RWTH
Aachen University, Aachen, Germany (D.D.J., M.A.); Institute of Pathology and
Molecular Pathology, Helios University Clinic Wuppertal, Universität
Witten/Herdecke, Wuppertal, Germany (M.A.); Institute of Functional and Clinical
Anatomy, University Medical Center of the Johannes Gutenberg–University
Mainz, Mainz, Germany (M.A.); and Research Complex at Harwell, Didcot, England
(P.D.L.)
| | - Peter D. Lee
- From the Department of Mechanical Engineering, University College
London, London, England (J.B., C.L.W., C.B., E.B.O.L., R.T., P.D.L.); European
Synchrotron Radiation Facility, 71 Av des Martyrs, 38000 Grenoble, France (J.B.,
P.T., C.B., K.D.); UCL Institute of Cardiovascular Science, London, England
(A.C.C.); Wellcome Sanger Institute, Hinxton, England (J.C.); Siemenst
Healthineers, Erlangen, Germany (K.E.); Department of Radiology, Great Ormond
Street Hospital for Children NHS Foundation Trust, London, England (O.A.);
Laboratoire d’Anatomie des Alpes Françaises, Université
Grenoble Alpes, Grenoble, France (A.B.); Institute of Pathology, Hannover
Medical School, Hannover, Germany (C.W.); Biomedical Research in Endstage and
Obstructive Lung Disease Hannover, German Center for Lung Research (DZL),
Hannover, Germany (D.D.J.); Institute of Pathology, Faculty of Medicine, RWTH
Aachen University, Aachen, Germany (D.D.J., M.A.); Institute of Pathology and
Molecular Pathology, Helios University Clinic Wuppertal, Universität
Witten/Herdecke, Wuppertal, Germany (M.A.); Institute of Functional and Clinical
Anatomy, University Medical Center of the Johannes Gutenberg–University
Mainz, Mainz, Germany (M.A.); and Research Complex at Harwell, Didcot, England
(P.D.L.)
| | - Sarah Atzen
- From the Department of Mechanical Engineering, University College
London, London, England (J.B., C.L.W., C.B., E.B.O.L., R.T., P.D.L.); European
Synchrotron Radiation Facility, 71 Av des Martyrs, 38000 Grenoble, France (J.B.,
P.T., C.B., K.D.); UCL Institute of Cardiovascular Science, London, England
(A.C.C.); Wellcome Sanger Institute, Hinxton, England (J.C.); Siemenst
Healthineers, Erlangen, Germany (K.E.); Department of Radiology, Great Ormond
Street Hospital for Children NHS Foundation Trust, London, England (O.A.);
Laboratoire d’Anatomie des Alpes Françaises, Université
Grenoble Alpes, Grenoble, France (A.B.); Institute of Pathology, Hannover
Medical School, Hannover, Germany (C.W.); Biomedical Research in Endstage and
Obstructive Lung Disease Hannover, German Center for Lung Research (DZL),
Hannover, Germany (D.D.J.); Institute of Pathology, Faculty of Medicine, RWTH
Aachen University, Aachen, Germany (D.D.J., M.A.); Institute of Pathology and
Molecular Pathology, Helios University Clinic Wuppertal, Universität
Witten/Herdecke, Wuppertal, Germany (M.A.); Institute of Functional and Clinical
Anatomy, University Medical Center of the Johannes Gutenberg–University
Mainz, Mainz, Germany (M.A.); and Research Complex at Harwell, Didcot, England
(P.D.L.)
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7
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Takamiya T, Takigawa M, Noda M, Yamamoto T, Martin C, Shigeta T, Ikenouchi T, Yamaguchi J, Amemiya M, Negishi M, Goto K, Nishimura T, Tao S, Miyazaki S, Goya M, Sasano T. Distribution of peak frequency and omnipolar voltage in electrograms across the atrial body and thoracic veins in a normal heart. J Interv Card Electrophysiol 2024:10.1007/s10840-024-01845-4. [PMID: 38880852 DOI: 10.1007/s10840-024-01845-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2023] [Accepted: 05/30/2024] [Indexed: 06/18/2024]
Abstract
BACKGROUND The innovative peak frequency mapping facilitates the quantification of electrogram sharpness. However, reference values for normal atrial tissue are currently undefined. In this study, we explored the distribution of peak frequency and omnipolar peak-to-peak voltage (V-max) in a normal heart. METHODS Twenty-two patients with structurally normal heart were included. Either the right atrium (RA) and superior vena cava (SVC) or the left atrium (LA) and pulmonary veins (PVs) were mapped during sinus rhythm. RESULTS In total, 13,654 points in the RA and 4143 points in the SVC from 15 patients and 4662 points in the LA and 2761 points in PVs from 7 patients were analyzed. The correlation between peak frequency and V-max was weak (R = 0.223). The median peak frequency was larger in the SVC than in the RA (441 [358-524] Hz vs. 358 [291-441] Hz, P < 0.0001) and in PVs than in the LA (346 [253-441] Hz vs. 323 [262-397] Hz, P < 0.0001). Conversely, the median V-max was smaller in the SVC than in the RA (1.96 [0.77-3.75] mV vs. 4.11 [2.10-6.83] mV, P < 0.0001) and in PVs than in the LA (1.16 [0.33-3.17] mV vs. 4.42 [2.63-6.84] mV, P < 0.0001). More than 95% of peak frequencies were > 174 Hz in the RA and > 185 Hz in the LA, and > 95% of V-maxes were > 0.52 and > 1.07 mV in the RA and LA, respectively. CONCLUSION Given the limited correlation between peak frequency and V-max, and recognizing their potential to provide distinct information, they can be used complementarily. Employing these parameters to extract varied insights can provide comprehensive understandings of tissue characteristics.
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Affiliation(s)
- Tomomasa Takamiya
- Department of Cardiovascular Medicine, Tokyo Medical and Dental University Hospital, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8510, Japan
| | - Masateru Takigawa
- Department of Cardiovascular Medicine, Tokyo Medical and Dental University Hospital, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8510, Japan.
| | - Masayuki Noda
- Department of Cardiovascular Medicine, Tokyo Medical and Dental University Hospital, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8510, Japan
| | - Tasuku Yamamoto
- Department of Cardiovascular Medicine, Tokyo Medical and Dental University Hospital, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8510, Japan
| | - Claire Martin
- Cardiology Department, Royal Papworth Hospital, Cambridge, UK
- Department of Medicine, University of Cambridge, Cambridge, UK
| | - Takatoshi Shigeta
- Department of Cardiovascular Medicine, Tokyo Medical and Dental University Hospital, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8510, Japan
| | - Takashi Ikenouchi
- Department of Cardiovascular Medicine, Tokyo Medical and Dental University Hospital, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8510, Japan
| | - Junji Yamaguchi
- Department of Cardiovascular Medicine, Tokyo Medical and Dental University Hospital, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8510, Japan
| | - Miki Amemiya
- Department of Cardiovascular Medicine, Tokyo Medical and Dental University Hospital, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8510, Japan
| | - Miho Negishi
- Department of Cardiovascular Medicine, Tokyo Medical and Dental University Hospital, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8510, Japan
| | - Kentaro Goto
- Department of Cardiovascular Medicine, Tokyo Medical and Dental University Hospital, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8510, Japan
| | - Takuro Nishimura
- Department of Cardiovascular Medicine, Tokyo Medical and Dental University Hospital, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8510, Japan
| | - Susumu Tao
- Department of Cardiovascular Medicine, Tokyo Medical and Dental University Hospital, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8510, Japan
| | - Shinsuke Miyazaki
- Department of Cardiovascular Medicine, Tokyo Medical and Dental University Hospital, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8510, Japan
| | - Masahiko Goya
- Department of Cardiovascular Medicine, Tokyo Medical and Dental University Hospital, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8510, Japan
| | - Tetsuo Sasano
- Department of Cardiovascular Medicine, Tokyo Medical and Dental University Hospital, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8510, Japan
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8
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Nakamura K, Sasaki T, Minami K, Aoki H, Kondo K, Yoshimura S, Kimura K, Haraguchi Y, Takizawa R, Nakatani Y, Miki Y, Goto K, Take Y, Kaseno K, Yamashita E, Naito S. Incidence, distribution, and electrogram characteristics of endocardial-epicardial connections identified by ultra-high-resolution mapping during a left atrial posterior wall isolation of atrial fibrillation. J Interv Card Electrophysiol 2024; 67:773-784. [PMID: 37843676 DOI: 10.1007/s10840-023-01663-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Accepted: 10/04/2023] [Indexed: 10/17/2023]
Abstract
PURPOSE The left atrial posterior wall (LAPW) can be a target for atrial fibrillation (AF) catheter ablation but is sometimes difficult to completely isolate due to the presence of endocardial-epicardial connections. We aimed to investigate the incidence and distribution of epicardial residual connections (epi-RCs) and the electrogram characteristics at epi-RC sites during an initial LAPW isolation. METHODS We retrospectively studied 102 AF patients who underwent LAPW mapping before and after a first-pass linear ablation along the superior and inferior LAPW (pre-ablation and post-ablation maps) using an ultra-high-resolution mapping system (Rhythmia, Boston Scientific). RESULTS Epi-RCs were observed in 41 patients (40.2%) and were widely distributed in the middle LAPW area and surrounding it. The sites with epi-RCs had a higher bipolar voltage amplitude and greater number of fractionated components than those without (median, 1.09 mV vs. 0.83 mV and 3.9 vs. 3.4 on the pre-ablation map and 0.38 mV vs. 0.27 mV and 8.5 vs. 4.2 on the post-ablation map, respectively; P < 0.001). Receiver operating characteristic analyses demonstrated that the number of fractionated components on the post-ablation map had a larger area under the curve of 0.847 than the others, and the sensitivity and specificity for predicting epi-RCs were 95.4% and 62.1%, respectively, at an optimal cutoff of 5.0. CONCLUSIONS Among the patients with epi-RCs after a first-pass LAPW linear ablation, areas with a greater number of fractionated components (> 5.0 on the post-ablation LAPW map) may have endocardial-epicardial connections and may be potential targets for touch-up ablation to eliminate the epi-RCs.
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Affiliation(s)
- Kohki Nakamura
- Division of Cardiology, Gunma Prefectural Cardiovascular Center, 3-12 Kameizumi-Machi, Maebashi City, Gunma, 371-0004, Japan.
| | - Takehito Sasaki
- Division of Cardiology, Gunma Prefectural Cardiovascular Center, 3-12 Kameizumi-Machi, Maebashi City, Gunma, 371-0004, Japan
| | - Kentaro Minami
- Department of Cardiovascular Medicine, Dokkyo Medical University, 880 Kitakobayashi, Mibu-Machi, Shimotsuga-Gun, Tochigi, 321-0293, Japan
| | - Hideyuki Aoki
- Division of Cardiology, Gunma Prefectural Cardiovascular Center, 3-12 Kameizumi-Machi, Maebashi City, Gunma, 371-0004, Japan
| | - Kan Kondo
- Division of Cardiology, Gunma Prefectural Cardiovascular Center, 3-12 Kameizumi-Machi, Maebashi City, Gunma, 371-0004, Japan
| | - Shingo Yoshimura
- Division of Cardiology, Gunma Prefectural Cardiovascular Center, 3-12 Kameizumi-Machi, Maebashi City, Gunma, 371-0004, Japan
| | - Kohki Kimura
- Division of Cardiology, Gunma Prefectural Cardiovascular Center, 3-12 Kameizumi-Machi, Maebashi City, Gunma, 371-0004, Japan
| | - Yumiko Haraguchi
- Division of Cardiology, Gunma Prefectural Cardiovascular Center, 3-12 Kameizumi-Machi, Maebashi City, Gunma, 371-0004, Japan
| | - Ryoya Takizawa
- Division of Cardiology, Gunma Prefectural Cardiovascular Center, 3-12 Kameizumi-Machi, Maebashi City, Gunma, 371-0004, Japan
| | - Yosuke Nakatani
- Division of Cardiology, Gunma Prefectural Cardiovascular Center, 3-12 Kameizumi-Machi, Maebashi City, Gunma, 371-0004, Japan
| | - Yuko Miki
- Division of Cardiology, Gunma Prefectural Cardiovascular Center, 3-12 Kameizumi-Machi, Maebashi City, Gunma, 371-0004, Japan
| | - Koji Goto
- Division of Cardiology, Gunma Prefectural Cardiovascular Center, 3-12 Kameizumi-Machi, Maebashi City, Gunma, 371-0004, Japan
| | - Yutaka Take
- Division of Cardiology, Gunma Prefectural Cardiovascular Center, 3-12 Kameizumi-Machi, Maebashi City, Gunma, 371-0004, Japan
| | - Kenichi Kaseno
- Division of Cardiology, Gunma Prefectural Cardiovascular Center, 3-12 Kameizumi-Machi, Maebashi City, Gunma, 371-0004, Japan
| | - Eiji Yamashita
- Division of Cardiology, Gunma Prefectural Cardiovascular Center, 3-12 Kameizumi-Machi, Maebashi City, Gunma, 371-0004, Japan
| | - Shigeto Naito
- Division of Cardiology, Gunma Prefectural Cardiovascular Center, 3-12 Kameizumi-Machi, Maebashi City, Gunma, 371-0004, Japan
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9
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Jacquemet V. Improved algorithm for generating evenly-spaced streamlines from an orientation field on a triangulated surface. COMPUTER METHODS AND PROGRAMS IN BIOMEDICINE 2024; 251:108202. [PMID: 38703718 DOI: 10.1016/j.cmpb.2024.108202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/20/2024] [Revised: 04/19/2024] [Accepted: 04/23/2024] [Indexed: 05/06/2024]
Abstract
BACKGROUND Vector fields such as cardiac fiber orientation can be visualized on a surface using streamlines. The application of evenly-spaced streamline generation to the construction of interconnected cable structure for cardiac propagation models has more stringent requirements imperfectly fulfilled by current algorithms. METHOD We developed an open-source C++/python package for the placement of evenly-spaced streamlines on a triangulated surface. The new algorithm improves upon previous works by more accurately handling streamline extremities, U-turns and limit cycles, by providing stronger geometrical guarantees on inter-streamline minimal distance, particularly when a high density of streamlines (up to 10μm spacing) is desired, and by making a more efficient parallel implementation available. The approach requires finding intersections between geometrical capsules and triangles to update an occupancy mask defined on the triangles. This enables fast streamline integration from thousands of seed points to identify optimal streamline placement. RESULTS The algorithm was assessed qualitatively on different left atrial models of fiber orientation with varying mesh resolutions (up to 375k triangles) and quantitatively by measuring streamline lengths and distribution of inter-streamline minimal distance. The complexity and the computational performance of the algorithm were studied as a function of streamline spacing in relation to triangular mesh resolution. CONCLUSION More accurate geometrical computations, attention to details and fine-tuning led to an algorithm more amenable to applications that require precise positioning of streamlines.
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Affiliation(s)
- Vincent Jacquemet
- Pharmacology and Physiology Department, Institute of Biomedical Engineering, Université de Montréal, Montreal, QC, H3T 1J4, Canada; Hôpital du Sacré-Cœur de Montréal, Research Center, 5400 boul. Gouin Ouest, Montreal, QC, H4J 1C5, Canada.
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10
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Sillett C, Razeghi O, Lee AWC, Solis Lemus JA, Roney C, Mannina C, de Vere F, Ananthan K, Ennis DB, Haberland U, Xu H, Young A, Rinaldi CA, Rajani R, Niederer SA. A three-dimensional left atrial motion estimation from retrospective gated computed tomography: application in heart failure patients with atrial fibrillation. Front Cardiovasc Med 2024; 11:1359715. [PMID: 38596691 PMCID: PMC11002108 DOI: 10.3389/fcvm.2024.1359715] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Accepted: 03/08/2024] [Indexed: 04/11/2024] Open
Abstract
Background A reduced left atrial (LA) strain correlates with the presence of atrial fibrillation (AF). Conventional atrial strain analysis uses two-dimensional (2D) imaging, which is, however, limited by atrial foreshortening and an underestimation of through-plane motion. Retrospective gated computed tomography (RGCT) produces high-fidelity three-dimensional (3D) images of the cardiac anatomy throughout the cardiac cycle that can be used for estimating 3D mechanics. Its feasibility for LA strain measurement, however, is understudied. Aim The aim of this study is to develop and apply a novel workflow to estimate 3D LA motion and calculate the strain from RGCT imaging. The utility of global and regional strains to separate heart failure in patients with reduced ejection fraction (HFrEF) with and without AF is investigated. Methods A cohort of 30 HFrEF patients with (n = 9) and without (n = 21) AF underwent RGCT prior to cardiac resynchronisation therapy. The temporal sparse free form deformation image registration method was optimised for LA feature tracking in RGCT images and used to estimate 3D LA endocardial motion. The area and fibre reservoir strains were calculated over the LA body. Universal atrial coordinates and a human atrial fibre atlas enabled the regional strain calculation and the fibre strain calculation along the local myofibre orientation, respectively. Results It was found that global reservoir strains were significantly reduced in the HFrEF + AF group patients compared with the HFrEF-only group patients (area strain: 11.2 ± 4.8% vs. 25.3 ± 12.6%, P = 0.001; fibre strain: 4.5 ± 2.0% vs. 15.2 ± 8.8%, P = 0.001), with HFrEF + AF patients having a greater regional reservoir strain dyssynchrony. All regional reservoir strains were reduced in the HFrEF + AF patient group, in whom the inferior wall strains exhibited the most significant differences. The global reservoir fibre strain and LA volume + posterior wall reservoir fibre strain exceeded LA volume alone and 2D global longitudinal strain (GLS) for AF classification (area-under-the-curve: global reservoir fibre strain: 0.94 ± 0.02, LA volume + posterior wall reservoir fibre strain: 0.95 ± 0.02, LA volume: 0.89 ± 0.03, 2D GLS: 0.90 ± 0.03). Conclusion RGCT enables 3D LA motion estimation and strain calculation that outperforms 2D strain metrics and LA enlargement for AF classification. Differences in regional LA strain could reflect regional myocardial properties such as atrial fibrosis burden.
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Affiliation(s)
- Charles Sillett
- School of Biomedical Engineering and Imaging Sciences, King’s College London, London, United Kingdom
- National Heart and Lung Institute, Imperial College London, London, United Kingdom
| | - Orod Razeghi
- School of Biomedical Engineering and Imaging Sciences, King’s College London, London, United Kingdom
- Department of Haematology, University of Cambridge, Cambridge, United Kingdom
| | - Angela W. C. Lee
- School of Biomedical Engineering and Imaging Sciences, King’s College London, London, United Kingdom
- National Heart and Lung Institute, Imperial College London, London, United Kingdom
| | - Jose Alonso Solis Lemus
- School of Biomedical Engineering and Imaging Sciences, King’s College London, London, United Kingdom
- National Heart and Lung Institute, Imperial College London, London, United Kingdom
| | - Caroline Roney
- School of Biomedical Engineering and Imaging Sciences, King’s College London, London, United Kingdom
- School of Engineering and Materials Science, Queen Mary University of London, London, United Kingdom
| | - Carlo Mannina
- Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Felicity de Vere
- Department of Cardiology, Guy’s and St Thomas’ NHS Foundation Trust, London, United Kingdom
| | - Kiruthika Ananthan
- Department of Cardiology, Guy’s and St Thomas’ NHS Foundation Trust, London, United Kingdom
| | - Daniel B. Ennis
- Department of Radiology, Stanford University, Stanford, CA, United States
| | | | - Hao Xu
- School of Biomedical Engineering and Imaging Sciences, King’s College London, London, United Kingdom
| | - Alistair Young
- School of Biomedical Engineering and Imaging Sciences, King’s College London, London, United Kingdom
| | - Christopher A. Rinaldi
- School of Biomedical Engineering and Imaging Sciences, King’s College London, London, United Kingdom
- Department of Cardiology, Guy’s and St Thomas’ NHS Foundation Trust, London, United Kingdom
| | - Ronak Rajani
- School of Biomedical Engineering and Imaging Sciences, King’s College London, London, United Kingdom
- Department of Cardiology, Guy’s and St Thomas’ NHS Foundation Trust, London, United Kingdom
| | - Steven A. Niederer
- School of Biomedical Engineering and Imaging Sciences, King’s College London, London, United Kingdom
- National Heart and Lung Institute, Imperial College London, London, United Kingdom
- Turing Research and Innovation Cluster: Digital Twins, The Alan Turing Institute, London, United Kingdom
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11
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Gu W, Liu W, Li J, Shen J, Liu R, Liang W, Luo X, Xiong N. Acute epicardial pulmonary vein reconnection: Nondurable transmural lesion or late manifestation of conduction through intercaval bundle. J Cardiovasc Electrophysiol 2024; 35:422-432. [PMID: 38205929 DOI: 10.1111/jce.16182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Revised: 12/20/2023] [Accepted: 12/26/2023] [Indexed: 01/12/2024]
Abstract
INTRODUCTION Acute pulmonary vein reconnection (PVR) via epicardial fibers can be found during observation period after PV isolation, the characteristics and related factors have not been fully studied. We aimed to investigate the prevalence, locations, electrogram characteristics, and ablation parameters related to acute epicardial pulmonary vein reconnection (AEPVR). METHODS Acute PVR was monitored during observation period after PV isolation. AEPVRs were mapped and distinguished from endocardial conduction gaps. The clinical, electrophysiological characteristics and lesion set parameters were compared between patients with and without PVR. They were also compared among AEPVR, gap-related reconnection, and epicardial PVR in repeat procedures. RESULTS A total of 56.1% acute PVR were AEPVR, which required a longer waiting period (p < .001) than endocardial gap. The majority of AEPVR were connections from the posterior PV carina to the left atrial posterior wall, followed by late manifestation of intercaval bundle conduction from the right anterior carina to right atrium. AEPVR was similar to epicardial PVR in redo procedures in distribution and electrogram characteristics. Smaller atrium (p < .001), lower impedance drop (p = .039), and ablation index (p = .028) on the posterior wall were independently associated with presence of AEPVR, while lower interlesion distance (p = .043) was the only predictor for AEPVR in acute PVR. An integrated model containing multiple lesion set parameters had the highest predictive ability for AEPVR in receiver operating characteristics analysis. CONCLUSIONS Epicardial reconduction accounted for the majority of acute PVR. AEPVR was associated with anatomic characteristics and multiple ablation-related parameters, which could be explained by nondurable transmural lesion or late manifestation of conduction through intercaval bundle.
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Affiliation(s)
- Wentao Gu
- Department of Cardiology, Huashan Hospital, Fudan University, Shanghai, China
| | - Weizhuo Liu
- Centre for Cardiopulmonary Translational Medicine, Shanghai Chest Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
- Department of Critical Care Medicine, Shanghai Chest Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Jian Li
- Department of Cardiology, Huashan Hospital, Fudan University, Shanghai, China
| | - Jun Shen
- Department of Cardiology, Huashan Hospital, Fudan University, Shanghai, China
| | - Rongchen Liu
- Department of Cardiology, Huashan Hospital, Fudan University, Shanghai, China
| | - Weiguo Liang
- Department of Cardiology, Huashan Hospital, Fudan University, Shanghai, China
| | - Xinping Luo
- Department of Cardiology, Huashan Hospital, Fudan University, Shanghai, China
| | - Nanqing Xiong
- Department of Cardiology, Huashan Hospital, Fudan University, Shanghai, China
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Kim D, Collins JD, White JA, Hanneman K, Lee DC, Patel AR, Hu P, Litt H, Weinsaft JW, Davids R, Mukai K, Ng MY, Luetkens JA, Roguin A, Rochitte CE, Woodard PK, Manisty C, Zareba KM, Mont L, Bogun F, Ennis DB, Nazarian S, Webster G, Stojanovska J. SCMR expert consensus statement for cardiovascular magnetic resonance of patients with a cardiac implantable electronic device. J Cardiovasc Magn Reson 2024; 26:100995. [PMID: 38219955 PMCID: PMC11211236 DOI: 10.1016/j.jocmr.2024.100995] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2023] [Accepted: 01/09/2024] [Indexed: 01/16/2024] Open
Abstract
Cardiovascular magnetic resonance (CMR) is a proven imaging modality for informing diagnosis and prognosis, guiding therapeutic decisions, and risk stratifying surgical intervention. Patients with a cardiac implantable electronic device (CIED) would be expected to derive particular benefit from CMR given high prevalence of cardiomyopathy and arrhythmia. While several guidelines have been published over the last 16 years, it is important to recognize that both the CIED and CMR technologies, as well as our knowledge in MR safety, have evolved rapidly during that period. Given increasing utilization of CIED over the past decades, there is an unmet need to establish a consensus statement that integrates latest evidence concerning MR safety and CIED and CMR technologies. While experienced centers currently perform CMR in CIED patients, broad availability of CMR in this population is lacking, partially due to limited availability of resources for programming devices and appropriate monitoring, but also related to knowledge gaps regarding the risk-benefit ratio of CMR in this growing population. To address the knowledge gaps, this SCMR Expert Consensus Statement integrates consensus guidelines, primary data, and opinions from experts across disparate fields towards the shared goal of informing evidenced-based decision-making regarding the risk-benefit ratio of CMR for patients with CIEDs.
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Affiliation(s)
- Daniel Kim
- Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
| | | | - James A White
- Departments of Cardiac Sciences and Diagnostic Imaging, Cummings School of Medicine, University of Calgary, Calgary, Canada
| | - Kate Hanneman
- Department of Medical Imaging, University Medical Imaging Toronto, Toronto General Hospital and Peter Munk Cardiac Centre, University of Toronto, Toronto, Canada
| | - Daniel C Lee
- Department of Medicine (Division of Cardiology), Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Amit R Patel
- Cardiovascular Division, University of Virginia, Charlottesville, VA, USA
| | - Peng Hu
- School of Biomedical Engineering, ShanghaiTech University, Shanghai, China
| | - Harold Litt
- Department of Radiology, Perelman School of Medicine of the University of Pennsylvania, Philadelphia, PA, USA
| | - Jonathan W Weinsaft
- Department of Medicine (Division of Cardiology), Weill Cornell Medicine, New York, NY, USA
| | - Rachel Davids
- SHS AM NAM USA DI MR COLLAB ADV-APPS, Siemens Medical Solutions USA, Inc., Chicago, Il, USA
| | - Kanae Mukai
- Salinas Valley Memorial Healthcare System, Ryan Ranch Center for Advanced Diagnostic Imaging, Monterey, CA, USA
| | - Ming-Yen Ng
- Department of Diagnostic Radiology, School of Clinical Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, the Hong Kong Special Administrative Region of China
| | - Julian A Luetkens
- Department of Diagnostic and Interventional Radiology, University Hospital Bonn, Venusberg-Campus 1, Bonn, Germany
| | - Ariel Roguin
- Department of Cardiology, Hillel Yaffe Medical Center, Hadera and Faculty of Medicine. Technion - Israel Institute of Technology, Israel
| | - Carlos E Rochitte
- Heart Institute, InCor, University of São Paulo Medical School, São Paulo, SP, Brazil
| | - Pamela K Woodard
- Mallinckrodt Institute of Radiology, Washington University School of Medicine in St. Louis, St. Louis, MO, USA
| | - Charlotte Manisty
- Institute of Cardiovascular Science, University College London, London, UK
| | - Karolina M Zareba
- Division of Cardiovascular Medicine, The Ohio State University, Columbus, OH, USA
| | - Lluis Mont
- Cardiovascular Institute, Hospital Clínic, University of Barcelona, Catalonia, Spain
| | - Frank Bogun
- Division of Cardiovascular Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Daniel B Ennis
- Department of Radiology, Stanford University, Stanford, CA, USA
| | - Saman Nazarian
- Section of Cardiac Electrophysiology, Perelman School of Medicine of the University of Pennsylvania, Philadelphia, PA, USA
| | - Gregory Webster
- Department of Pediatrics (Cardiology), Ann & Robert H. Lurie Children's Hospital, Chicago, IL, USA
| | - Jadranka Stojanovska
- Department of Radiology, Grossman School of Medicine, New York University, New York, NY, USA
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Strocchi M, Rodero C, Roney CH, Mendonca Costa C, Plank G, Lamata P, Niederer SA. A Semi-automatic Pipeline for Generation of Large Cohorts of Four-Chamber Heart Meshes. Methods Mol Biol 2024; 2735:117-127. [PMID: 38038846 DOI: 10.1007/978-1-0716-3527-8_7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2023]
Abstract
Computational models for cardiac electro-mechanics have been increasingly used to further understand heart function. Small cohort and single patient computational studies provide useful insight into cardiac pathophysiology and response to therapy. However, these smaller studies have limited capability to capture the high level of anatomical variability seen in cardiology patients. Larger cohort studies are, on the other hand, more representative of the study population, but building several patient-specific anatomical meshes can be time-consuming and requires access to larger datasets of imaging data, image processing software to label anatomical structures and tools to create high fidelity anatomical meshes. Limited access to these tools and data might limit advances in this area of research. In this chapter, we present our semi-automatic pipeline to build patient-specific four-chamber heart meshes from CT imaging datasets, including ventricular myofibers and a set of universal ventricular and atrial coordinates. This pipeline was applied to CT images from both heart failure patients and healthy controls to generate cohorts of tetrahedral meshes suitable for electro-mechanics simulations. Both cohorts were made publicly available in order to promote computational studies employing large virtual cohorts.
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Affiliation(s)
- Marina Strocchi
- Department of Biomedical Engineering, King's College London, London, UK
| | - Cristobal Rodero
- Department of Biomedical Engineering, King's College London, London, UK
| | - Caroline H Roney
- Department of Biomedical Engineering, King's College London, London, UK
| | | | | | - Pablo Lamata
- Department of Biomedical Engineering, King's College London, London, UK
| | - Steven A Niederer
- Department of Biomedical Engineering, King's College London, London, UK.
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Zahid S, Malik T, Peterson C, Tarabanis C, Dai M, Katz M, Bernstein SA, Barbhaiya C, Park DS, Knotts RJ, Holmes DS, Kushnir A, Aizer A, Chinitz LA, Jankelson L. Conduction velocity is reduced in the posterior wall of hypertrophic cardiomyopathy patients with normal bipolar voltage undergoing ablation for paroxysmal atrial fibrillation. J Interv Card Electrophysiol 2024; 67:203-210. [PMID: 36952090 DOI: 10.1007/s10840-023-01533-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Accepted: 03/15/2023] [Indexed: 03/24/2023]
Abstract
OBJECTIVES We investigated characteristics of left atrial conduction in patients with HCM, paroxysmal AF and normal bipolar voltage. BACKGROUND Patients with hypertrophic cardiomyopathy (HCM) exhibit abnormal cardiac tissue arrangement. The incidence of atrial fibrillation (AF) is increased fourfold in patients with HCM and confers a fourfold increased risk of death. Catheter ablation is less effective in HCM, with twofold increased risk of AF recurrence. The mechanisms of AF perpetuation in HCM are poorly understood. METHODS We analyzed 20 patients with HCM and 20 controls presenting for radiofrequency ablation of paroxysmal AF normal left atrial voltage(> 0.5 mV). Intracardiac electrograms were extracted from the CARTO mapping system and analyzed using Matlab/Python code interfacing with Core OpenEP software. Conduction velocity maps were calculated using local activation time gradients. RESULTS There were no differences in baseline demographics, atrial size, or valvular disease between HCM and control patients. Patients with HCM had significantly reduced atrial conduction velocity compared to controls (0.44 ± 0.17 vs 0.56 ± 0.10 m/s, p = 0.01), despite no significant differences in bipolar voltage amplitude (1.23 ± 0.38 vs 1.20 ± 0.41 mV, p = 0.76). There was a statistically significant reduction in conduction velocity in the posterior left atrium in HCM patients relative to controls (0.43 ± 0.18 vs 0.58 ± 0.10 m/s, p = 0.003), but not in the anterior left atrium (0.46 ± 0.17 vs 0.55 ± 0.10 m/s, p = 0.05). There was a significant association between conduction velocity and interventricular septal thickness (slope = -0.013, R2 = 0.13, p = 0.03). CONCLUSIONS Atrial conduction velocity is significantly reduced in patients with HCM and paroxysmal AF, possibly contributing to arrhythmia persistence after catheter ablation.
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Affiliation(s)
- Sohail Zahid
- Leon H. Charney Division of Cardiology, Department of Internal Medicine, NYU Langone Health, 550 1st Ave., New York, NY, 10016, USA.
| | - Tahir Malik
- Leon H. Charney Division of Cardiology, Department of Internal Medicine, NYU Langone Health, 550 1st Ave., New York, NY, 10016, USA
| | - Connor Peterson
- Leon H. Charney Division of Cardiology, Department of Internal Medicine, NYU Langone Health, 550 1st Ave., New York, NY, 10016, USA
| | - Constantine Tarabanis
- Leon H. Charney Division of Cardiology, Department of Internal Medicine, NYU Langone Health, 550 1st Ave., New York, NY, 10016, USA
| | - Matthew Dai
- Leon H. Charney Division of Cardiology, Department of Internal Medicine, NYU Langone Health, 550 1st Ave., New York, NY, 10016, USA
| | - Moshe Katz
- Leon H. Charney Division of Cardiology, Department of Internal Medicine, NYU Langone Health, 550 1st Ave., New York, NY, 10016, USA
| | - Scott A Bernstein
- Leon H. Charney Division of Cardiology, Department of Internal Medicine, NYU Langone Health, 550 1st Ave., New York, NY, 10016, USA
| | - Chirag Barbhaiya
- Leon H. Charney Division of Cardiology, Department of Internal Medicine, NYU Langone Health, 550 1st Ave., New York, NY, 10016, USA
| | - David S Park
- Leon H. Charney Division of Cardiology, Department of Internal Medicine, NYU Langone Health, 550 1st Ave., New York, NY, 10016, USA
| | - Robert J Knotts
- Leon H. Charney Division of Cardiology, Department of Internal Medicine, NYU Langone Health, 550 1st Ave., New York, NY, 10016, USA
| | - Douglas S Holmes
- Leon H. Charney Division of Cardiology, Department of Internal Medicine, NYU Langone Health, 550 1st Ave., New York, NY, 10016, USA
| | - Alexander Kushnir
- Leon H. Charney Division of Cardiology, Department of Internal Medicine, NYU Langone Health, 550 1st Ave., New York, NY, 10016, USA
| | - Anthony Aizer
- Leon H. Charney Division of Cardiology, Department of Internal Medicine, NYU Langone Health, 550 1st Ave., New York, NY, 10016, USA
| | - Larry A Chinitz
- Leon H. Charney Division of Cardiology, Department of Internal Medicine, NYU Langone Health, 550 1st Ave., New York, NY, 10016, USA
| | - Lior Jankelson
- Leon H. Charney Division of Cardiology, Department of Internal Medicine, NYU Langone Health, 550 1st Ave., New York, NY, 10016, USA.
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Trayanova NA, Prakosa A. Up digital and personal: How heart digital twins can transform heart patient care. Heart Rhythm 2024; 21:89-99. [PMID: 37871809 PMCID: PMC10872898 DOI: 10.1016/j.hrthm.2023.10.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Revised: 10/12/2023] [Accepted: 10/15/2023] [Indexed: 10/25/2023]
Abstract
Precision medicine is the vision of health care where therapy is tailored to each patient. As part of this vision, digital twinning technology promises to deliver a digital representation of organs or even patients by using tools capable of simulating personal health conditions and predicting patient or disease trajectories on the basis of relationships learned both from data and from biophysics knowledge. Such virtual replicas would update themselves with data from monitoring devices and medical tests and assessments, reflecting dynamically the changes in our health conditions and the responses to treatment. In precision cardiology, the concepts and initial applications of heart digital twins have slowly been gaining popularity and the trust of the clinical community. In this article, we review the advancement in heart digital twinning and its initial translation to the management of heart rhythm disorders.
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Affiliation(s)
- Natalia A Trayanova
- Alliance for Cardiovascular Diagnostic and Treatment Innovation, Johns Hopkins University, Baltimore, Maryland; Department of Biomedical Engineering, Johns Hopkins University, Baltimore, Maryland.
| | - Adityo Prakosa
- Alliance for Cardiovascular Diagnostic and Treatment Innovation, Johns Hopkins University, Baltimore, Maryland
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Çöteli C, Dural M, Yorgun H, Aytemir K. Cryoballoon ablation of non-PV triggers in persistent atrial fibrillation. Pacing Clin Electrophysiol 2024; 47:66-79. [PMID: 37971717 DOI: 10.1111/pace.14878] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2023] [Revised: 09/21/2023] [Accepted: 11/05/2023] [Indexed: 11/19/2023]
Abstract
Cryoballoon-based catheter ablation has emerged as an efficacious and safe therapeutic intervention for patients with paroxysmal atrial fibrillation (PAF). PAF is primarily associated with the triggers in the pulmonary vein (PV). However, persistent atrial fibrillation (PeAF) is a complex condition that involves changes in the atrial substrate and the presence of non-PV triggers. Therefore, a comprehensive treatment approach is necessary for patients with PeAF. Utilizing a 3D electroanatomical map, the radiofrequency-based ablation technique adeptly identifies and targets the atrial substrate and non-PV triggers. On the other hand, the cryoballoon-based AF ablation was initially designed for PV isolation. However, its single-shot feature makes it a great choice for electrophysiologists looking to address non-PV triggers. It is possible to target the left atrial appendage (LAA), superior vena cava (SVC), left atrial roof, and posterior wall using the apparatus's unique configuration and ablation abilities. This review focuses on the increasing literature regarding cryoballoon-based methods for non-PV trigger ablation. Specifically, it delves into the technical procedures used to isolate the LAA, SVC, and ablate the left atrial roof and posterior wall.
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Affiliation(s)
- Cem Çöteli
- Faculty of Medicine, Department of Cardiology, Hacettepe University, Ankara, Turkey
| | - Muhammet Dural
- Faculty of Medicine, Department of Cardiology, Osmangazi University, Eskişehir, Turkey
- Department of Cardiology, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Center, Maastricht, The Netherlands
| | - Hikmet Yorgun
- Faculty of Medicine, Department of Cardiology, Hacettepe University, Ankara, Turkey
- Department of Cardiology, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Center, Maastricht, The Netherlands
| | - Kudret Aytemir
- Faculty of Medicine, Department of Cardiology, Hacettepe University, Ankara, Turkey
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Masuda M, Matsuda Y, Uematsu H, Asai M, Okamoto S, Ishihara T, Nanto K, Tsujimura T, Hata Y, Higashino N, Nakao S, Mano T. Comparison of voltage maps using OCTARAY catheter and PENTARAY catheter. Pacing Clin Electrophysiol 2024; 47:28-35. [PMID: 38029377 DOI: 10.1111/pace.14890] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Revised: 11/07/2023] [Accepted: 11/15/2023] [Indexed: 12/01/2023]
Abstract
BACKGROUND Recently, a new OCTARAY® mapping catheter was commercially launched. The catheter is designed to enable high-density mapping and precise signal recording via 48 small electrodes arranged on eight radiating splines. The purpose of this study was to compare bipolar voltage and low-voltage-area size, and mapping efficacy between the OCTARAY catheter and the PENTARAY® catheter METHODS: Twelve consecutive patients who underwent initial and second ablations for persistent atrial fibrillation within 2 years were considered for enrollment. Voltage mapping was performed twice, first during the initial ablation using the PENTARY catheter and second during the second ablation using the OCTARAY Long 3-3-3-3-3 (L3) catheter. RESULTS Mean voltage with the OCTARAY-L3 catheter (1.64 ± 0.57 mV) was 32.3% greater than that with the PENTARAY catheter (1.24 ± 0.46 mV, p < .0001) in total left atrium. Low-voltage-area (<0.50 mV) size with the OCTARAY-L3 catheter was smaller than that with the PENTARAY catheter (6.9 ± 9.7 vs. 11.4 ± 13.0 cm2 , p < .0001). The OCTARAY-L3 catheter demonstrated greater efficacy than the PENTARAY catheter in terms of shorter mapping time (606 ± 99 vs. 782 ± 211 s, p = .008) and more mapping points (3,026 ± 838 vs. 781 ± 342 points, p < .0001). CONCLUSION The OCTARAY catheter demonstrated higher voltage recordings, narrower low-voltage areas, and a more efficacious mapping procedure than the PENTARAY catheter.
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Affiliation(s)
- Masaharu Masuda
- Cardiovascular Center, Kansai Rosai Hospital, Amagasaki, Hyogo, Japan
| | - Yasuhiro Matsuda
- Cardiovascular Center, Kansai Rosai Hospital, Amagasaki, Hyogo, Japan
| | - Hiroyuki Uematsu
- Cardiovascular Center, Kansai Rosai Hospital, Amagasaki, Hyogo, Japan
| | - Mitsutoshi Asai
- Cardiovascular Center, Kansai Rosai Hospital, Amagasaki, Hyogo, Japan
| | - Shin Okamoto
- Cardiovascular Center, Kansai Rosai Hospital, Amagasaki, Hyogo, Japan
| | - Takayuki Ishihara
- Cardiovascular Center, Kansai Rosai Hospital, Amagasaki, Hyogo, Japan
| | - Kiyonori Nanto
- Cardiovascular Center, Kansai Rosai Hospital, Amagasaki, Hyogo, Japan
| | - Takuya Tsujimura
- Cardiovascular Center, Kansai Rosai Hospital, Amagasaki, Hyogo, Japan
| | - Yosuke Hata
- Cardiovascular Center, Kansai Rosai Hospital, Amagasaki, Hyogo, Japan
| | - Naoko Higashino
- Cardiovascular Center, Kansai Rosai Hospital, Amagasaki, Hyogo, Japan
| | - Sho Nakao
- Cardiovascular Center, Kansai Rosai Hospital, Amagasaki, Hyogo, Japan
| | - Toshiaki Mano
- Cardiovascular Center, Kansai Rosai Hospital, Amagasaki, Hyogo, Japan
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18
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Tamura S, Shimeno K, Hayashi Y, Naruko T, Fukuda D. Effective ablation of atrial tachycardia with an epicardial circuit-insights from endocardial scars sites: a case study. J Interv Card Electrophysiol 2024; 67:1-3. [PMID: 37991668 DOI: 10.1007/s10840-023-01687-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Accepted: 10/30/2023] [Indexed: 11/23/2023]
Abstract
A previous study reported primary macroreentrant atrial tachycardia (AT) in the left atrium (LA), including the epicardial circuit on a left atrial anterior wall (LAAW) scar, without any prior cardiac intervention (Miyazawa et al. in J Cardiovasc Electrophysiol 2019; 30: 263-264). However, determining the target for terminating macroreentrant ATs is challenging. The mapping revealed a centrifugal pattern but did not fully elucidate the AT circuit. The reentrant mechanism of these ATs was confirmed using entrainment pacing. The earliest excitation site (EES) was traditionally selected as the ablation site, typically located in healthy tissue. However, our two cases provide new insights into AT termination, including the epicardial bridge across the endocardial LAAW scar, using minimum ablation points, without the need to ablate the healthy EES.
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Affiliation(s)
- Shota Tamura
- Department of Cardiology, Osaka City General Hospital, 2-13-22 Miyakojima-hondori, Miyakojima-Ku, Osaka, 534-0021, Japan
| | - Kenji Shimeno
- Department of Cardiology, Osaka City General Hospital, 2-13-22 Miyakojima-hondori, Miyakojima-Ku, Osaka, 534-0021, Japan.
| | - Yusuke Hayashi
- Department of Cardiology, Osaka City General Hospital, 2-13-22 Miyakojima-hondori, Miyakojima-Ku, Osaka, 534-0021, Japan
| | - Takahiko Naruko
- Department of Cardiology, Osaka City General Hospital, 2-13-22 Miyakojima-hondori, Miyakojima-Ku, Osaka, 534-0021, Japan
| | - Daiju Fukuda
- Department of Cardiovascular Medicine, Osaka Metropolitan University Graduate School of Medicine, 1-4-3 Asahimachi, Abenoku, Osaka, 545-8585, Japan
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19
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Roney CH, Solis Lemus JA, Lopez Barrera C, Zolotarev A, Ulgen O, Kerfoot E, Bevis L, Misghina S, Vidal Horrach C, Jaffery OA, Ehnesh M, Rodero C, Dharmaprani D, Ríos-Muñoz GR, Ganesan A, Good WW, Neic A, Plank G, Hopman LHGA, Götte MJW, Honarbakhsh S, Narayan SM, Vigmond E, Niederer S. Constructing bilayer and volumetric atrial models at scale. Interface Focus 2023; 13:20230038. [PMID: 38106921 PMCID: PMC10722212 DOI: 10.1098/rsfs.2023.0038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Accepted: 11/15/2023] [Indexed: 12/19/2023] Open
Abstract
To enable large in silico trials and personalized model predictions on clinical timescales, it is imperative that models can be constructed quickly and reproducibly. First, we aimed to overcome the challenges of constructing cardiac models at scale through developing a robust, open-source pipeline for bilayer and volumetric atrial models. Second, we aimed to investigate the effects of fibres, fibrosis and model representation on fibrillatory dynamics. To construct bilayer and volumetric models, we extended our previously developed coordinate system to incorporate transmurality, atrial regions and fibres (rule-based or data driven diffusion tensor magnetic resonance imaging (MRI)). We created a cohort of 1000 biatrial bilayer and volumetric models derived from computed tomography (CT) data, as well as models from MRI, and electroanatomical mapping. Fibrillatory dynamics diverged between bilayer and volumetric simulations across the CT cohort (correlation coefficient for phase singularity maps: left atrial (LA) 0.27 ± 0.19, right atrial (RA) 0.41 ± 0.14). Adding fibrotic remodelling stabilized re-entries and reduced the impact of model type (LA: 0.52 ± 0.20, RA: 0.36 ± 0.18). The choice of fibre field has a small effect on paced activation data (less than 12 ms), but a larger effect on fibrillatory dynamics. Overall, we developed an open-source user-friendly pipeline for generating atrial models from imaging or electroanatomical mapping data enabling in silico clinical trials at scale (https://github.com/pcmlab/atrialmtk).
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Affiliation(s)
- Caroline H. Roney
- School of Engineering and Materials Science, Queen Mary University of London, London, UK
- School of Biomedical Engineering and Imaging Sciences, King’s College London, London, UK
| | - Jose Alonso Solis Lemus
- School of Biomedical Engineering and Imaging Sciences, King’s College London, London, UK
- National Heart and Lung Institute, Imperial College London, London, UK
| | - Carlos Lopez Barrera
- School of Engineering and Materials Science, Queen Mary University of London, London, UK
- Center for Research in Advanced Materials S.C (CIMAV), Chihuahua, Mexico
| | - Alexander Zolotarev
- School of Engineering and Materials Science, Queen Mary University of London, London, UK
| | - Onur Ulgen
- School of Biomedical Engineering and Imaging Sciences, King’s College London, London, UK
| | - Eric Kerfoot
- School of Biomedical Engineering and Imaging Sciences, King’s College London, London, UK
| | - Laura Bevis
- School of Engineering and Materials Science, Queen Mary University of London, London, UK
| | - Semhar Misghina
- School of Engineering and Materials Science, Queen Mary University of London, London, UK
| | - Caterina Vidal Horrach
- School of Engineering and Materials Science, Queen Mary University of London, London, UK
| | - Ovais A. Jaffery
- School of Engineering and Materials Science, Queen Mary University of London, London, UK
| | - Mahmoud Ehnesh
- School of Engineering and Materials Science, Queen Mary University of London, London, UK
| | - Cristobal Rodero
- School of Biomedical Engineering and Imaging Sciences, King’s College London, London, UK
- National Heart and Lung Institute, Imperial College London, London, UK
| | - Dhani Dharmaprani
- College of Medicine and Public Health, Flinders University, Adelaide, Australia
| | - Gonzalo R. Ríos-Muñoz
- Bioengineering Department, Universidad Carlos III de Madrid, Madrid 28911, Spain
- Department of Cardiology, Gregorio Marañón Health Research Institute (IiSGM), Hospital General Universitario Gregorio Marañón, Madrid 28007, Spain
- Center for Biomedical Research in Cardiovascular Disease Network (CIBERCV), Madrid 28029, Spain
| | - Anand Ganesan
- College of Medicine and Public Health, Flinders University, Adelaide, Australia
| | | | | | - Gernot Plank
- Gottfried Schatz Research Center-Biophysics, Medical University of Graz, Graz, Austria
- BioTechMed-Graz, Graz, Austria
| | | | | | - Shohreh Honarbakhsh
- Electrophysiology Department, Barts Heart Centre, Barts Health NHS Trust, London, UK
| | - Sanjiv M. Narayan
- Department of Medicine and Cardiovascular Institute, Stanford University, Palo Alto, CA, USA
| | - Edward Vigmond
- IHU Liryc, Electrophysiology and Heart Modeling Institute, Fondation Bordeaux Université, Bordeaux, France
- IMB, UMR 5251, University Bordeaux, Talence 33400, France
| | - Steven Niederer
- School of Biomedical Engineering and Imaging Sciences, King’s College London, London, UK
- National Heart and Lung Institute, Imperial College London, London, UK
- Turing Research and Innovation Cluster in Digital Twins (TRIC: DT), The Alan Turing Institute, London, UK
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20
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Nesapiragasan V, Hayıroğlu Mİ, Sciacca V, Sommer P, Sohns C, Fink T. Catheter Ablation Approaches for the Treatment of Arrhythmia Recurrence in Patients with a Durable Pulmonary Vein Isolation. Balkan Med J 2023; 40:386-394. [PMID: 37817408 PMCID: PMC10613749 DOI: 10.4274/balkanmedj.galenos.2023.2023-9-48] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Accepted: 09/20/2023] [Indexed: 10/12/2023] Open
Abstract
Catheter ablation has emerged as an effective treatment for atrial arrhythmias, and pulmonary vein isolation (PVI) is the cornerstone of ablation strategies. Significant technological evolution and widespread increase in operator experience have facilitated the effectiveness of catheter ablation to achieve durable PVIs in single or multiple ablation procedures. Nevertheless, arrhythmia recurrence is a common problem even after establishing PVI. Data on catheter ablation in these patients are sparse and repeat ablation in this population is highly challenging. In this review we have summarized the available data as well as potential strategies of catheter ablation following the initial PVI.
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Affiliation(s)
- Vinitha Nesapiragasan
- Clinics for Electrophysiology, Herz- und Diabeteszentrum Nordrhein-Westfalen, Ruhr-Universität Bochum, Bad Oeynhausen, Germany
| | - Mert İlker Hayıroğlu
- Clinic Cardiology, Siyami Ersek Thoracic and Cardiovascular Surgery Training and Research Hospital, İstanbul, Türkiye
| | - Vanessa Sciacca
- Clinics for Electrophysiology, Herz- und Diabeteszentrum Nordrhein-Westfalen, Ruhr-Universität Bochum, Bad Oeynhausen, Germany
| | - Philipp Sommer
- Clinics for Electrophysiology, Herz- und Diabeteszentrum Nordrhein-Westfalen, Ruhr-Universität Bochum, Bad Oeynhausen, Germany
| | - Christian Sohns
- Clinics for Electrophysiology, Herz- und Diabeteszentrum Nordrhein-Westfalen, Ruhr-Universität Bochum, Bad Oeynhausen, Germany
| | - Thomas Fink
- Clinics for Electrophysiology, Herz- und Diabeteszentrum Nordrhein-Westfalen, Ruhr-Universität Bochum, Bad Oeynhausen, Germany
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21
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Tonko JB, Silberbauer J, Mann I. How to ablate the septo-pulmonary bundle: a case-based review of percutaneous ablation strategies to achieve roof line block. Europace 2023; 25:euad283. [PMID: 37713215 PMCID: PMC10558061 DOI: 10.1093/europace/euad283] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Revised: 08/29/2023] [Accepted: 09/06/2023] [Indexed: 09/16/2023] Open
Abstract
Electrical conduction through cardiac muscle fibres separated from the main myocardial wall by layers of interposed adipose tissue are notoriously difficult to target by endocardial ablation alone. They are a recognised important cause for procedural failure due to the difficulties of delivering sufficient energy via the endocardial radiofrequency catheter to reach the outer epicardial layer without risking adverse events of the otherwise thin walled atria. Left atrial ablations for atrial fibrillation (AF) and tachycardia are commonly affected by the presence of several epicardial structures, with the septo-pulmonary bundle (SPB), Bachmann's bundle, and the ligament of Marshall all posing substantial challenges for endocardial procedures. Delivery of a transmural lesion set is essential for sustained pulmonary vein isolation and for conduction block across linear atrial lines which in turn has been described to translate into a reduced AF/atrial tachycardia recurrence rate. To overcome the limitations of endocardial-only approaches, surgical ablation techniques for epicardial or combined hybrid endo-epicardial ablations have been described to successfully target these connections. Yet, these techniques confer an increase in procedure complexity, duration, cost, and morbidity. Alternatively, coronary venous system ethanol ablation has been successfully employed by sub-selecting the vein of Marshall to facilitate mitral isthmus line block, although this approach is naturally limited to this area by the coronary venous anatomy. Increased awareness of the pathophysiological relevance of these epicardial structures and their intracardiac conduction patterns in the era of high-resolution 3D electro-anatomical mapping technology has allowed greater understanding of their contribution to the persistence of AF as well as failure to achieve transmural block by traditional ablation approaches. This might translate into novel catheter ablation strategies with procedural success rates comparable to surgical 'cut-and-sew' techniques. This review aims to give an overview of percutaneous catheter ablation strategies to target the SPB, an important cause of failed block across the roof line and isolation of the left atrial posterior wall and/or the pulmonary veins. Existing and investigational technologies will be discussed and an outlook of future approaches provided.
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Affiliation(s)
- Johanna Bérénice Tonko
- Institute for Cardiovascular Science, University College London, 5 University Street, WC1E 6JF London, UK
- Department of Cardiology, Royal Sussex County Hospital, Brighton and Sussex University Hospitals NHS Foundation Trust, Eastern Rd, Brighton BN2 5BE, UK
| | - John Silberbauer
- Department of Cardiology, Royal Sussex County Hospital, Brighton and Sussex University Hospitals NHS Foundation Trust, Eastern Rd, Brighton BN2 5BE, UK
| | - Ian Mann
- Department of Cardiology, Royal Sussex County Hospital, Brighton and Sussex University Hospitals NHS Foundation Trust, Eastern Rd, Brighton BN2 5BE, UK
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22
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Cui H, Yu ZX, Huang Y, Hann SY, Esworthy T, Shen YL, Zhang LG. 3D printing of thick myocardial tissue constructs with anisotropic myofibers and perfusable vascular channels. BIOMATERIALS ADVANCES 2023; 153:213579. [PMID: 37566935 DOI: 10.1016/j.bioadv.2023.213579] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Revised: 07/30/2023] [Accepted: 08/04/2023] [Indexed: 08/13/2023]
Abstract
Engineering of myocardial tissues has become a promising therapeutic strategy for treating myocardial infarction (MI). However, a significant challenge remains in generating clinically relevant myocardial tissues that possess native microstructural characteristics and fulfill the requirements for implantation within the human body. In this study, a thick 3D myocardial construct with anisotropic myofibers and perfusable branched vascular channels is created with clinically relevant dimensions using a customized beam-scanning stereolithography printing technique. To obtain tissue-specific matrix niches, a decellularized extracellular matrix microfiber-reinforced gelatin-based bioink is developed. The bioink plays a crucial role in facilitating the precise manufacturing of a hierarchical microstructure, enabling us to better replicate the physiological characteristics of the native myocardial tissue matrix in terms of structure, biomechanics, and bioactivity. Through the integration of the tailored bioink with our printing method, we demonstrate a biomimetic architecture, appropriate biomechanical properties, vascularization, and improved functionality of induced pluripotent stem cell-derived cardiomyocytes in the thick tissue construct in vitro. This work not only offers a novel and effective means to generate biomimetic heart tissue in vitro for the treatment of MI, but also introduces a potential methodology for creating clinically relevant tissue products to aid in other complex tissue/organ regeneration and disease model applications.
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Affiliation(s)
- Haitao Cui
- Key Laboratory of Biorheological Science and Technology, Ministry of Education, College of Bioengineering, Chongqing University, Chongqing, 400044, China; Department of Mechanical and Aerospace Engineering, The George Washington University, Washington, DC 20052, United States of America
| | - Zu-Xi Yu
- National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD 20892, United States of America
| | - Yimin Huang
- National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD 20892, United States of America
| | - Sung Yun Hann
- Department of Mechanical and Aerospace Engineering, The George Washington University, Washington, DC 20052, United States of America
| | - Timothy Esworthy
- Department of Mechanical and Aerospace Engineering, The George Washington University, Washington, DC 20052, United States of America
| | - Yin-Lin Shen
- Department of Mechanical and Aerospace Engineering, The George Washington University, Washington, DC 20052, United States of America
| | - Lijie Grace Zhang
- Department of Mechanical and Aerospace Engineering, The George Washington University, Washington, DC 20052, United States of America; Departments of Electrical and Computer Engineering, The George Washington University, Washington, DC 20052, United States of America; Department of Biomedical Engineering, The George Washington University, Washington, DC 20052, United States of America; Department of Medicine, The George Washington University, Washington, DC 20052, United States of America.
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23
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Takahashi Y, Yamaguchi T, Otsubo T, Nakashima K, Shinzato K, Osako R, Shichida S, Kawano Y, Fukui A, Kawaguchi A, Aishima S, Saito T, Takahashi N, Node K. Histological validation of atrial structural remodelling in patients with atrial fibrillation. Eur Heart J 2023; 44:3339-3353. [PMID: 37350738 PMCID: PMC10499545 DOI: 10.1093/eurheartj/ehad396] [Citation(s) in RCA: 24] [Impact Index Per Article: 24.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Revised: 05/03/2023] [Accepted: 06/01/2023] [Indexed: 06/24/2023] Open
Abstract
BACKGROUND AND AIMS This study aimed to histologically validate atrial structural remodelling associated with atrial fibrillation. METHODS AND RESULTS Patients undergoing atrial fibrillation ablation and endomyocardial atrial biopsy were included (n = 230; 67 ± 12 years old; 69 women). Electroanatomic mapping was performed during right atrial pacing. Voltage at the biopsy site (Vbiopsy), global left atrial voltage (VGLA), and the proportion of points with fractionated electrograms defined as ≥5 deflections in each electrogram (%Fractionated EGM) were evaluated. SCZtotal was calculated as the total width of slow conduction zones, defined as regions with a conduction velocity of <30 cm/s. Histological factors potentially associated with electroanatomic characteristics were evaluated using multiple linear regression analyses. Ultrastructural features and immune cell infiltration were evaluated by electron microscopy and immunohistochemical staining in 33 and 60 patients, respectively. Fibrosis, intercellular space, myofibrillar loss, and myocardial nuclear density were significantly associated with Vbiopsy (P = .014, P < .001, P < .001, and P = .002, respectively) and VGLA (P = .010, P < .001, P = .001, and P < .001, respectively). The intercellular space was associated with the %Fractionated EGM (P = .001). Fibrosis, intercellular space, and myofibrillar loss were associated with SCZtotal (P = .028, P < .001, and P = .015, respectively). Electron microscopy confirmed plasma components and immature collagen fibrils in the increased intercellular space and myofilament lysis in cardiomyocytes, depending on myofibrillar loss. Among the histological factors, the severity of myofibrillar loss was associated with an increase in macrophage infiltration. CONCLUSION Histological correlates of atrial structural remodelling were fibrosis, increased intercellular space, myofibrillar loss, and decreased nuclear density. Each histological component was defined using electron microscopy and immunohistochemistry studies.
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Affiliation(s)
- Yuya Takahashi
- Department of Cardiovascular Medicine, Saga University, 5-1-1 Nabeshima, Saga 849-8501, Japan
| | - Takanori Yamaguchi
- Department of Cardiovascular Medicine, Saga University, 5-1-1 Nabeshima, Saga 849-8501, Japan
| | - Toyokazu Otsubo
- Department of Cardiovascular Medicine, Saga University, 5-1-1 Nabeshima, Saga 849-8501, Japan
| | - Kana Nakashima
- Department of Cardiovascular Medicine, Saga University, 5-1-1 Nabeshima, Saga 849-8501, Japan
| | - Kodai Shinzato
- Department of Cardiovascular Medicine, Saga University, 5-1-1 Nabeshima, Saga 849-8501, Japan
| | - Ryosuke Osako
- Department of Cardiovascular Medicine, Saga University, 5-1-1 Nabeshima, Saga 849-8501, Japan
| | - Shigeki Shichida
- Department of Cardiovascular Medicine, Saga University, 5-1-1 Nabeshima, Saga 849-8501, Japan
| | - Yuki Kawano
- Division of Cardiology, Saiseikai Futsukaichi Hospital, 3-13-1, Yumachi, Chikushino, Fukoka 818-8516, Japan
| | - Akira Fukui
- Department of Cardiology and Clinical Examination, Faculty of Medicine, Oita University, 1-1, Idaigaoka, Hasama, Yufu, Oita 879-5593, Japan
| | - Atsushi Kawaguchi
- Education and Research Center for Community Medicine, Faculty of Medicine, Saga University, 5-1-1 Nabeshima, Saga 849-8501, Japan
| | - Shinichi Aishima
- Department of Pathology and Microbiology, Saga University, Saga, Japan
| | - Tsunenori Saito
- Department of Cardiovascular Medicine, Nippon Medical School Tama Nagayama Hospital, Tama, Tokyo, Japan
| | - Naohiko Takahashi
- Department of Cardiology and Clinical Examination, Faculty of Medicine, Oita University, 1-1, Idaigaoka, Hasama, Yufu, Oita 879-5593, Japan
| | - Koichi Node
- Department of Cardiovascular Medicine, Saga University, 5-1-1 Nabeshima, Saga 849-8501, Japan
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24
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Lee SR, Park HS, Kwon S, Choi EK, Oh S. Tailored ablation index based on left atrial wall thickness assessed by computed tomography for pulmonary vein isolation in patients with atrial fibrillation. J Cardiovasc Electrophysiol 2023; 34:1811-1819. [PMID: 37595097 DOI: 10.1111/jce.16026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Revised: 07/19/2023] [Accepted: 07/22/2023] [Indexed: 08/20/2023]
Abstract
INTRODUCTION Although left atrial wall thickness (LAWT) is known to be varied, a fixed target Ablation Index (AI) based pulmonary vein isolation (PVI) has been suggested in catheter ablation for atrial fibrillation (AF). We aimed to evaluate the efficacy and safety of PVI applying tailored AI based on LAWT assessed by cardiac computed tomography (CT). METHODS The thick segment was defined as the segment including ≥LAWT grade 3 (≥1.5 mm). The fixed AI strategy was defined as AI targets were 450 on the anterior/roof segments and 350 on the posterior/inferior/carina segments regardless of LAWT. The tailored AI strategy consisted of AI increasing the targets to 500 on the anterior/roof segments and to 400 on the posterior/inferior/carina segments when ablating the thick segment. After PVI, acute pulmonary vein (PV) reconnection, defined by the composite of residual potential and early reconnection, was evaluated. RESULTS A total of 156 patients (paroxysmal AF 72%) were consecutively included (86 for the fixed AI group and 70 for the tailored AI group). The tailored AI group showed a significantly lower rate of segments with acute PV reconnection than the fixed AI group (8% vs. 5%, p = .007). The tailored AI group showed a trend for shorter ablation time for PVI. One-year AF/atrial tachycardia free survival rate was similar in two groups (87.2% in the fixed AI group and 90.0% in the tailored AI group, p = .606). CONCLUSION Applying tailored AI based on the LAWT was a feasible and effective strategy to reduce acute PV reconnection after PVI.
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Affiliation(s)
- So-Ryoung Lee
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Hyoung-Seob Park
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
- Department of Internal Medicine, Division of Cardiology, Dongsan Medical Center, Keimyung University, Daegu, Republic of Korea
| | - Soonil Kwon
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Eue-Keun Choi
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Seil Oh
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
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25
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Chabanovska O, Lemcke H, Lang H, Vollmar B, Dohmen PM, David R, Etz C, Neßelmann C. Sarcomeric network analysis of ex vivo cultivated human atrial appendage tissue using super-resolution microscopy. Sci Rep 2023; 13:13041. [PMID: 37563225 PMCID: PMC10415305 DOI: 10.1038/s41598-023-39962-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Accepted: 08/02/2023] [Indexed: 08/12/2023] Open
Abstract
Investigating native human cardiac tissue with preserved 3D macro- and microarchitecture is fundamental for clinical and basic research. Unfortunately, the low accessibility of the human myocardium continues to limit scientific progress. To overcome this issue, utilizing atrial appendages of the human heart may become highly beneficial. Atrial appendages are often removed during open-heart surgery and can be preserved ex vivo as living tissue with varying durability depending on the culture method. In this study, we prepared living thin myocardial slices from left atrial appendages that were cultured using an air-liquid interface system for overall 10 days. Metabolic activity of the cultured slices was assessed using a conventional methyl thiazolyl tetrazolium (MTT) assay. To monitor the structural integrity of cardiomyocytes within the tissue, we implemented our recently described super-resolution microscopy approach that allows both qualitative and quantitative in-depth evaluation of sarcomere network based on parameters such as overall sarcomere content, filament size and orientation. Additionally, expression of mRNAs coding for key structural and functional proteins was analyzed by real-time reverse transcription polymerase chain reaction (qRT-PCR). Our findings demonstrate highly significant disassembly of contractile apparatus represented by degradation of [Formula: see text]-actinin filaments detected after three days in culture, while metabolic activity was constantly rising and remained high for up to seven days. However, gene expression of crucial cardiac markers strongly decreased after the first day in culture indicating an early destructive response to ex vivo conditions. Therefore, we suggest static cultivation of living myocardial slices derived from left atrial appendage and prepared according to our protocol only for short-termed experiments (e.g. medicinal drug testing), while introduction of electro-mechanical stimulation protocols may offer the possibility for long-term integrity of such constructs.
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Affiliation(s)
- Oleksandra Chabanovska
- Reference and Translation Center for Cardiac Stem Cell therapy (RTC), Department of Cardiac Surgery, Rostock University Medical Center, 18057, Rostock, Germany
- Department of Life, Light, and Matter of the Interdisciplinary Faculty, Rostock University, 18059, Rostock, Germany
- Department of Operative Dentistry and Periodontology, Rostock University Medical Center, 18059, Rostock, Germany
| | - Heiko Lemcke
- Reference and Translation Center for Cardiac Stem Cell therapy (RTC), Department of Cardiac Surgery, Rostock University Medical Center, 18057, Rostock, Germany
- Department of Life, Light, and Matter of the Interdisciplinary Faculty, Rostock University, 18059, Rostock, Germany
| | - Hermann Lang
- Department of Operative Dentistry and Periodontology, Rostock University Medical Center, 18059, Rostock, Germany
| | - Brigitte Vollmar
- Rudolf-Zenker-Institute of Experimental Surgery, Rostock University Medical Center, 18059, Rostock, Germany
| | - Pascal M Dohmen
- Department of Cardiac Surgery, Rostock University Medical Center, 18059, Rostock, Germany
- Department of Cardiothoracic Surgery, Faculty of Health Science, University of the Free State, Bloemfontein, 9301, South Africa
| | - Robert David
- Reference and Translation Center for Cardiac Stem Cell therapy (RTC), Department of Cardiac Surgery, Rostock University Medical Center, 18057, Rostock, Germany.
- Department of Life, Light, and Matter of the Interdisciplinary Faculty, Rostock University, 18059, Rostock, Germany.
| | - Christian Etz
- Department of Cardiac Surgery, Rostock University Medical Center, 18059, Rostock, Germany
| | - Catharina Neßelmann
- Department of Cardiac Surgery, Rostock University Medical Center, 18059, Rostock, Germany
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26
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Hashimoto K, Kimura T, Seki Y, Ibe S, Yamashita T, Miyama H, Fujisawa T, Katsumata Y, Fukuda K, Takatsuki S. Delineation of conduction gaps of linear lesions during atrial fibrillation ablation using ultra-high-density mapping. Europace 2023; 25:euad188. [PMID: 37395219 PMCID: PMC10350393 DOI: 10.1093/europace/euad188] [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: 12/09/2022] [Accepted: 05/29/2023] [Indexed: 07/04/2023] Open
Abstract
AIMS Linear lesions are routinely created by radiofrequency catheter ablation. Unwanted electrical conduction gaps can be produced and are often difficult to ablate. This study aimed to clarify the characteristics of conduction gaps during atrial fibrillation ablation by analysing bidirectional activation maps using a high-density mapping system (RHYTHMIA). METHODS AND RESULTS This retrospective study included 31 patients who had conduction gaps along pulmonary vein (PV) isolation or box ablation lesions. Activation maps were sequentially created during pacing from the coronary sinus and PV to reveal the earliest activation site, defined by the entrance and exit. The locations, length between the entrance and exit (gap length), and direction were analysed. Thirty-four bidirectional activation maps were drawn: 21 were box isolation lesions (box group), and 13 were PV isolation lesions (PVI group). Among the box group, nine conduction gaps were present in the roof region and 12 in the bottom region, while nine in right PV and four in left PV among the PVI group. Gap lengths in the roof region were longer than those in the bottom region (26.8 ± 11.8 vs. 14.5 ± 9.8 mm; P = 0.022), while those in right PV tended to longer than those in left PV (28.0 ± 15.3 vs. 16.8 ± 8.0 mm, P = 0.201). CONCLUSION The entrances and exits of electrical conduction gaps were separated, especially in the roof region, indicating that epicardial conduction might contribute to gap formation. Identifying the bidirectional conduction gap might indicate the location and direction of epicardial conduction.
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Affiliation(s)
- Kenji Hashimoto
- Department of Cardiology, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo 160-8582, Japan
| | - Takehiro Kimura
- Department of Cardiology, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo 160-8582, Japan
| | - Yuta Seki
- Department of Cardiology, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo 160-8582, Japan
| | - Susumu Ibe
- Department of Cardiology, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo 160-8582, Japan
| | - Terumasa Yamashita
- Department of Cardiology, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo 160-8582, Japan
| | - Hiroshi Miyama
- Department of Cardiology, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo 160-8582, Japan
| | - Taishi Fujisawa
- Department of Cardiology, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo 160-8582, Japan
| | - Yoshinori Katsumata
- Department of Cardiology, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo 160-8582, Japan
| | - Keiichi Fukuda
- Department of Cardiology, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo 160-8582, Japan
| | - Seiji Takatsuki
- Department of Cardiology, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo 160-8582, Japan
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Telle Å, Bargellini C, Chahine Y, Del Álamo JC, Akoum N, Boyle PM. Personalized biomechanical insights in atrial fibrillation: opportunities & challenges. Expert Rev Cardiovasc Ther 2023; 21:817-837. [PMID: 37878350 PMCID: PMC10841537 DOI: 10.1080/14779072.2023.2273896] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2023] [Accepted: 10/18/2023] [Indexed: 10/26/2023]
Abstract
INTRODUCTION Atrial fibrillation (AF) is an increasingly prevalent and significant worldwide health problem. Manifested as an irregular atrial electrophysiological activation, it is associated with many serious health complications. AF affects the biomechanical function of the heart as contraction follows the electrical activation, subsequently leading to reduced blood flow. The underlying mechanisms behind AF are not fully understood, but it is known that AF is highly correlated with the presence of atrial fibrosis, and with a manifold increase in risk of stroke. AREAS COVERED In this review, we focus on biomechanical aspects in atrial fibrillation, current and emerging use of clinical images, and personalized computational models. We also discuss how these can be used to provide patient-specific care. EXPERT OPINION Understanding the connection betweenatrial fibrillation and atrial remodeling might lead to valuable understanding of stroke and heart failure pathophysiology. Established and emerging imaging modalities can bring us closer to this understanding, especially with continued advancements in processing accuracy, reproducibility, and clinical relevance of the associated technologies. Computational models of cardiac electromechanics can be used to glean additional insights on the roles of AF and remodeling in heart function.
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Affiliation(s)
- Åshild Telle
- Department of Bioengineering, University of Washington, Seattle, WA, USA
| | - Clarissa Bargellini
- Department of Mechanical Engineering, University of Washington, Seattle, WA, USA
| | - Yaacoub Chahine
- Division of Cardiology, University of Washington, Seattle, WA, USA
| | - Juan C Del Álamo
- Department of Mechanical Engineering, University of Washington, Seattle, WA, USA
- Center for Cardiovascular Biology, University of Washington, Seattle, WA, USA
| | - Nazem Akoum
- Department of Bioengineering, University of Washington, Seattle, WA, USA
- Division of Cardiology, University of Washington, Seattle, WA, USA
| | - Patrick M Boyle
- Department of Bioengineering, University of Washington, Seattle, WA, USA
- Center for Cardiovascular Biology, University of Washington, Seattle, WA, USA
- Institute for Stem Cell and Regenerative Medicine, University of Washington, Seattle, WA, USA
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Nemes A, Kormányos Á, Ruzsa Z, Achim A, Ambrus N, Lengyel C. Three-Dimensional Speckle-Tracking Echocardiography-Derived Tricuspid Annular Dimensions and Right Atrial Strains in Healthy Adults-Is There a Relationship? (Insights from the MAGYAR-Healthy Study). J Clin Med 2023; 12:4240. [PMID: 37445275 DOI: 10.3390/jcm12134240] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Revised: 06/12/2023] [Accepted: 06/14/2023] [Indexed: 07/15/2023] Open
Abstract
INTRODUCTION The tricuspid valve and its annulus (TA) are thought to be integrally related to right atrial (RA) size and function. The present study aimed to assess associations between TA dimensions and RA strains, and quantitative features of its contractility were determined by 3DSTE in healthy adults. METHODS The study comprised 145 healthy volunteers with a mean age of 34.4 ± 12.5 years (73 males). Electrocardiographic, two-dimensional Doppler echocardiographic and 3DSTE parameters were in normal reference ranges in all subjects. RESULTS Enlarged TA areas, regardless of which phase of the cardiac cycle were measured, were not associated with the deterioration of peak RA strains in longitudinal (LS) and circumferential (CS) directions. Increased end-diastolic TA area was associated with reduced RA strain in the radial direction (RS). Dilation of end-diastolic and end-systolic TA areas was related to increased RA volumes. End-diastolic TA area was the smallest in case of increased peak global RA-RS, and other associations between increasing TA areas and peak global strains could not be detected. Peak global RA-CS and RA-LS were not related to TA areas. Increasing peak global RA-RS was not associated with peak global RA-LS and RA-CS, while increasing peak global RA-LS and RA-CS were not associated with peak global RA-RS. Increasing peak global RS did not show associations with RA volumes, Vmin was the smallest in the case of highest peak global RA-CS and RA-LS. Vmax increased with increasing peak global RA-LS. CONCLUSIONS 3DSTE is suitable for simultaneous non-invasive determination of TA dimensions and RA volumes and strains using the same acquired 3D dataset, allowing physiologic studies. RA volumes are associated with end-diastolic and end-systolic TA areas. RA strains in radial direction (RS) show associations with end-diastolic TA area.
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Affiliation(s)
- Attila Nemes
- Department of Medicine, Albert Szent-Györgyi Medical School, University of Szeged, Semmelweis Street 8, H-6725 Szeged, Hungary
| | - Árpád Kormányos
- Department of Medicine, Albert Szent-Györgyi Medical School, University of Szeged, Semmelweis Street 8, H-6725 Szeged, Hungary
| | - Zoltán Ruzsa
- Department of Medicine, Albert Szent-Györgyi Medical School, University of Szeged, Semmelweis Street 8, H-6725 Szeged, Hungary
| | - Alexandru Achim
- Department of Medicine, Albert Szent-Györgyi Medical School, University of Szeged, Semmelweis Street 8, H-6725 Szeged, Hungary
| | - Nóra Ambrus
- Department of Medicine, Albert Szent-Györgyi Medical School, University of Szeged, Semmelweis Street 8, H-6725 Szeged, Hungary
| | - Csaba Lengyel
- Department of Medicine, Albert Szent-Györgyi Medical School, University of Szeged, Semmelweis Street 8, H-6725 Szeged, Hungary
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Campos-García B, Alonso-Martín C, Guerra JM, Moreno-Weidmann Z, Méndez-Zurita F, Montiel-Quintero R, Betancur-Gutiérrez A, Viñolas-Prat X, Rodríguez-Font E. Reassessment of the electrical connection between the pulmonary veins and the left atrium: A study to determine the different contributions of myocardial fibers along the standard ablation circumference. Front Cardiovasc Med 2023; 10:1162197. [PMID: 37346283 PMCID: PMC10280734 DOI: 10.3389/fcvm.2023.1162197] [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: 02/09/2023] [Accepted: 05/18/2023] [Indexed: 06/23/2023] Open
Abstract
Background Circumferential ablation around the ipsilateral pulmonary veins (PVs) is the standard strategy for atrial fibrillation ablation. The present study seeks to assess which regions of the standard ablation circumference are the main contributors to the venoatrial electrical connection. Methods A total of 41 patients were included under a specific atrial fibrillation ablation protocol in which the anterior and posterior segments of the standard circumference, between the equatorial line of the superior and the inferior ipsilateral PVs, were ablated first. If PV isolation was not achieved, ablation was extended superiorly or inferiorly, on the basis of the earliest atrial activation recorded during pacing from inside the PV. Complete PV isolation and the length of the areas not requiring ablation (ANRA) at the time of electrical isolation were evaluated. Results Ablation of the anterior and posterior segments of the standard circumference led to the isolation of 77% left-PV pairs and 51% right-PV pairs (p = 0,015). A superior extension was required in 23% left-PV pairs and in 46% right-PV pairs, while an inferior extension was required only in 10% left-PV pairs and in 11% right-PV pairs. PV isolation was achieved before completing the standard ablation circumference in 97% left-PV pairs and in 94% right-PV pairs, with a median ANRA of 36.9 (IQR: 30.9-42.1) mm in the left PVs [16.0 (IQR: 12.0-19.0) mm superior and 18.8 (IQR: 16.1-24.9) mm inferior, p < 0.01] and 36.9 (IQR: 30.2-41.0) mm in the right PVs [15.1 (IQR: 10.7-19.1) mm superior and 20.6 (IQR: 16.9-23.3) mm inferior, p < 0.01]. Conclusions The myocardial fibers along the anterior and posterior regions of the standard ablation circumference are the main contributors to the electrical connection between the pulmonary veins and the left atrium. Ablation of these regions results in PV isolation in the majority of patients.
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30
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Viola F, Del Corso G, De Paulis R, Verzicco R. GPU accelerated digital twins of the human heart open new routes for cardiovascular research. Sci Rep 2023; 13:8230. [PMID: 37217483 DOI: 10.1038/s41598-023-34098-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2022] [Accepted: 04/24/2023] [Indexed: 05/24/2023] Open
Abstract
The recruitment of patients for rare or complex cardiovascular diseases is a bottleneck for clinical trials and digital twins of the human heart have recently been proposed as a viable alternative. In this paper we present an unprecedented cardiovascular computer model which, relying on the latest GPU-acceleration technologies, replicates the full multi-physics dynamics of the human heart within a few hours per heartbeat. This opens the way to extensive simulation campaigns to study the response of synthetic cohorts of patients to cardiovascular disorders, novel prosthetic devices or surgical procedures. As a proof-of-concept we show the results obtained for left bundle branch block disorder and the subsequent cardiac resynchronization obtained by pacemaker implantation. The in-silico results closely match those obtained in clinical practice, confirming the reliability of the method. This innovative approach makes possible a systematic use of digital twins in cardiovascular research, thus reducing the need of real patients with their economical and ethical implications. This study is a major step towards in-silico clinical trials in the era of digital medicine.
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Affiliation(s)
- Francesco Viola
- Gran Sasso Science Institute (GSSI), L'Aquila, Italy
- INFN-Laboratori Nazionali del Gran Sasso, Assergi (AQ), Italy
| | - Giulio Del Corso
- Gran Sasso Science Institute (GSSI), L'Aquila, Italy
- Institute of Information Science and Technologies A. Faedo, CNR, Pisa, Italy
| | - Ruggero De Paulis
- European Hospital, Rome, Italy
- UniCamillus International University of Health Sciences, Rome, Italy
| | - Roberto Verzicco
- Gran Sasso Science Institute (GSSI), L'Aquila, Italy.
- University of Rome Tor Vergata, Rome, Italy.
- POF Group, University of Twente, Enschede, The Netherlands.
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31
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He J, Pertsov AM, Cherry EM, Fenton FH, Roney CH, Niederer SA, Zang Z, Mangharam R. Fiber Organization Has Little Effect on Electrical Activation Patterns During Focal Arrhythmias in the Left Atrium. IEEE Trans Biomed Eng 2023; 70:1611-1621. [PMID: 36399589 PMCID: PMC10183233 DOI: 10.1109/tbme.2022.3223063] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Over the past two decades there has been a steady trend towards the development of realistic models of cardiac conduction with increasing levels of detail. However, making models more realistic complicates their personalization and use in clinical practice due to limited availability of tissue and cellular scale data. One such limitation is obtaining information about myocardial fiber organization in the clinical setting. In this study, we investigated a chimeric model of the left atrium utilizing clinically derived patient-specific atrial geometry and a realistic, yet foreign for a given patient fiber organization. We discovered that even significant variability of fiber organization had a relatively small effect on the spatio-temporal activation pattern during regular pacing. For a given pacing site, the activation maps were very similar across all fiber organizations tested.
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32
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Scuderi M, Dermol-Černe J, Batista Napotnik T, Chaigne S, Bernus O, Benoist D, Sigg DC, Rems L, Miklavčič D. Characterization of Experimentally Observed Complex Interplay between Pulse Duration, Electrical Field Strength, and Cell Orientation on Electroporation Outcome Using a Time-Dependent Nonlinear Numerical Model. Biomolecules 2023; 13:727. [PMID: 37238597 PMCID: PMC10216437 DOI: 10.3390/biom13050727] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Revised: 04/17/2023] [Accepted: 04/18/2023] [Indexed: 05/28/2023] Open
Abstract
Electroporation is a biophysical phenomenon involving an increase in cell membrane permeability to molecules after a high-pulsed electric field is applied to the tissue. Currently, electroporation is being developed for non-thermal ablation of cardiac tissue to treat arrhythmias. Cardiomyocytes have been shown to be more affected by electroporation when oriented with their long axis parallel to the applied electric field. However, recent studies demonstrate that the preferentially affected orientation depends on the pulse parameters. To gain better insight into the influence of cell orientation on electroporation with different pulse parameters, we developed a time-dependent nonlinear numerical model where we calculated the induced transmembrane voltage and pores creation in the membrane due to electroporation. The numerical results show that the onset of electroporation is observed at lower electric field strengths for cells oriented parallel to the electric field for pulse durations ≥10 µs, and cells oriented perpendicular for pulse durations ~100 ns. For pulses of ~1 µs duration, electroporation is not very sensitive to cell orientation. Interestingly, as the electric field strength increases beyond the onset of electroporation, perpendicular cells become more affected irrespective of pulse duration. The results obtained using the developed time-dependent nonlinear model are corroborated by in vitro experimental measurements. Our study will contribute to the process of further development and optimization of pulsed-field ablation and gene therapy in cardiac treatments.
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Affiliation(s)
- Maria Scuderi
- Faculty of Electrical Engineering, University of Ljubljana, SI-1000 Ljubljana, Slovenia
| | - Janja Dermol-Černe
- Faculty of Electrical Engineering, University of Ljubljana, SI-1000 Ljubljana, Slovenia
| | - Tina Batista Napotnik
- Faculty of Electrical Engineering, University of Ljubljana, SI-1000 Ljubljana, Slovenia
| | - Sebastien Chaigne
- INSERM, CRCTB, U 1045, IHU Liryc, University of Bordeaux, F-33000 Bordeaux, France
| | - Olivier Bernus
- INSERM, CRCTB, U 1045, IHU Liryc, University of Bordeaux, F-33000 Bordeaux, France
| | - David Benoist
- INSERM, CRCTB, U 1045, IHU Liryc, University of Bordeaux, F-33000 Bordeaux, France
| | - Daniel C. Sigg
- Medtronic, Cardiac Ablation Solutions, Minneapolis, MN 55105, USA
| | - Lea Rems
- Faculty of Electrical Engineering, University of Ljubljana, SI-1000 Ljubljana, Slovenia
| | - Damijan Miklavčič
- Faculty of Electrical Engineering, University of Ljubljana, SI-1000 Ljubljana, Slovenia
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33
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He J, Pertsov AM, Cherry EM, Fenton FH, Roney CH, Niederer SA, Zang Z, Mangharam R. Fiber Organization has Little Effect on Electrical Activation Patterns during Focal Arrhythmias in the Left Atrium. ARXIV 2023:arXiv:2210.16497v3. [PMID: 36776816 PMCID: PMC9915751] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Figures] [Subscribe] [Scholar Register] [Indexed: 04/21/2023]
Abstract
Over the past two decades there has been a steady trend towards the development of realistic models of cardiac conduction with increasing levels of detail. However, making models more realistic complicates their personalization and use in clinical practice due to limited availability of tissue and cellular scale data. One such limitation is obtaining information about myocardial fiber organization in the clinical setting. In this study, we investigated a chimeric model of the left atrium utilizing clinically derived patient-specific atrial geometry and a realistic, yet foreign for a given patient fiber organization. We discovered that even significant variability of fiber organization had a relatively small effect on the spatio-temporal activation pattern during regular pacing. For a given pacing site, the activation maps were very similar across all fiber organizations tested.
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Affiliation(s)
- Jiyue He
- Department of Electrical and Systems Engineering, University of Pennsylvania, USA
| | | | - Elizabeth M Cherry
- School of Computational Science and Engineering, Georgia Institute of Technology, USA
| | | | - Caroline H Roney
- School of Engineering and Materials Science, Queen Mary University of London, UK
| | - Steven A Niederer
- School of Biomedical Engineering and Imaging Sciences, King's College London, UK
| | - Zirui Zang
- Department of Electrical and Systems Engineering, University of Pennsylvania, USA
| | - Rahul Mangharam
- Department of Electrical and Systems Engineering, University of Pennsylvania, USA
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van Schie MS, Ramdat Misier NL, Razavi Ebrahimi P, Heida A, Kharbanda RK, Taverne YJHJ, de Groot NMS. Premature atrial contractions promote local directional heterogeneities in conduction velocity vectors. Europace 2023; 25:1162-1171. [PMID: 36637110 PMCID: PMC10062298 DOI: 10.1093/europace/euac283] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Accepted: 12/15/2022] [Indexed: 01/14/2023] Open
Abstract
AIMS Loss of cell-to-cell communication results in local conduction disorders and directional heterogeneity (LDH) in conduction velocity (CV) vectors, which may be unmasked by premature atrial contractions (PACs). We quantified LDH and examined differences between sinus rhythm (SR) and spontaneous PACs in patients with and without atrial fibrillation (AF). METHODS AND RESULTS Intra-operative epicardial mapping of the right and left atrium (RA, LA), Bachmann's bundle (BB) and pulmonary vein area (PVA) was performed in 228 patients (54 with AF). Conduction velocity vectors were computed at each electrode using discrete velocity vectors. Directions and magnitudes of individual vectors were compared with surrounding vectors to identify LDH. Five hundred and three PACs [2 (1-3) per patient; prematurity index of 45 ± 12%] were included. During SR, most LDH were found at BB and LA [11.9 (8.3-14.9) % and 11.3 (8.0-15.2) %] and CV was lowest at BB [83.5 (72.4-94.3) cm/s, all P < 0.05]. Compared with SR, the largest increase in LDH during PAC was found at BB and PVA [+13.0 (7.7, 18.3) % and +12.5 (10.8, 14.2) %, P < 0.001]; CV decreased particularly at BB, PVA and LA [-10.0 (-13.2, -6.9) cm/s, -9.3 (-12.5, -6.2) cm/s and -9.1 (-11.7, -6.6) cm/s, P < 0.001]. Comparing patients with and without AF, more LDH were found during SR in AF patients at PVA and BB, although the increase in LDH during PACs was similar for all sites. CONCLUSION Local directional heterogeneity is a novel methodology to quantify local heterogeneity in CV as a possible indicator of electropathology. Intra-operative high-resolution mapping indeed revealed that LDH increased during PACs particularly at BB and PVA. Also, patients with AF already have more LDH during SR, which becomes more pronounced during PACs.
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Affiliation(s)
- Mathijs S van Schie
- Department of Cardiology, Erasmus Medical Center, Dr. Molewaterplein 40, 3015GD Rotterdam, the Netherlands
| | - Nawin L Ramdat Misier
- Department of Cardiology, Erasmus Medical Center, Dr. Molewaterplein 40, 3015GD Rotterdam, the Netherlands
| | - Payam Razavi Ebrahimi
- Department of Cardiology, Erasmus Medical Center, Dr. Molewaterplein 40, 3015GD Rotterdam, the Netherlands
| | - Annejet Heida
- Department of Cardiology, Erasmus Medical Center, Dr. Molewaterplein 40, 3015GD Rotterdam, the Netherlands
| | - Rohit K Kharbanda
- Department of Cardiology, Erasmus Medical Center, Dr. Molewaterplein 40, 3015GD Rotterdam, the Netherlands
- Department of Cardiothoracic Surgery, Erasmus Medical Center, Dr. Molewaterplein 40, 3015GD Rotterdam, the Netherlands
| | - Yannick J H J Taverne
- Department of Cardiothoracic Surgery, Erasmus Medical Center, Dr. Molewaterplein 40, 3015GD Rotterdam, the Netherlands
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Li X, Chen Y, Chen G, Deng C, Tang C, Zhang J. Single ring isolation of pulmonary veins combined with electrical isolation of the superior vena cava in patients with paroxysmal atrial fibrillation. Front Cardiovasc Med 2023; 9:1028053. [PMID: 36698934 PMCID: PMC9869763 DOI: 10.3389/fcvm.2022.1028053] [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: 08/25/2022] [Accepted: 11/21/2022] [Indexed: 01/12/2023] Open
Abstract
Background Single-ring isolation (SRI) of the pulmonary veins and the left atrial post wall (LAPW) is an accepted strategy in atrial fibrillation ablation. Whether SRI combined with superior vena cava isolation (SVCI) could further increase the success rate of paroxysmal atrial fibrillation (PAF) has not been reported. Objective This study aimed to investigate whether SRI combined with SVCI was feasible and whether it could improve the success rate of PAF ablation. Methods and results In our study, sixty patients with PAF from May 2019 to March 2021 were included. SRI plus SVCI was completed with ablation index (AI)-guided high-power ablation. The success rates of SRI and SVCI were 100% and 97%, respectively. One-pass SRI was achieved in 41 out of 60 patients, with 19 out of 60 patients requiring additional ablation to complete the SRI. SVC was not isolated in 2 out of the 60 cases due to concerns about the phrenic nerve (PN) injury. Among the enrolled patients, 2 patients had anomalous pulmonary veins (PVs) (common ostium of inferior PVs). SRI was applied to achieve the PV and PW isolation. After ablation, one patient had an ischemic stroke but recovered without severe morbidity. The average follow-up period was (20 ± 7) months, and single-procedure freedom from atrial arrhythmia was 91.7%. AT/AF recurred in five patients, and 2 out of 5 patients underwent redo ablation. The multi-procedure freedom from atrial arrhythmia was 95%. Conclusion Our novel ablation strategy, SRI combined with SVCI, in patients with PAF was feasible and safe, with a relatively high success rate.
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Ohguchi S, Inden Y, Yanagisawa S, Fujita R, Yasuda K, Katagiri K, Oguri M, Murohara T. Regional left atrial conduction velocity in the anterior wall is associated with clinical recurrence of atrial fibrillation after catheter ablation: efficacy in combination with the ipsilateral low voltage area. BMC Cardiovasc Disord 2022; 22:457. [PMID: 36319975 PMCID: PMC9628089 DOI: 10.1186/s12872-022-02881-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2022] [Accepted: 09/30/2022] [Indexed: 11/06/2022] Open
Abstract
Background Left atrial (LA) conduction velocity (CV) is an electrical remodeling parameter of atrial fibrillation (AF) substrate. However, the pathophysiological substrate of LA-CV and its impact on outcomes after catheter ablation for AF have not been well evaluated. Methods We retrospectively evaluated 119 patients with AF who underwent catheter ablation and electroanatomical mapping during sinus rhythm. To measure regional LA-CV, we took triplet sites (A, B, and C) on the activation map and calculated the magnitude of the matched orthogonal projection vector between vector-AB and vector-AC, indicating two-dimensional CV. The median of the LA-CVs from four triad sites in both the anterior and posterior walls was set as the ‘model LA-CV’. We evaluated the impact of the model LA-CV on recurrence after ablation and relationship between the model LA-CV and LA-low voltage area (LVA) of < 0.5 mV. Results During the 12-month follow-up, 29 patients experienced recurrence. The LA-CV model was significantly correlated with ipsilateral LVA. The lower anterior model LA-CV was significantly associated with recurrence, with the cut-off value of 0.80 m/s having a sensitivity of 72% and specificity of 67%. Multivariable analysis revealed that the anterior model LA-CV (hazard ratio, 0.09; 95% confidence interval, 0.01–0.94; p = 0.043) and anterior LA-LVA (hazard ratio, 1.06; 95% confidence interval, 1.00–1.11; p = 0.033) were independently associated with AF recurrence. The anterior LA-LVA was mildly correlated with the anterior model LA-CV (r = -0.358; p < 0.001), and patients with both lower LA-CV and greater anterior LA-LVA based on each cut-off value had the worst prognosis. However, decreased LA-CV was more likely to be affected by the distribution pattern of the LVA rather than the total size of the LVA. Conclusion Decreased anterior LA-CV was a significant predictor of AF recurrence and was a useful electrical parameter in addition to LA-LVA for estimating AF arrhythmogenicity. Supplementary Information The online version contains supplementary material available at 10.1186/s12872-022-02881-6.
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Affiliation(s)
- Shiou Ohguchi
- grid.415067.10000 0004 1772 4590Department of Cardiology, Kasugai Municipal Hospital, Kasugai, Japan ,grid.27476.300000 0001 0943 978XDepartment of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Yasuya Inden
- grid.27476.300000 0001 0943 978XDepartment of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Satoshi Yanagisawa
- grid.27476.300000 0001 0943 978XDepartment of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan ,grid.27476.300000 0001 0943 978XDepartment of Advanced Cardiovascular Therapeutics, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, 466-8550 Nagoya, Aichi Japan
| | - Rin Fujita
- grid.415067.10000 0004 1772 4590Department of Cardiology, Kasugai Municipal Hospital, Kasugai, Japan
| | - Kenichiro Yasuda
- grid.415067.10000 0004 1772 4590Department of Cardiology, Kasugai Municipal Hospital, Kasugai, Japan
| | - Ken Katagiri
- grid.415067.10000 0004 1772 4590Department of Cardiology, Kasugai Municipal Hospital, Kasugai, Japan
| | - Mitsutoshi Oguri
- grid.415067.10000 0004 1772 4590Department of Cardiology, Kasugai Municipal Hospital, Kasugai, Japan
| | - Toyoaki Murohara
- grid.27476.300000 0001 0943 978XDepartment of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan
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Yamamoto C, Trayanova NA. Atrial fibrillation: Insights from animal models, computational modeling, and clinical studies. EBioMedicine 2022; 85:104310. [PMID: 36309006 PMCID: PMC9619190 DOI: 10.1016/j.ebiom.2022.104310] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Revised: 09/25/2022] [Accepted: 10/04/2022] [Indexed: 11/11/2022] Open
Abstract
Atrial fibrillation (AF) is the most common human arrhythmia, affecting millions of patients worldwide. A combination of risk factors and comorbidities results in complex atrial remodeling, which increases AF vulnerability and persistence. Insights from animal models, clinical studies, and computational modeling have advanced the understanding of the mechanisms and pathophysiology of AF. Areas of heterogeneous pathological remodeling, as well as altered electrophysiological properties, serve as a substrate for AF drivers and spontaneous activations. The complex and individualized presentation of this arrhythmia suggests that mechanisms-based personalized approaches will likely be needed to overcome current challenges in AF management. In this paper, we review the insights on the mechanisms of AF obtained from animal models and clinical studies and how computational models integrate this knowledge to advance AF clinical management. We also assess the challenges that need to be overcome to implement these mechanistic models in clinical practice.
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Affiliation(s)
- Carolyna Yamamoto
- Department of Biomedical Engineering, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Natalia A. Trayanova
- Department of Biomedical Engineering, Johns Hopkins University School of Medicine, Baltimore, MD, USA,Alliance for Cardiovascular Diagnostic and Treatment Innovation (ADVANCE), Johns Hopkins University, Baltimore, MD, USA,Corresponding author. Johns Hopkins, Johns Hopkins University, United States.
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Rossi S, Abdala L, Woodward A, Vavalle JP, Henriquez CS, Griffith BE. Rule-based definition of muscle bundles in patient-specific models of the left atrium. Front Physiol 2022; 13:912947. [PMID: 36311246 PMCID: PMC9597256 DOI: 10.3389/fphys.2022.912947] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Accepted: 06/29/2022] [Indexed: 11/13/2022] Open
Abstract
Atrial fibrillation (AF) is the most common arrhythmia encountered clinically, and as the population ages, its prevalence is increasing. Although the CHA2DS2- VASc score is the most used risk-stratification system for stroke risk in AF, it lacks personalization. Patient-specific computer models of the atria can facilitate personalized risk assessment and treatment planning. However, a challenge faced in creating such models is the complexity of the atrial muscle arrangement and its influence on the atrial fiber architecture. This work proposes a semi-automated rule-based algorithm to generate the local fiber orientation in the left atrium (LA). We use the solutions of several harmonic equations to decompose the LA anatomy into subregions. Solution gradients define a two-layer fiber field in each subregion. The robustness of our approach is demonstrated by recreating the fiber orientation on nine models of the LA obtained from AF patients who underwent WATCHMAN device implantation. This cohort of patients encompasses a variety of morphology variants of the left atrium, both in terms of the left atrial appendages (LAAs) and the number of pulmonary veins (PVs). We test the fiber construction algorithm by performing electrophysiology (EP) simulations. Furthermore, this study is the first to compare its results with other rule-based algorithms for the LA fiber architecture definition available in the literature. This analysis suggests that a multi-layer fiber architecture is important to capture complex electrical activation patterns. A notable advantage of our approach is the ability to reconstruct the main LA fiber bundles in a variety of morphologies while solving for a small number of harmonic fields, leading to a comparatively straightforward and reproducible approach.
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Affiliation(s)
- Simone Rossi
- Department of Mathematics, UNC Chapel Hill, Chapel Hill, NC, United States
| | - Laryssa Abdala
- Department of Mathematics, UNC Chapel Hill, Chapel Hill, NC, United States
| | - Andrew Woodward
- Advanced Medical Imaging Lab, UNC Chapel Hill, Chapel Hill, NC, United States
| | - John P. Vavalle
- Department of Medicine, UNC Chapel Hill, Chapel Hill, NC, United States
| | - Craig S. Henriquez
- Department of Biomedical Engineering, Duke University, Durham, NC, United States
| | - Boyce E. Griffith
- Department of Mathematics, UNC Chapel Hill, Chapel Hill, NC, United States
- Department of Biomedical Engineering, UNC Chapel Hill, Chapel Hill, NC, United States
- McAllister Heart Institute, UNC Chapel Hill, Chapel Hill, NC, United States
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Zang L, Gu K, Ji X, Zhang H, Yan S, Wu X. Effect of Anisotropic Electrical Conductivity Induced by Fiber Orientation on Ablation Characteristics of Pulsed Field Ablation in Atrial Fibrillation Treatment: A Computational Study. J Cardiovasc Dev Dis 2022; 9:319. [PMID: 36286271 PMCID: PMC9604654 DOI: 10.3390/jcdd9100319] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Revised: 09/15/2022] [Accepted: 09/19/2022] [Indexed: 09/07/2024] Open
Abstract
Pulsed field ablation (PFA) is a promising new ablation modality for the treatment of atrial fibrillation (AF); however, the effect of fiber orientation on the ablation characteristics of PFA in AF treatment is still unclear, which is likely an essential factor in influencing the ablation characteristics. This study constructed an anatomy-based left atrium (LA) model incorporating fiber orientation and selected various electrical conductivity and ablation targets to investigate the effect of anisotropic electrical conductivity (AC), compared with isotropic electrical conductivity (IC), on the ablation characteristics of PFA in AF treatment. The results show that the percentage differences in the size of the surface ablation area between AC and IC are greater than 73.71%; the maximum difference in the size of the ablation isosurface between AC and IC at different locations in the atrial wall is 3.65 mm (X-axis), 3.65 mm (Z-axis), and 4.03 mm (X-axis), respectively; and the percentage differences in the size of the ablation volume are greater than 6.9%. Under the condition of the pulse, the amplitude is 1000 V, the total PFA duration is 1 s, and the pulse train interval is 198.4 ms; the differences in the temperature increase between AC and IC in LA are less than 2.46 °C. Hence, this study suggests that in further exploration of the computational study of PFA in AF treatment using the same or similar conditions as those used here (myocardial electrical conductivity, pulse parameters, and electric field intensity damage threshold), to obtain more accurate computational results, it is necessary to adopt AC rather than IC to investigate the size of the surface ablation area, the size of the ablation isosurface, or the size of the ablation volume generated by PFA in LA. Moreover, if only investigating the temperature increase generated by PFA in LA, adopting IC instead of AC for simplifying the model construction process is reasonable.
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Affiliation(s)
- Lianru Zang
- Center for Biomedical Engineering, School of Information Science and Technology, Fudan University, Shanghai 200438, China
| | - Kaihao Gu
- Center for Biomedical Engineering, School of Information Science and Technology, Fudan University, Shanghai 200438, China
| | - Xingkai Ji
- Center for Biomedical Engineering, School of Information Science and Technology, Fudan University, Shanghai 200438, China
| | - Hao Zhang
- Center for Biomedical Engineering, School of Information Science and Technology, Fudan University, Shanghai 200438, China
| | - Shengjie Yan
- Center for Biomedical Engineering, School of Information Science and Technology, Fudan University, Shanghai 200438, China
| | - Xiaomei Wu
- Center for Biomedical Engineering, School of Information Science and Technology, Fudan University, Shanghai 200438, China
- Academy for Engineering and Technology, Fudan University, Shanghai 200433, China
- Key Laboratory of Medical Imaging Computing and Computer-Assisted Intervention (MICCAI) of Shanghai, Fudan University, Shanghai 200032, China
- Shanghai Engineering Research Center of Assistive Devices, Shanghai 200093, China
- Yiwu Research Institute, Fudan University, Yiwu 322000, China
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Abstract
The global burden caused by cardiovascular disease is substantial, with heart disease representing the most common cause of death around the world. There remains a need to develop better mechanistic models of cardiac function in order to combat this health concern. Heart rhythm disorders, or arrhythmias, are one particular type of disease which has been amenable to quantitative investigation. Here we review the application of quantitative methodologies to explore dynamical questions pertaining to arrhythmias. We begin by describing single-cell models of cardiac myocytes, from which two and three dimensional models can be constructed. Special focus is placed on results relating to pattern formation across these spatially-distributed systems, especially the formation of spiral waves of activation. Next, we discuss mechanisms which can lead to the initiation of arrhythmias, focusing on the dynamical state of spatially discordant alternans, and outline proposed mechanisms perpetuating arrhythmias such as fibrillation. We then review experimental and clinical results related to the spatio-temporal mapping of heart rhythm disorders. Finally, we describe treatment options for heart rhythm disorders and demonstrate how statistical physics tools can provide insights into the dynamics of heart rhythm disorders.
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Affiliation(s)
- Wouter-Jan Rappel
- Department of Physics, University of California San Diego, La Jolla, CA 92037
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41
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Jin Z, Hwang I, Lim B, Kwon OS, Park JW, Yu HT, Kim TH, Joung B, Lee MH, Pak HN. Ablation and antiarrhythmic drug effects on PITX2+/− deficient atrial fibrillation: A computational modeling study. Front Cardiovasc Med 2022; 9:942998. [PMID: 35928934 PMCID: PMC9343754 DOI: 10.3389/fcvm.2022.942998] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Accepted: 06/23/2022] [Indexed: 11/13/2022] Open
Abstract
IntroductionAtrial fibrillation (AF) is a heritable disease, and the paired-like homeodomain transcription factor 2 (PITX2) gene is highly associated with AF. We explored the differences in the circumferential pulmonary vein isolation (CPVI), which is the cornerstone procedure for AF catheter ablation, additional high dominant frequency (DF) site ablation, and antiarrhythmic drug (AAD) effects according to the patient genotype (wild-type and PITX2+/− deficient) using computational modeling.MethodsWe included 25 patients with AF (68% men, 59.8 ± 9.8 years of age, 32% paroxysmal AF) who underwent AF catheter ablation to develop a realistic computational AF model. The ion currents for baseline AF and the amiodarone, dronedarone, and flecainide AADs according to the patient genotype (wild type and PITX2+/− deficient) were defined by relevant publications. We tested the virtual CPVI (V-CPVI) with and without DF ablation (±DFA) and three virtual AADs (V-AADs, amiodarone, dronedarone, and flecainide) and evaluated the AF defragmentation rates (AF termination or changes to regular atrial tachycardia (AT), DF, and maximal slope of the action potential duration restitution curves (Smax), which indicates the vulnerability of wave-breaks.ResultsAt the baseline AF, mean DF (p = 0.003), and Smax (p < 0.001) were significantly lower in PITX2+/− deficient patients than wild-type patients. In the overall AF episodes, V-CPVI (±DFA) resulted in a higher AF defragmentation relative to V-AADs (65 vs. 42%, p < 0.001) without changing the DF or Smax. Although a PITX2+/− deficiency did not affect the AF defragmentation rate after the V-CPVI (±DFA), V-AADs had a higher AF defragmentation rate (p = 0.014), lower DF (p < 0.001), and lower Smax (p = 0.001) in PITX2+/− deficient AF than in wild-type patients. In the clinical setting, the PITX2+/− genetic risk score did not affect the AF ablation rhythm outcome (Log-rank p = 0.273).ConclusionConsistent with previous clinical studies, the V-CPVI had effective anti-AF effects regardless of the PITX2 genotype, whereas V-AADs exhibited more significant defragmentation or wave-dynamic change in the PITX2+/− deficient patients.
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Zghaib T, Markman TM, Nazarian S. All That Glitters Is Not Scar. Circ Arrhythm Electrophysiol 2022; 15:e011173. [PMID: 35749265 DOI: 10.1161/circep.122.011173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Tarek Zghaib
- Division of Cardiovascular Medicine, Section of Cardiac Electrophysiology, Hospital of the University of Pennsylvania, Philadelphia, PA
| | - Timothy M Markman
- Division of Cardiovascular Medicine, Section of Cardiac Electrophysiology, Hospital of the University of Pennsylvania, Philadelphia, PA
| | - Saman Nazarian
- Division of Cardiovascular Medicine, Section of Cardiac Electrophysiology, Hospital of the University of Pennsylvania, Philadelphia, PA
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Anderson RH, Sánchez-Quintana D, Spicer DE, Farré J, Sternick EB. How does the cardiac impulse pass from the sinus to the atrioventricular node? Heart Rhythm 2022; 19:1738-1746. [PMID: 35660474 DOI: 10.1016/j.hrthm.2022.05.032] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2022] [Revised: 04/25/2022] [Accepted: 05/17/2022] [Indexed: 11/16/2022]
Abstract
Over a century has passed since Tawara demonstrated the presence of the insulated pathways that extend from the "knoten" at the base of the atrial septum to their ramifications at the ventricular apexes. Having initially doubted the existence of the atrioventricular bundle until reading the monograph produced by Tawara, Keith, together with Flack, soon revealed the presence of the sinus node. Shortly thereafter, Thorel suggested that a special system might be found within the atrial walls, connecting the newly discovered atrial nodes. This prompted the convening of a special session of the German Pathological Society in 1910. The consensus was that no tracts existed within the atrial walls, with Aschoff and Mönckeberg establishing criterions to be met by those proposing recognition of "specialised" atrial conducting pathways. None of those subsequently proposing the presence of such pathways have discussed their findings on the basis of the criterions established at the meeting of 1910. It remains the case, nonetheless, that drawings continue to be offered by cardiological experts showing narrow pathways within the atrial walls that parallel the arrangement used to show the ventricular conduction pathways. A similar drawing adorns the front cover of "Heart Rhythm". We are unaware of any evidence supporting the presence of pathways as illustrated existing within the overall walls of the atrial chambers. In this review, we summarise the evidence that shows, instead, that it is the aggregation of the working atrial cardiomyocytes within the atrial walls that underscores preferential anisotropic interatrial conduction.
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Affiliation(s)
- Robert H Anderson
- Institute of Biosciences, Newcastle University, Newcastle upon Tyne, United Kingdom
| | | | - Diane E Spicer
- Johns Hopkins All Children's Hospital, Johns Hopkins University, Saint Petersburg, Florida, USA; Department of Pediatric Cardiology, University of Florida, Gainesville, Florida, USA
| | - Jeronimo Farré
- Fundación Jiménez Díaz University Hospital and Institute of Biomedical Research, Madrid, Spain
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Frontera A, Pagani S, Limite LR, Peirone A, Fioravanti F, Enache B, Cuellar Silva J, Vlachos K, Meyer C, Montesano G, Manzoni A, Dedé L, Quarteroni A, Lațcu DG, Rossi P, Della Bella P. Slow Conduction Corridors and Pivot Sites Characterize the Electrical Remodeling in Atrial Fibrillation. JACC Clin Electrophysiol 2022; 8:561-577. [PMID: 35589168 DOI: 10.1016/j.jacep.2022.01.019] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Revised: 12/14/2021] [Accepted: 01/12/2022] [Indexed: 11/16/2022]
Abstract
OBJECTIVES This study aimed to evaluate the progression of electrophysiological phenomena in a cohort of patients with paroxysmal atrial fibrillation (PAF) and persistent atrial fibrillation (PsAF). BACKGROUND Electrical remodeling has been conjectured to determine atrial fibrillation (AF) progression. METHODS High-density electroanatomic maps during sinus rhythm of 20 patients with AF (10 PAF, 10 PsAF) were compared with 5 healthy control subjects (subjects undergoing ablation of a left-sided accessory pathway). A computational postprocessing of electroanatomic maps was performed to identify specific electrophysiological phenomena: slow conductions corridors, defined as discrete areas of conduction velocity <50 cm/s, and pivot points, defined as sites showing high wave-front curvature documented by a curl module >2.5 1/s. RESULTS A progressive decrease of mean conduction velocity was recorded across the groups (111.6 ± 55.5 cm/s control subjects, 97.1 ± 56.3 cm/s PAF, and 84.7 ± 55.7 cm/s PsAF). The number and density of slow conduction corridors increase in parallel with the progression of AF (8.6 ± 2.2 control subjects, 13.3 ± 3.2 PAF, and 20.5 ± 4.5 PsAF). In PsAF the atrial substrate is characterized by a higher curvature of wave-front propagation (0.86 ± 0.71 1/s PsAF vs 0.74 ± 0.63 1/s PAF; P = 0.003) and higher number of pivot points (25.1 ± 13.8 PsAF vs 9.5 ± 6.7 PAF; P < 0.0001). Slow conductions: corridors were mostly associated with pivot sites tending to cluster around pulmonary veins antra. CONCLUSIONS The electrical remodeling hinges mainly on corridors of slow conduction and higher curvature of wave-front propagation. Pivot points associated to SC corridors may be the major determinants for functional localized re-entrant circuits creating the substrate for maintenance of AF.
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Affiliation(s)
- Antonio Frontera
- Department of Arrhythmology, San Raffaele Hospital, Milan, Italy.
| | - Stefano Pagani
- MOX-Department of Mathematics, Politecnico di Milano, Milan, Italy
| | | | - Andrea Peirone
- Department of Arrhythmology, San Raffaele Hospital, Milan, Italy
| | | | | | - Jose Cuellar Silva
- University of Texas Health Science Center at Houston (UTHealth), Houston, Texas
| | | | - Christian Meyer
- Division of Cardiology, Angiology, and Intensive Care, EVK Düsseldorf, University of Düsseldorf, Düsseldorf, Germany
| | - Giovanni Montesano
- Optometry and Vision Science - City, University of London, London, United Kingdom
| | - Andrea Manzoni
- MOX-Department of Mathematics, Politecnico di Milano, Milan, Italy
| | - Luca Dedé
- MOX-Department of Mathematics, Politecnico di Milano, Milan, Italy
| | - Alfio Quarteroni
- MOX-Department of Mathematics, Politecnico di Milano, Milan, Italy; Institute of Mathematics, École Polytechnique Fédérale de Lausanne, Lausanne, Switzerland
| | | | - Pietro Rossi
- San Giovanni Calibita Hospital, Fatebenefratelli, Rome, Italy
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45
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Jin Z, Hwang I, Lim B, Kwon OS, Park JW, Yu HT, Kim TH, Joung B, Lee MH, Pak HN. Anti-atrial Fibrillation Effects of Pulmonary Vein Isolation With or Without Ablation Gaps: A Computational Modeling Study. Front Physiol 2022; 13:846620. [PMID: 35370797 PMCID: PMC8968313 DOI: 10.3389/fphys.2022.846620] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2021] [Accepted: 02/24/2022] [Indexed: 01/22/2023] Open
Abstract
Background Although pulmonary vein isolation (PVI) gaps contribute to recurrence after atrial fibrillation (AF) catheter ablation, the mechanism is unclear. We used realistic computational human AF modeling to explore the AF wave-dynamic changes of PVI with gaps (PVI-gaps). Methods We included 40 patients (80% male, 61.0 ± 9.8 years old, 92.5% persistent AF) who underwent AF catheter ablation to develop our realistic computational AF model. We compared the effects of a complete PVI (CPVI) and PVI-gap (2-mm × 4) on the AF wave-dynamics by evaluating the dominant frequency (DF), spatial change of DF, maximal slope of the action potential duration restitution curve (Smax), and AF defragmentation rate (termination or change to atrial tachycardia), and tested the effects of additional virtual interventions and flecainide on ongoing AF with PVI-gaps. Results Compared with the baseline AF, CPVIs significantly reduced extra-PV DFs (p < 0.001), but PVI-gaps did not. COV-DFs were greater after CPVIs than PVI-gaps (p < 0.001). Neither CPVIs nor PVI-gaps changed the mean Smax. CPVIs resulted in higher AF defragmentation rates (80%) than PVI-gaps (12.5%, p < 0.001). In ongoing AF after PVI-gaps, the AF defragmentation rates after a wave-breaking gap ablation, extra-PV DF ablation, or flecainide were 60.0, 34.3, and 25.7%, respectively (p = 0.010). Conclusion CPVIs effectively reduced the DF, increased its spatial heterogeneity in extra-PV areas, and offered better anti-AF effects than extra-PV DF ablation or additional flecainide in PVI-gap conditions.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | - Hui-Nam Pak
- Yonsei University College of Medicine, Yonsei University Health System, Seoul, South Korea
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Yamaguchi T, Otsubo T, Takahashi Y, Nakashima K, Fukui A, Hirota K, Ishii Y, Shinzato K, Osako R, Tahara M, Kawano Y, Kawaguchi A, Aishima S, Takahashi N, Node K. Atrial Structural Remodeling in Patients With Atrial Fibrillation Is a Diffuse Fibrotic Process: Evidence From High-Density Voltage Mapping and Atrial Biopsy. J Am Heart Assoc 2022; 11:e024521. [PMID: 35261287 PMCID: PMC9075313 DOI: 10.1161/jaha.121.024521] [Citation(s) in RCA: 24] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background Low‐voltage areas (LVAs) in the atria of patients with atrial fibrillation are considered local fibrosis. We hypothesized that voltage reduction in the atria is a diffuse process associated with fibrosis and that the presence of LVAs reflects a global voltage reduction. Methods and Results We examined 140 patients with atrial fibrillation and 13 patients with a left accessory pathway (controls). High‐density bipolar voltage mapping was performed using a grid‐mapping catheter during high right atrial pacing. Global left atrial (LA) voltage (VGLA) in the whole LA and regional LA voltage (VRLA) in 6 anatomic regions were evaluated with the mean of the highest voltage at a sampling density of 1 cm2. Patients with atrial fibrillation were categorized into quartiles by VGLA. LVAs were evaluated at voltage cutoffs of 0.1, 0.5, 1.0, and 1.5 mV. Twenty‐eight patients with atrial fibrillation also underwent right atrial septum biopsy, and the fibrosis extent was quantified. Voltage at the biopsy site (Vbiopsy) was recorded. VGLA results by category were Q1 (<4.2 mV), Q2 (4.2–5.6 mV), Q3 (5.7–7.0 mV), and Q4 (≥7.1 mV). VRLA at any region was reduced as VGLA decreased. VGLA and VRLA did not differ between Q4 and controls. The presence of LVAs increased as VGLA decreased at any voltage cutoff. Biopsies revealed 11±6% fibrosis, which was inversely correlated with both Vbiopsy and VGLA (r=–0.71 and –0.72, respectively). Vbiopsy was correlated with VGLA (r=0.82). Conclusions Voltage reduction in the LA is a diffuse process associated with fibrosis. Presence of LVAs reflects diffuse voltage reduction of the LA.
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Affiliation(s)
- Takanori Yamaguchi
- Department of Cardiovascular Medicine Saga University Saga Japan.,Department of Advanced Management of Cardiac Arrhythmia Saga University Saga Japan
| | - Toyokazu Otsubo
- Department of Cardiovascular Medicine Saga University Saga Japan.,Department of Advanced Management of Cardiac Arrhythmia Saga University Saga Japan
| | - Yuya Takahashi
- Department of Cardiovascular Medicine Saga University Saga Japan
| | - Kana Nakashima
- Department of Cardiovascular Medicine Saga University Saga Japan
| | - Akira Fukui
- Department of Cardiology and Clinical Examination Faculty of Medicine Oita University Yufu Japan
| | - Kei Hirota
- Department of Cardiology and Clinical Examination Faculty of Medicine Oita University Yufu Japan
| | - Yumi Ishii
- Department of Cardiology and Clinical Examination Faculty of Medicine Oita University Yufu Japan
| | - Kodai Shinzato
- Department of Cardiovascular Medicine Saga University Saga Japan
| | - Ryosuke Osako
- Department of Cardiovascular Medicine Saga University Saga Japan
| | - Mai Tahara
- Department of Cardiovascular Medicine Saga University Saga Japan
| | - Yuki Kawano
- Division of Cardiology Saiseikai Futsukaichi Hospital Fukuoka Japan
| | - Atsushi Kawaguchi
- Education and Research Center for Community Medicine Saga University Saga Japan
| | - Shinichi Aishima
- Department of Pathology and Microbiology Saga University Saga Japan
| | - Naohiko Takahashi
- Department of Cardiology and Clinical Examination Faculty of Medicine Oita University Yufu Japan
| | - Koichi Node
- Department of Cardiovascular Medicine Saga University Saga Japan
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Roney CH, Sim I, Yu J, Beach M, Mehta A, Alonso Solis-Lemus J, Kotadia I, Whitaker J, Corrado C, Razeghi O, Vigmond E, Narayan SM, O’Neill M, Williams SE, Niederer SA. Predicting Atrial Fibrillation Recurrence by Combining Population Data and Virtual Cohorts of Patient-Specific Left Atrial Models. Circ Arrhythm Electrophysiol 2022; 15:e010253. [PMID: 35089057 PMCID: PMC8845531 DOI: 10.1161/circep.121.010253] [Citation(s) in RCA: 30] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Accepted: 01/03/2022] [Indexed: 01/14/2023]
Abstract
BACKGROUND Current ablation therapy for atrial fibrillation is suboptimal, and long-term response is challenging to predict. Clinical trials identify bedside properties that provide only modest prediction of long-term response in populations, while patient-specific models in small cohorts primarily explain acute response to ablation. We aimed to predict long-term atrial fibrillation recurrence after ablation in large cohorts, by using machine learning to complement biophysical simulations by encoding more interindividual variability. METHODS Patient-specific models were constructed for 100 atrial fibrillation patients (43 paroxysmal, 41 persistent, and 16 long-standing persistent), undergoing first ablation. Patients were followed for 1 year using ambulatory ECG monitoring. Each patient-specific biophysical model combined differing fibrosis patterns, fiber orientation maps, electrical properties, and ablation patterns to capture uncertainty in atrial properties and to test the ability of the tissue to sustain fibrillation. These simulation stress tests of different model variants were postprocessed to calculate atrial fibrillation simulation metrics. Machine learning classifiers were trained to predict atrial fibrillation recurrence using features from the patient history, imaging, and atrial fibrillation simulation metrics. RESULTS We performed 1100 atrial fibrillation ablation simulations across 100 patient-specific models. Models based on simulation stress tests alone showed a maximum accuracy of 0.63 for predicting long-term fibrillation recurrence. Classifiers trained to history, imaging, and simulation stress tests (average 10-fold cross-validation area under the curve, 0.85±0.09; recall, 0.80±0.13; precision, 0.74±0.13) outperformed those trained to history and imaging (area under the curve, 0.66±0.17) or history alone (area under the curve, 0.61±0.14). CONCLUSION A novel computational pipeline accurately predicted long-term atrial fibrillation recurrence in individual patients by combining outcome data with patient-specific acute simulation response. This technique could help to personalize selection for atrial fibrillation ablation.
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Affiliation(s)
- Caroline H. Roney
- School of Biomedical Engineering and Imaging Sciences, King’s College London, United Kingdom (C.H.R., I.S., J.Y., M.B., A.M., J.A.S.-L., I.K., J.W., C.C., O.R., M.O., S.E.W., S.A.N.)
- School of Engineering and Materials Science, Queen Mary University of London, United Kingdom (C.H.R.)
| | - Iain Sim
- School of Biomedical Engineering and Imaging Sciences, King’s College London, United Kingdom (C.H.R., I.S., J.Y., M.B., A.M., J.A.S.-L., I.K., J.W., C.C., O.R., M.O., S.E.W., S.A.N.)
| | - Jin Yu
- School of Biomedical Engineering and Imaging Sciences, King’s College London, United Kingdom (C.H.R., I.S., J.Y., M.B., A.M., J.A.S.-L., I.K., J.W., C.C., O.R., M.O., S.E.W., S.A.N.)
| | - Marianne Beach
- School of Biomedical Engineering and Imaging Sciences, King’s College London, United Kingdom (C.H.R., I.S., J.Y., M.B., A.M., J.A.S.-L., I.K., J.W., C.C., O.R., M.O., S.E.W., S.A.N.)
| | - Arihant Mehta
- School of Biomedical Engineering and Imaging Sciences, King’s College London, United Kingdom (C.H.R., I.S., J.Y., M.B., A.M., J.A.S.-L., I.K., J.W., C.C., O.R., M.O., S.E.W., S.A.N.)
| | - Jose Alonso Solis-Lemus
- School of Biomedical Engineering and Imaging Sciences, King’s College London, United Kingdom (C.H.R., I.S., J.Y., M.B., A.M., J.A.S.-L., I.K., J.W., C.C., O.R., M.O., S.E.W., S.A.N.)
| | - Irum Kotadia
- School of Biomedical Engineering and Imaging Sciences, King’s College London, United Kingdom (C.H.R., I.S., J.Y., M.B., A.M., J.A.S.-L., I.K., J.W., C.C., O.R., M.O., S.E.W., S.A.N.)
| | - John Whitaker
- School of Biomedical Engineering and Imaging Sciences, King’s College London, United Kingdom (C.H.R., I.S., J.Y., M.B., A.M., J.A.S.-L., I.K., J.W., C.C., O.R., M.O., S.E.W., S.A.N.)
- The Department of Internal Medicine, Cardiovascular Division, Brigham and Women’s Hospital, Boston, MA (J.W.)
| | - Cesare Corrado
- School of Biomedical Engineering and Imaging Sciences, King’s College London, United Kingdom (C.H.R., I.S., J.Y., M.B., A.M., J.A.S.-L., I.K., J.W., C.C., O.R., M.O., S.E.W., S.A.N.)
| | - Orod Razeghi
- School of Biomedical Engineering and Imaging Sciences, King’s College London, United Kingdom (C.H.R., I.S., J.Y., M.B., A.M., J.A.S.-L., I.K., J.W., C.C., O.R., M.O., S.E.W., S.A.N.)
| | - Edward Vigmond
- IHU Liryc, Electrophysiology and Heart Modeling Institute, Fondation Bordeaux Université, France (E.V.)
- Univ. Bordeaux, IMB, UMR 5251, F-33400 Talence, France (E.V.)
| | - Sanjiv M. Narayan
- Department of Medicine and Cardiovascular Institute, Stanford University, Palo Alto, CA (S.M.N.)
| | - Mark O’Neill
- School of Biomedical Engineering and Imaging Sciences, King’s College London, United Kingdom (C.H.R., I.S., J.Y., M.B., A.M., J.A.S.-L., I.K., J.W., C.C., O.R., M.O., S.E.W., S.A.N.)
| | - Steven E. Williams
- School of Biomedical Engineering and Imaging Sciences, King’s College London, United Kingdom (C.H.R., I.S., J.Y., M.B., A.M., J.A.S.-L., I.K., J.W., C.C., O.R., M.O., S.E.W., S.A.N.)
- Centre for Cardiovascular Science, College of Medicine and Veterinary Medicine, University of Edinburgh (S.E.W.)
| | - Steven A. Niederer
- School of Biomedical Engineering and Imaging Sciences, King’s College London, United Kingdom (C.H.R., I.S., J.Y., M.B., A.M., J.A.S.-L., I.K., J.W., C.C., O.R., M.O., S.E.W., S.A.N.)
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Tamura S, Shimeno K, Nakatsuji K, Hayashi Y, Abe Y, Naruko T. Differences in the durability of left atrial posterior wall isolation based on the isolation process. J Interv Card Electrophysiol 2022; 65:45-51. [PMID: 34985641 DOI: 10.1007/s10840-021-01108-6] [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] [Received: 07/16/2021] [Accepted: 12/27/2021] [Indexed: 10/19/2022]
Abstract
PURPOSE The best strategy for durable left atrial posterior wall isolation (PWI) after completion of pulmonary vein isolation (PVI) is not yet determined. This study aimed to examine the differences in the durability of PWI based on the isolation process and the predictors of the reconduction of PWI. METHODS Among the 221 patients (mean age, 65 ± 11 years) with consecutive non-paroxysmal atrial fibrillation (AF) who completed PVI and PWI, 50 patients undergoing repeat AF ablation were enrolled and divided into the following groups based on how PWI was achieved at the initial procedure: by only the first line on the roof and floor line (group A), by additional gap ablation to the first line or second liner ablation next to the first line (group B), and by adjunct ablation inside the PW revealing the earliest activation (group C). RESULTS Reconduction of PWI occurred in 24 of the 50 patients (48%). The durability of PWI in groups A, B, and C was 81% (17 of 21 patients), 75% (6 of 8 patients), and 14% (3 of 21 patients), respectively (p < 0.01). In a multivariate analysis, the ablation inside the PW for PWI was the independent predictor of the reconduction of PWI (p < 0.001). CONCLUSION PWI achieved by the ablation inside the PW resulted in a high rate of reconduction. It may be necessary to aim to achieve the PWI without ablating the inside of the PW to prevent reconduction.
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Affiliation(s)
- Shota Tamura
- Department of Cardiology, Osaka City General Hospital, 2-13-22 Miyakojima-hondori, Miyakojima-Ku, Osaka, 534-0021, Japan
| | - Kenji Shimeno
- Department of Cardiology, Osaka City General Hospital, 2-13-22 Miyakojima-hondori, Miyakojima-Ku, Osaka, 534-0021, Japan.
| | - Kenichi Nakatsuji
- Department of Cardiology, Osaka City General Hospital, 2-13-22 Miyakojima-hondori, Miyakojima-Ku, Osaka, 534-0021, Japan
| | - Yusuke Hayashi
- Department of Cardiology, Osaka City General Hospital, 2-13-22 Miyakojima-hondori, Miyakojima-Ku, Osaka, 534-0021, Japan
| | - Yukio Abe
- Department of Cardiology, Osaka City General Hospital, 2-13-22 Miyakojima-hondori, Miyakojima-Ku, Osaka, 534-0021, Japan
| | - Takahiko Naruko
- Department of Cardiology, Osaka City General Hospital, 2-13-22 Miyakojima-hondori, Miyakojima-Ku, Osaka, 534-0021, Japan
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Baek YS, Kwon OS, Lim B, Yang SY, Park JW, Yu HT, Kim TH, Uhm JS, Joung B, Kim DH, Lee MH, Park J, Pak HN. Clinical Outcomes of Computational Virtual Mapping-Guided Catheter Ablation in Patients With Persistent Atrial Fibrillation: A Multicenter Prospective Randomized Clinical Trial. Front Cardiovasc Med 2021; 8:772665. [PMID: 34957255 PMCID: PMC8692944 DOI: 10.3389/fcvm.2021.772665] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Accepted: 11/17/2021] [Indexed: 11/23/2022] Open
Abstract
Background: Clinical recurrence after atrial fibrillation catheter ablation (AFCA) still remains high in patients with persistent AF (PeAF). We investigated whether an extra-pulmonary vein (PV) ablation targeting the dominant frequency (DF) extracted from electroanatomical map–integrated AF computational modeling improves the AFCA rhythm outcome in patients with PeAF. Methods: In this open-label, randomized, multi-center, controlled trial, 170 patients with PeAF were randomized at a 1:1 ratio to the computational modeling-guided virtual DF (V-DF) ablation and empirical PV isolation (E-PVI) groups. We generated a virtual dominant frequency (DF) map based on the atrial substrate map obtained during the clinical AF ablation procedure using computational modeling. This simulation was possible within the time of the PVI procedure. V-DF group underwent extra-PV V-DF ablation in addition to PVI, but DF information was not notified to the operators from the core lab in the E-PVI group. Results: After a mean follow-up period of 16.3 ± 5.3 months, the clinical recurrence rate was significantly lower in the V-DF than with E-PVI group (P = 0.018, log-rank). Recurrences appearing as atrial tachycardias (P = 0.145) and the cardioversion rates (P = 0.362) did not significantly differ between the groups. At the final follow-up, sinus rhythm was maintained without any AADs in 74.7% in the V-DF group and 48.2% in the E-PVI group (P < 0.001). No significant difference was found in the major complication rates (P = 0.489) or total procedure time (P = 0.513) between the groups. The V-DF ablation was independently associated with a reduced AF recurrence after AFCA [hazard ratio: 0.51 (95% confidence interval: 0.30–0.88); P = 0.016]. Conclusions: The computational modeling-guided V-DF ablation improved the rhythm outcome of AFCA in patients with PeAF. Clinical Trial Registration: Clinical Research Information Service, CRIS identifier: KCT0003613.
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Affiliation(s)
- Yong-Soo Baek
- Inha University College of Medicine and Inha University Hospital, Incheon, South Korea
| | - Oh-Seok Kwon
- Division of Cardiology, Department of Internal Medicine, Yonsei University Health System, Seoul, South Korea
| | - Byounghyun Lim
- Division of Cardiology, Department of Internal Medicine, Yonsei University Health System, Seoul, South Korea
| | - Song-Yi Yang
- Division of Cardiology, Department of Internal Medicine, Yonsei University Health System, Seoul, South Korea
| | - Je-Wook Park
- Division of Cardiology, Department of Internal Medicine, Yonsei University Health System, Seoul, South Korea
| | - Hee Tae Yu
- Division of Cardiology, Department of Internal Medicine, Yonsei University Health System, Seoul, South Korea
| | - Tae-Hoon Kim
- Division of Cardiology, Department of Internal Medicine, Yonsei University Health System, Seoul, South Korea
| | - Jae-Sun Uhm
- Division of Cardiology, Department of Internal Medicine, Yonsei University Health System, Seoul, South Korea
| | - Boyoung Joung
- Division of Cardiology, Department of Internal Medicine, Yonsei University Health System, Seoul, South Korea
| | - Dae-Hyeok Kim
- Inha University College of Medicine and Inha University Hospital, Incheon, South Korea
| | - Moon-Hyoung Lee
- Division of Cardiology, Department of Internal Medicine, Yonsei University Health System, Seoul, South Korea
| | - Junbeom Park
- Division of Cardiology, Department of Internal Medicine, Ewha Womans University, Seoul, South Korea
| | - Hui-Nam Pak
- Division of Cardiology, Department of Internal Medicine, Yonsei University Health System, Seoul, South Korea
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50
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Peters DC, Lamy J, Sinusas AJ, Baldassarre LA. Left atrial evaluation by cardiovascular magnetic resonance: sensitive and unique biomarkers. Eur Heart J Cardiovasc Imaging 2021; 23:14-30. [PMID: 34718484 DOI: 10.1093/ehjci/jeab221] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Accepted: 10/12/2021] [Indexed: 12/12/2022] Open
Abstract
Left atrial (LA) imaging is still not routinely used for diagnosis and risk stratification, although recent studies have emphasized its importance as an imaging biomarker. Cardiovascular magnetic resonance is able to evaluate LA structure and function, metrics that serve as early indicators of disease, and provide prognostic information, e.g. regarding diastolic dysfunction, and atrial fibrillation (AF). MR angiography defines atrial anatomy, useful for planning ablation procedures, and also for characterizing atrial shapes and sizes that might predict cardiovascular events, e.g. stroke. Long-axis cine images can be evaluated to define minimum, maximum, and pre-atrial contraction LA volumes, and ejection fractions (EFs). More modern feature tracking of these cine images provides longitudinal LA strain through the cardiac cycle, and strain rates. Strain may be a more sensitive marker than EF and can predict post-operative AF, AF recurrence after ablation, outcomes in hypertrophic cardiomyopathy, stratification of diastolic dysfunction, and strain correlates with atrial fibrosis. Using high-resolution late gadolinium enhancement (LGE), the extent of fibrosis in the LA can be estimated and post-ablation scar can be evaluated. The LA LGE method is widely available, its reproducibility is good, and validations with voltage-mapping exist, although further scan-rescan studies are needed, and consensus regarding atrial segmentation is lacking. Using LGE, scar patterns after ablation in AF subjects can be reproducibly defined. Evaluation of 'pre-existent' atrial fibrosis may have roles in predicting AF recurrence after ablation, predicting new-onset AF and diastolic dysfunction in patients without AF. LA imaging biomarkers are ready to enter into diagnostic clinical practice.
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Affiliation(s)
- Dana C Peters
- Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, CT, USA
| | - Jérôme Lamy
- Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, CT, USA
| | - Albert J Sinusas
- Department of Cardiology, Yale School of Medicine, New Haven, CT, USA
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