1
|
Okuyama Y, Ozawa T, Nishikawa T, Fujii Y, Kato K, Sugimoto Y, Nakagawa Y, Ashihara T. Association with the nonparoxysmal atrial fibrillation duration and outcome of ExTRa Mapping-guided rotor ablation. J Arrhythm 2023; 39:531-538. [PMID: 37560288 PMCID: PMC10407168 DOI: 10.1002/joa3.12897] [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: 12/18/2022] [Revised: 06/21/2023] [Accepted: 06/25/2023] [Indexed: 08/11/2023] Open
Abstract
Background Additional ablation strategies after pulmonary vein isolation (PVI) for patients with nonparoxysmal atrial fibrillation (non-PAF) lasting ≥2 years have not been fully effective. This is presumably because of insufficient identification of non-PAF maintenance mechanisms. In this study, we employed a novel online and real-time phase mapping system, ExTRa Mapping, to identify and modulate rotors as one of the non-PAF maintenance mechanisms in patients with non-PAF sustained after PVI. We investigated the relationship between outcomes of ExTRa Mapping-guided rotor ablation (ExTRa-ABL) and non-PAF duration prior to this procedure. Methods This study consisted of 73 non-PAF patients (63 ± 8 years, non-PAF duration 31 ± 37 months) who underwent the first ExTRa-ABL in patients with non-PAF sustained after completion of PVI. Results Freedom from non-PAF/atrial tachycardia (AT) recurrence at 12 months after ExTRa-ABL was achieved in 50 (69%) of patients. The non-PAF duration prior to ExTRa-ABL was significantly longer in patients with non-PAF/AT recurrence after ExTRa-ABL compared with those without (56 ± 50 vs. 19 ± 22 months, p = .001). In patients with non-PAF duration of ≤60 months prior to ExTRa-ABL, compared with >60 months, non-PAF/AT-free rate was significantly higher (68.9% vs. 23.1%, p < .001), during the follow-up of 36 ± 18 months. Conclusions A non-PAF duration of ≤60 months prior to ExTRa-ABL was associated with a better outcome. The effect of ExTRa-ABL was considered to be limited in patients with >60 months of non-PAF duration.
Collapse
Affiliation(s)
- Yusuke Okuyama
- Department of Cardiovascular MedicineShiga University of Medical ScienceOtsuJapan
| | - Tomoya Ozawa
- Department of Cardiovascular MedicineShiga University of Medical ScienceOtsuJapan
| | - Takuma Nishikawa
- Department of Cardiovascular MedicineShiga University of Medical ScienceOtsuJapan
| | - Yusuke Fujii
- Department of Cardiovascular MedicineShiga University of Medical ScienceOtsuJapan
| | - Koichi Kato
- Department of Cardiovascular MedicineShiga University of Medical ScienceOtsuJapan
| | - Yoshihisa Sugimoto
- Department of Cardiovascular MedicineShiga University of Medical ScienceOtsuJapan
- Department of Medical Informatics and Biomedical EngineeringShiga University of Medical ScienceOtsuJapan
| | - Yoshihisa Nakagawa
- Department of Cardiovascular MedicineShiga University of Medical ScienceOtsuJapan
| | - Takashi Ashihara
- Department of Cardiovascular MedicineShiga University of Medical ScienceOtsuJapan
- Department of Medical Informatics and Biomedical EngineeringShiga University of Medical ScienceOtsuJapan
| |
Collapse
|
2
|
Aoyama D, Miyazaki S, Hasegawa K, Nomura R, Kakehashi S, Mukai M, Miyoshi M, Yamaguchi J, Sato Y, Shiomi Y, Ikeda H, Ishida K, Uzui H, Tada H. Atrial fibrillation activation patterns predict freedom from arrhythmias after catheter ablation: utility of ExTRa mapping™. Front Cardiovasc Med 2023; 10:1161691. [PMID: 37576113 PMCID: PMC10416434 DOI: 10.3389/fcvm.2023.1161691] [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: 02/08/2023] [Accepted: 07/20/2023] [Indexed: 08/15/2023] Open
Abstract
Background Mechanisms underlying atrial fibrillation (AF) are widely complex and vary tremendously among individuals. Objectives This retrospective study aimed to investigate the association between AF activation patterns and clinical outcomes post-ablation. Methods Fifty-five AF patients (64.0 ± 12.9 years; 41 men; 17 paroxysmal) underwent bi-atrial endocardial driver mapping during AF pre-ablation with a real-time phase mapping system (ExTRa Mapping). The nonpassively activated ratio (%NP) of meandering rotors and multiple wavelets relative to the recording time was evaluated in 26 atrial segments [15 in the left atrium (LA) and 11 in the right atrium]. Irrespective of the mapping results, all patients underwent standard AF ablation via cryoballoons and/or radiofrequency catheters. Results In a median follow-up interval of 27(14-30) months, 69.1% of patients were free from recurrent arrhythmias and antiarrhythmic drugs at one year post-procedure. Patients with recurrent AF were more likely to have non-paroxysmal AF, a significantly larger LA size, and higher LA maximal %NP(LAmax%NP) and LA anterior wall %NP(LAAW%NP) than those without recurrent AF. A multivariate Cox regression analysis showed that both an LAmax%NP (hazard ratio [HR] = 1.075; 95% confidence interval [CI] = 1.02-1.14, p = 0.012) and LAAW%NP (HR = 1.061; 95% CI = 1.01-1.11, p = 0.013) were independent predictors of atrial arrhythmia recurrence. The optimal cutoff points for the LAmax%NP and LAAW%NP for predicting AF recurrence were 64.5% and 60.0%, respectively. A Kaplan-Meier analysis demonstrated that both an LAmax%NP > 64.5% (p = 0.0062) and LAAW%NP > 60.0% (p = 0.014) were associated with more frequent AF recurrences. Conclusion Baseline AF activation pattern mapping may aid in predicting freedom from arrhythmias after standard AF ablation procedures.
Collapse
Affiliation(s)
- Daisetsu Aoyama
- Department of Cardiovascular Medicine, Faculty of Medical Sciences, University of Fukui, Fukui, Japan
| | - Shinsuke Miyazaki
- Department of Cardiovascular Medicine, Tokyo Medical and Dental University, Tokyo, Japan
| | - Kanae Hasegawa
- Department of Cardiovascular Medicine, Faculty of Medical Sciences, University of Fukui, Fukui, Japan
| | - Ryohei Nomura
- Department of Cardiovascular Medicine, Faculty of Medical Sciences, University of Fukui, Fukui, Japan
| | - Shota Kakehashi
- Department of Cardiovascular Medicine, Faculty of Medical Sciences, University of Fukui, Fukui, Japan
| | - Moe Mukai
- Department of Cardiovascular Medicine, Faculty of Medical Sciences, University of Fukui, Fukui, Japan
| | - Machiko Miyoshi
- Department of Cardiovascular Medicine, Faculty of Medical Sciences, University of Fukui, Fukui, Japan
| | - Junya Yamaguchi
- Department of Cardiovascular Medicine, Faculty of Medical Sciences, University of Fukui, Fukui, Japan
| | - Yusuke Sato
- Department of Cardiovascular Medicine, Faculty of Medical Sciences, University of Fukui, Fukui, Japan
| | - Yuichiro Shiomi
- Department of Cardiovascular Medicine, Faculty of Medical Sciences, University of Fukui, Fukui, Japan
| | - Hiroyuki Ikeda
- Department of Cardiovascular Medicine, Faculty of Medical Sciences, University of Fukui, Fukui, Japan
| | - Kentaro Ishida
- Department of Cardiovascular Medicine, Faculty of Medical Sciences, University of Fukui, Fukui, Japan
| | - Hiroyasu Uzui
- Department of Cardiovascular Medicine, Faculty of Medical Sciences, University of Fukui, Fukui, Japan
| | - Hiroshi Tada
- Department of Cardiovascular Medicine, Faculty of Medical Sciences, University of Fukui, Fukui, Japan
| |
Collapse
|
3
|
Nanbu T, Yotsukura A, Suzuki G, Takekawa H, Tanaka Y, Yamanashi K, Tsuda M, Yoshida I, Sakurai M, Ashihara T. Organization of atrial fibrillation using a pure sodium channel blocker: Implications of rotor ablation therapy. J Arrhythm 2023. [DOI: 10.1002/joa3.12844] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/03/2023] Open
Affiliation(s)
- Tadafumi Nanbu
- Department of Cardiovascular Medicine Hokko Memorial Hospital Sapporo‐shi Japan
| | - Akihiko Yotsukura
- Department of Cardiovascular Medicine Hokko Memorial Hospital Sapporo‐shi Japan
| | - George Suzuki
- Department of Cardiovascular Medicine Hokko Memorial Hospital Sapporo‐shi Japan
| | - Hiroyuki Takekawa
- Department of Cardiovascular Medicine Hokko Memorial Hospital Sapporo‐shi Japan
| | - Yuki Tanaka
- Department of Cardiovascular Medicine Hokko Memorial Hospital Sapporo‐shi Japan
| | - Katsuma Yamanashi
- Department of Cardiovascular Medicine Hokko Memorial Hospital Sapporo‐shi Japan
| | - Masaya Tsuda
- Department of Cardiovascular Medicine Hokko Memorial Hospital Sapporo‐shi Japan
| | - Izumi Yoshida
- Department of Cardiovascular Medicine Hokko Memorial Hospital Sapporo‐shi Japan
| | - Masayuki Sakurai
- Department of Cardiovascular Medicine Hokko Memorial Hospital Sapporo‐shi Japan
| | - Takashi Ashihara
- Department of Medical Informatics and Biomedical Engineering Shiga University of Medical Science Seta Tsukinowa‐cho, Otsu Japan
| |
Collapse
|
4
|
Amino M, Yamazaki M, Yoshioka K, Kawabe N, Tanaka S, Shimokawa T, Niwa R, Tomii N, Kabuki S, Kunieda E, Yagishita A, Ikari Y, Kodama I. Heavy Ion Irradiation Reduces Vulnerability to Atrial Tachyarrhythmias ― Gap Junction and Sympathetic Neural Remodeling ―. Circ J 2022. [DOI: 10.1253/circj.cj-22-0527] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Affiliation(s)
- Mari Amino
- Department of Cardiology, Tokai University
| | | | | | | | | | - Takashi Shimokawa
- National Institute for Quantum and Radiological Science and Technology
| | - Ryoko Niwa
- Research Institute of Environmental Medicine, Nagoya University
| | - Naoki Tomii
- School of Engineering, The University of Tokyo
| | | | | | | | - Yuji Ikari
- Department of Cardiology, Tokai University
| | - Itsuo Kodama
- Research Institute of Environmental Medicine, Nagoya University
| |
Collapse
|
5
|
Nishimura A, Harada M, Ashihara T, Nomura Y, Motoike Y, Koshikawa M, Ito T, Watanabe E, Ozaki Y, Izawa H. Effect of pulmonary vein isolation on rotor/multiple wavelet dynamics in persistent atrial fibrillation, association with vagal response and implications for adjunctive ablation. Heart Vessels 2022; 38:699-710. [PMID: 36436027 PMCID: PMC10085924 DOI: 10.1007/s00380-022-02209-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Accepted: 11/16/2022] [Indexed: 11/29/2022]
Abstract
AbstractPersistent atrial fibrillation (PeAF) may develop arrhythmogenic substrates of rotors/multiple wavelets. However, the ways in which pulmonary vein isolation (PVI) affects the dynamics of rotor/multiple wavelets in PeAF patients remain elusive. Real-time phase-mapping (ExTRa mapping, EXT) in the whole left atrium (LA) was performed during PeAF before and after PVI (n = 111). The percentage of time in which rotor/multiple wavelets (phase singularities) was observed during each 5-s phase-mapping recording (non-passive activation ratio, %NP) was measured as an index of its burden. The mapping areas showing %NP ≥ 50% were defined as rotor/multiple-wavelet substrates (RSs). Before PVI, RSs were globally distributed in the LA. After PVI, %NP decreased (< 50%) in many RSs (PVI-modifiable RSs) but remained high (≥ 50%) in some RSs, especially localized in the anterior/septum/inferior regions (PVI-unmodifiable RSs, 2.3 ± 1.0 areas/patient). Before PVI, vagal response (VR) to high-frequency stimulation was observed in 23% of RSs, especially localized in the inferior region. VR disappearance after PVI was more frequently observed in PVI-modifiable RSs (79%) than in PVI-unmodifiable RSs (55%, p < 0.05), suggesting that PVI affects autonomic nerve activities and rotor/multiple wavelet dynamics. PVI-unmodifiable RSs were adjunctively ablated in 104 patients. The 1-year AT/AF-free survival rate was 70% in those with PVI alone (n = 115), and 86% in patients with the adjunctive ablation (log-rank test = 7.65, p < 0.01). PVI suppresses not only ectopic firing but also rotor/multiple wavelets partly via modification of autonomic nerve activities. The adjunctive ablation of PVI-unmodifiable RSs improved the outcome in PeAF patients and might be a novel ablation strategy beyond PVI.
Collapse
Affiliation(s)
- Asuka Nishimura
- Department of Cardiology, Fujita Health University, 1-98 Dengakugakubo, Kutsukake-Cho, Toyoake, Aichi, 4701192, Japan
| | - Masahide Harada
- Department of Cardiology, Fujita Health University, 1-98 Dengakugakubo, Kutsukake-Cho, Toyoake, Aichi, 4701192, Japan.
| | - Takashi Ashihara
- Information Technology and Management Center, Shiga University of Medical Science, Seta Tsukinowa-Cho, Otsu, Shiga, 5202192, Japan
| | - Yoshihiro Nomura
- Department of Cardiology, Fujita Health University, 1-98 Dengakugakubo, Kutsukake-Cho, Toyoake, Aichi, 4701192, Japan
| | - Yuji Motoike
- Department of Cardiology, Fujita Health University, 1-98 Dengakugakubo, Kutsukake-Cho, Toyoake, Aichi, 4701192, Japan
| | - Masayuki Koshikawa
- Department of Cardiology, Fujita Health University, 1-98 Dengakugakubo, Kutsukake-Cho, Toyoake, Aichi, 4701192, Japan
| | - Takehiro Ito
- Department of Cardiology, Fujita Health University, 1-98 Dengakugakubo, Kutsukake-Cho, Toyoake, Aichi, 4701192, Japan
| | - Eiichi Watanabe
- Department of Cardiology, Fujita Health University, 1-98 Dengakugakubo, Kutsukake-Cho, Toyoake, Aichi, 4701192, Japan
| | - Yukio Ozaki
- Department of Cardiology, Fujita Health University, 1-98 Dengakugakubo, Kutsukake-Cho, Toyoake, Aichi, 4701192, Japan
| | - Hideo Izawa
- Department of Cardiology, Fujita Health University, 1-98 Dengakugakubo, Kutsukake-Cho, Toyoake, Aichi, 4701192, Japan
| |
Collapse
|
6
|
Nakamura T, Kiuchi K, Fukuzawa K, Takami M, Watanabe Y, Izawa Y, Takemoto M, Sakai J, Yatomi A, Sonoda Y, Takahara H, Nakasone K, Yamamoto K, Suzuki Y, Tani K, Negi N, Kono A, Ashihara T, Hirata K. The impact of the atrial wall thickness in normal/mild late‐gadolinium enhancement areas on atrial fibrillation rotors in persistent atrial fibrillation patients. J Arrhythm 2022; 38:221-231. [PMID: 35387140 PMCID: PMC8977582 DOI: 10.1002/joa3.12676] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Revised: 12/03/2021] [Accepted: 01/03/2022] [Indexed: 11/20/2022] Open
Abstract
Background Some of atrial fibrillation (AF) drivers are found in normal/mild late‐gadolinium enhancement (LGE) areas, as well as moderate ones. The atrial wall thickness (AWT) has been reported to be important as a possible AF substrate. However, the AWT and degree of LGEs as an AF substrate has not been fully validated in humans. Objective The purpose of this study was to evaluate the impact of the AWT in normal/mild LGE areas on AF drivers. Methods A total of 287 segments in 15 persistent AF patients were assessed. AF drivers were defined as non‐passively activated areas (NPAs), where rotational activation was frequently observed, and were detected by the novel real‐time phase mapping (ExTRa Mapping), mild LGE areas were defined as areas with a volume ratio of the enhancement voxel of 0% to <10%. The AWT was defined as the minimum distance from the manually determined endocardium to the epicardial border on the LGE‐MRI. Results NPAs were found in 20 (18.0%) of 131 normal/mild LGE areas where AWT was significantly thicker than that in the passively activated areas (PAs) (2.5 ± 0.3 vs. 2.2 ± 0.3 mm, p < .001). However, NPAs were found in 41 (26.3%) of 156 moderate LGE areas where AWT was thinner than that of PAs (2.1 ± 0.2 mm vs. 2.23 ± 0.3 mm, p = .02). An ROC curve analysis yielded an optimal cutoff value of 2.2 mm for predicting the presence of an NPA in normal/mild LGE areas. Conclusion The location of AF drivers in normal/mild LGE areas might be more accurately identified by evaluating AWT.
Collapse
Affiliation(s)
- Toshihiro Nakamura
- Section of Arrhythmia Division of Cardiovascular Medicine Department of Internal Medicine Kobe University Graduate School of Medicine Kobe Japan
| | - Kunihiko Kiuchi
- Section of Arrhythmia Division of Cardiovascular Medicine Department of Internal Medicine Kobe University Graduate School of Medicine Kobe Japan
| | - Koji Fukuzawa
- Section of Arrhythmia Division of Cardiovascular Medicine Department of Internal Medicine Kobe University Graduate School of Medicine Kobe Japan
| | - Mitsuru Takami
- Section of Arrhythmia Division of Cardiovascular Medicine Department of Internal Medicine Kobe University Graduate School of Medicine Kobe Japan
| | - Yoshiaki Watanabe
- Department of Radiology Kobe University Graduate School of Medicine Kobe Japan
| | - Yu Izawa
- Section of Arrhythmia Division of Cardiovascular Medicine Department of Internal Medicine Kobe University Graduate School of Medicine Kobe Japan
| | - Makoto Takemoto
- Section of Arrhythmia Division of Cardiovascular Medicine Department of Internal Medicine Kobe University Graduate School of Medicine Kobe Japan
| | - Jun Sakai
- Section of Arrhythmia Division of Cardiovascular Medicine Department of Internal Medicine Kobe University Graduate School of Medicine Kobe Japan
| | - Atsusuke Yatomi
- Section of Arrhythmia Division of Cardiovascular Medicine Department of Internal Medicine Kobe University Graduate School of Medicine Kobe Japan
| | - Yusuke Sonoda
- Section of Arrhythmia Division of Cardiovascular Medicine Department of Internal Medicine Kobe University Graduate School of Medicine Kobe Japan
| | - Hiroyuki Takahara
- Section of Arrhythmia Division of Cardiovascular Medicine Department of Internal Medicine Kobe University Graduate School of Medicine Kobe Japan
| | - Kazutaka Nakasone
- Section of Arrhythmia Division of Cardiovascular Medicine Department of Internal Medicine Kobe University Graduate School of Medicine Kobe Japan
| | - Kyoko Yamamoto
- Section of Arrhythmia Division of Cardiovascular Medicine Department of Internal Medicine Kobe University Graduate School of Medicine Kobe Japan
| | - Yuya Suzuki
- Section of Arrhythmia Division of Cardiovascular Medicine Department of Internal Medicine Kobe University Graduate School of Medicine Kobe Japan
| | - Ken‐ichi Tani
- Section of Arrhythmia Division of Cardiovascular Medicine Department of Internal Medicine Kobe University Graduate School of Medicine Kobe Japan
| | - Noriyuki Negi
- Division of Radiology Center for Radiology and Radiation Oncology Kobe University Hospital Kobe Japan
| | - Atsushi Kono
- Department of Radiology Kobe University Graduate School of Medicine Kobe Japan
| | - Takashi Ashihara
- Department of Medical Informatics and Biomedical Engineering Shiga University of Medical Science Otsu Japan
| | - Ken‐ichi Hirata
- Section of Arrhythmia Division of Cardiovascular Medicine Department of Internal Medicine Kobe University Graduate School of Medicine Kobe Japan
| |
Collapse
|
7
|
Yokoyama Y, Nakamura H, Kato N, Higuchi K. A case report on the usefulness of combining online continuous wavelet transform analysis with a novel real-time phase mapping system during non-paroxysmal atrial fibrillation catheter ablation. HeartRhythm Case Rep 2022; 8:250-253. [PMID: 35497478 PMCID: PMC9039114 DOI: 10.1016/j.hrcr.2022.01.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
|
8
|
Nakamura T, Kiuchi K, Fukuzawa K, Takami M, Watanabe Y, Izawa Y, Suehiro H, Akita T, Takemoto M, Sakai J, Yatomi A, Sonoda Y, Takahara H, Nakasone K, Yamamoto K, Negi N, Kono A, Ashihara T, Hirata KI. Late-gadolinium enhancement properties associated with atrial fibrillation rotors in patients with persistent atrial fibrillation. J Cardiovasc Electrophysiol 2021; 32:1005-1013. [PMID: 33556994 DOI: 10.1111/jce.14933] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Revised: 01/12/2021] [Accepted: 01/21/2021] [Indexed: 01/08/2023]
Abstract
BACKGROUND A computational model demonstrated that atrial fibrillation (AF) rotors could be distributed in patchy late-gadolinium enhancement (LGE) areas and play an important role in AF drivers. However, this was not validated in humans. OBJECTIVE The purpose of this study was to evaluate the LGE properties of AF rotors in patients with persistent AF. METHODS A total of 287 segments in 15 patients with persistent AF (long-standing persistent AF in 9 patients) that underwent AF ablation were assessed. Non-passively activated areas (NPAs), where rotational activation (AF rotor) was frequently observed, were detected by the novel real-time phase mapping (ExTRa Mapping). The properties of the LGE areas were assessed using the LGE heterogeneity and the density which was evaluated by the entropy (LGE-entropy) and the volume ratio of the enhancement voxel (LGE-volume ratio), respectively. RESULTS NPAs were found in 61 (21%) of 287 segments and were mostly found around the pulmonary vein antrum. A receiver operating characteristic curve analysis yielded an optimal cutoff value of 5.7% and 10% for the LGE-entropy and LGE-volume ratio, respectively. The incidence of NPAs was significantly higher at segments with an LGE-entropy of >5.7 and LGE-volume ratio of >10% than at the other segments (38 [30%] of 126 vs. 23 [14%] of 161 segments; p = .001). No NPAs were found at segments with an LGE-volume ratio of >50% regardless of the LGE-entropy. Of five patients with AF recurrence, NPAs outside the PV antrum were not ablated in three patients and the remaining NPAs were ablated, but their LGE-entropy and LGE-volume ratio were low. CONCLUSION AF rotors are mostly distributed in relatively weak and much more heterogenous LGE areas.
Collapse
Affiliation(s)
- Toshihiro Nakamura
- Section of Arrhythmia, Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Kunihiko Kiuchi
- Section of Arrhythmia, Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Koji Fukuzawa
- Section of Arrhythmia, Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Mitsuru Takami
- Section of Arrhythmia, Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Yoshiaki Watanabe
- Division of Radiology, Center for Radiology and Radiation Oncology, Kobe University Hospital, Kobe, Japan
| | - Yu Izawa
- Section of Arrhythmia, Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Hideya Suehiro
- Section of Arrhythmia, Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Tomomi Akita
- Section of Arrhythmia, Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Makoto Takemoto
- Section of Arrhythmia, Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Jun Sakai
- Section of Arrhythmia, Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Atsusuke Yatomi
- Section of Arrhythmia, Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Yusuke Sonoda
- Section of Arrhythmia, Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Hiroyuki Takahara
- Section of Arrhythmia, Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Kazutaka Nakasone
- Section of Arrhythmia, Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Kyoko Yamamoto
- Section of Arrhythmia, Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Noriyuki Negi
- Division of Radiology, Center for Radiology and Radiation Oncology, Kobe University Hospital, Kobe, Japan
| | - Atsushi Kono
- Department of Radiology, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Takashi Ashihara
- Department of Medical Informatics and Biomedical Engineering, Shiga University of Medical Science, Otsu, Japan
| | - Ken-Ichi Hirata
- Section of Arrhythmia, Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Japan
| |
Collapse
|
9
|
Tomii N, Yamazaki M, Ashihara T, Nakazawa K, Shibata N, Honjo H, Sakuma I. Spatial phase discontinuity at the center of moving cardiac spiral waves. Comput Biol Med 2021; 130:104217. [PMID: 33516959 DOI: 10.1016/j.compbiomed.2021.104217] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Revised: 01/10/2021] [Accepted: 01/10/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND Precise analysis of cardiac spiral wave (SW) dynamics is essential for effective arrhythmia treatment. Although the phase singularity (PS) point in the spatial phase map has been used to determine the cardiac SW center for decades, quantitative detection algorithms that assume PS as a point fail to trace complex and rapid PS dynamics. Through a detailed analysis of numerical simulations, we examined our hypothesis that a boundary of spatial phase discontinuity induced by a focal conduction block exists around the moving SW center in the phase map. METHOD In a numerical simulation model of a 2D cardiac sheet, three different types of SWs (short wavelength; long wavelength; and low excitability) were induced by regulating ion channels. Discontinuities of all boundaries among adjacent cells at each instance were evaluated by calculating the phase bipolarity (PB). The total amount of phase transition (PTA) in each cell during the study period was evaluated. RESULTS Pivoting, drifting, and shifting SWs were observed in the short-wavelength, low-excitability, and long-wavelength models, respectively. For both the drifting and shifting cases, long high-PB edges were observed on the SW trajectories. In all cases, the conduction block (CB) was observed at the same boundaries. These were also identical to the boundaries in the PTA maps. CONCLUSIONS The analysis of the simulations revealed that the conduction block at the center of a moving SW induces discontinuous boundaries in spatial phase maps that represent a more appropriate model of the SW center than the PS point.
Collapse
Affiliation(s)
- Naoki Tomii
- Faculty of Medicine, The University of Tokyo, 7 -3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan.
| | - Masatoshi Yamazaki
- School of Engineering, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8656, Japan
| | - Takashi Ashihara
- Shiga University of Medical Science, Setatsukinowa-cho, Otsu-city, Shiga, 520-2192, Japan
| | - Kazuo Nakazawa
- Morinomiya University of Medical Sciences, 1-26-16 Minami-Kohoku, Suminoe-ku, Osaka City, 559-8611, Japan
| | - Nitaro Shibata
- Shinjuku Mitsui Building Clinic, 2-1-1 Nishi-Shinjuku, Shinjuku-ku, Tokyo, 163-0404, Japan
| | - Haruo Honjo
- Research Institute of Environmental Medicine, Nagoya University, Furo-cho Chikusa-ku, Nagoya City, Aichi, 464-8601, Japan
| | - Ichiro Sakuma
- School of Engineering, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8656, Japan
| |
Collapse
|