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Wyatt B, McIntosh G, Campbell A, Little M, Rogers L, Wyatt B. Simulating left atrial arrhythmias with an interactive N-body model. J Electrocardiol 2024; 86:153762. [PMID: 39059214 DOI: 10.1016/j.jelectrocard.2024.153762] [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: 10/17/2023] [Revised: 05/31/2024] [Accepted: 07/10/2024] [Indexed: 07/28/2024]
Abstract
BACKGROUND Heart disease and strokes are leading global killers. While atrial arrhythmias are not deadly by themselves, they can disrupt blood flow in the heart, causing blood clots. These clots can travel to the brain, causing strokes, or to the coronary arteries, causing heart attacks. Additionally, prolonged periods of elevated heart rates can lead to structural and functional changes in the heart, ultimately leading to heart failure if untreated. The left atrium, with its more complex topology, is the primary site for complex arrhythmias. Much remains unknown about the causes of these arrhythmias, and computer modeling is employed to study them. METHODS We use N-body modeling techniques and parallel computing to build an interactive model of the left atrium. Through user input, individual muscle attributes can be adjusted, and ectopic events can be placed to induce arrhythmias in the model. Users can test ablation scenarios to determine the most effective way to eliminate these arrhythmias. RESULTS We set up muscle conditions that either spontaneously generate common arrhythmias or, with a properly timed and located ectopic event, induce an arrhythmia. These arrhythmias were successfully eliminated with simulated ablation. CONCLUSIONS We believe the model could be useful to doctors, researchers, and medical students studying left atrial arrhythmias.
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Affiliation(s)
- Bryant Wyatt
- Tarleton State University, Department of Mathematics,1333 W Washington St, Stephenville, TX 76401, United States of America.
| | - Gavin McIntosh
- Tarleton State University, Department of Mathematics,1333 W Washington St, Stephenville, TX 76401, United States of America
| | - Avery Campbell
- Oncor Electric Delivery, 1616 Woodall Rodgers Fwy, Dallas, TX 75202, United States of America
| | - Melanie Little
- MD Anderson School of Health Professions, 1515 Holocombe Blvd, Houston, TX 77030, United States of America
| | - Leah Rogers
- Tarleton State University, Department of Mathematics,1333 W Washington St, Stephenville, TX 76401, United States of America
| | - Brandon Wyatt
- Biosense Webster, 31 Technology Dr. Suite 200, Irvine, CA 92618, United States of America
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Quah JX, Jenkins E, Dharmaprani D, Tiver K, Smith C, Hecker T, Joseph MX, Selvanayagam JB, Tung M, Stanton T, Ahmad W, Stoyanov N, Lahiri A, Chahadi F, Singleton C, Ganesan A. Role of interatrial conduction in atrial fibrillation. Mechanistic insights from renewal theory-based fibrillatory dynamic analysis. Heart Rhythm O2 2022; 3:335-343. [PMID: 36097465 PMCID: PMC9463713 DOI: 10.1016/j.hroo.2022.05.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Background Interatrial conduction has been postulated to play an important role in atrial fibrillation (AF). The pathways involved in interatrial conduction during AF remain incompletely defined. Objective We recently showed physiological assessment of fibrillatory dynamics could be performed using renewal theory, which determines rates of phase singularity formation (λf) and destruction (λd). Using the renewal approach, we aimed to understand the role of the interatrial septum and other electrically coupled regions during AF. Method RENEWAL-AF is a prospective multicenter observational study recruiting AF ablation patients (ACTRN 12619001172190). We studied unipolar electrograms obtained from 16 biatrial locations prior to ablation using a 16-electrode Advisor HD Grid catheter. Renewal rate constants λf and λd were calculated, and the relationships between these rate constants in regions of interatrial connectivity were examined. Results Forty-one AF patients (28.5% female) were recruited. A positive linear correlation was observed between λf and λd (1) across the interatrial septum (λf r2 = 0.5, P < .001, λd r2 = 0.45, P < .001), (2) in regions connected by the Bachmann bundle (right atrial appendage–left atrial appendage λf r2 = 0.29, P = .001; λd r2 = 0.2, P = .008), and (3) across the inferior interatrial routes (cavotricuspid isthmus–left atrial septum λf r2 = 0.67, P < .001; λd r2 = 0.55, P < .001). Persistent AF status and left atrial volume were found to be important effect modifiers of the degree of interatrial renewal rate statistical correlation. Conclusion Our findings support the role of interseptal statistically determined electrical disrelation in sustaining AF. Additionally, renewal theory identified preferential conduction through specific interatrial pathways during fibrillation. These findings may be of importance in identifying clinically significant targets for ablation in AF patients.
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Affiliation(s)
- Jing Xian Quah
- College of Medicine and Public Health, Flinders University of South Australia, Adelaide, Australia
- Department of Cardiovascular Medicine, Flinders Medical Centre, Adelaide, Australia
| | - Evan Jenkins
- College of Science and Engineering, Flinders University of South Australia, Adelaide, Australia
| | - Dhani Dharmaprani
- College of Medicine and Public Health, Flinders University of South Australia, Adelaide, Australia
- College of Science and Engineering, Flinders University of South Australia, Adelaide, Australia
| | - Kathryn Tiver
- Department of Cardiovascular Medicine, Flinders Medical Centre, Adelaide, Australia
| | - Corey Smith
- Department of Cardiology, Fiona Stanley Hospital, Perth, Australia
| | - Teresa Hecker
- Department of Cardiovascular Medicine, Flinders Medical Centre, Adelaide, Australia
| | - Majo X. Joseph
- Department of Cardiovascular Medicine, Flinders Medical Centre, Adelaide, Australia
| | | | - Matthew Tung
- Department of Cardiovascular Medicine, Sunshine Coast University Hospital, Birtinya, Australia
| | - Tony Stanton
- Department of Cardiovascular Medicine, Sunshine Coast University Hospital, Birtinya, Australia
- School of Medicine and Dentistry, Griffith University, Sunshine Coast University Hospital, Birtinya, Australia
| | - Waheed Ahmad
- Department of Cardiovascular Medicine, Princess Alexandra Hospital, Brisbane, Australia
| | - Nik Stoyanov
- Department of Cardiology, Fiona Stanley Hospital, Perth, Australia
| | - Anandaroop Lahiri
- Department of Cardiovascular Medicine, Flinders Medical Centre, Adelaide, Australia
| | - Fahd Chahadi
- Department of Cardiovascular Medicine, Flinders Medical Centre, Adelaide, Australia
| | - Cameron Singleton
- Department of Cardiovascular Medicine, Flinders Medical Centre, Adelaide, Australia
| | - Anand Ganesan
- College of Medicine and Public Health, Flinders University of South Australia, Adelaide, Australia
- Department of Cardiovascular Medicine, Flinders Medical Centre, Adelaide, Australia
- Address reprint requests and correspondence: Dr Anand Ganesan, College of Medicine and Public Health, Flinders University, Flinders Dr, Bedford Park SA 5042, Australia.
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Tiver KD, Dharmaprani D, Quah JX, Lahiri A, Waddell-Smith KE, Ganesan AN. Vomiting, electrolyte disturbance, and medications; the perfect storm for acquired long QT syndrome and cardiac arrest: a case report. J Med Case Rep 2022; 16:9. [PMID: 35012656 PMCID: PMC8751273 DOI: 10.1186/s13256-021-03204-7] [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: 05/24/2021] [Accepted: 11/22/2021] [Indexed: 01/30/2023] Open
Abstract
Background Acquired long QT syndrome is an important and preventable cause of cardiac arrest. Certain medications and electrolyte disturbance are common contributors, and often coexist. In this case, we report five contributors to cardiac arrest. Case presentation This case is of a 51-year-old Caucasian female patient who presented with vomiting associated with hypokalemia and hypomagnesemia. She subsequently received ondansetron and metoclopramide, on the background of chronic treatment with fluoxetine. She then suffered an in-hospital monitored cardiac arrest, with features of long QT and torsades de pointes retrospectively noted on her prearrest electrocardiogram. She was diagnosed with acquired long QT syndrome, and her QT interval later normalized after removal of offending causes. Conclusions This case highlights the importance of proper consideration prior to prescribing QT prolonging medications, especially in patients who have other risk factors for prolonged QT, such as electrolyte disturbances and pretreatment with QT prolonging medications.
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Affiliation(s)
- K D Tiver
- Department of Cardiology, Level 6, Flinders Medical Centre, Flinders Drive, Bedford Park, SA, 5042, Australia.,College of Medicine and Public Health, Flinders University, Bedford Park, Australia
| | - D Dharmaprani
- College of Medicine and Public Health, Flinders University, Bedford Park, Australia
| | - J X Quah
- Department of Cardiology, Level 6, Flinders Medical Centre, Flinders Drive, Bedford Park, SA, 5042, Australia.,College of Medicine and Public Health, Flinders University, Bedford Park, Australia
| | - A Lahiri
- Department of Cardiology, Level 6, Flinders Medical Centre, Flinders Drive, Bedford Park, SA, 5042, Australia
| | - K E Waddell-Smith
- Department of Cardiology, Level 6, Flinders Medical Centre, Flinders Drive, Bedford Park, SA, 5042, Australia
| | - A N Ganesan
- Department of Cardiology, Level 6, Flinders Medical Centre, Flinders Drive, Bedford Park, SA, 5042, Australia. .,College of Medicine and Public Health, Flinders University, Bedford Park, Australia.
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Jenkins EV, Dharmaprani D, Schopp M, Quah JX, Tiver K, Mitchell L, Xiong F, Aguilar M, Pope K, Akar FG, Roney CH, Niederer SA, Nattel S, Nash MP, Clayton RH, Ganesan AN. The inspection paradox: An important consideration in the evaluation of rotor lifetimes in cardiac fibrillation. Front Physiol 2022; 13:920788. [PMID: 36148313 PMCID: PMC9486478 DOI: 10.3389/fphys.2022.920788] [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: 04/15/2022] [Accepted: 08/10/2022] [Indexed: 11/18/2022] Open
Abstract
Background and Objective: Renewal theory is a statistical approach to model the formation and destruction of phase singularities (PS), which occur at the pivots of spiral waves. A common issue arising during observation of renewal processes is an inspection paradox, due to oversampling of longer events. The objective of this study was to characterise the effect of a potential inspection paradox on the perception of PS lifetimes in cardiac fibrillation. Methods: A multisystem, multi-modality study was performed, examining computational simulations (Aliev-Panfilov (APV) model, Courtmanche-Nattel model), experimentally acquired optical mapping Atrial and Ventricular Fibrillation (AF/VF) data, and clinically acquired human AF and VF. Distributions of all PS lifetimes across full epochs of AF, VF, or computational simulations, were compared with distributions formed from lifetimes of PS existing at 10,000 simulated commencement timepoints. Results: In all systems, an inspection paradox led towards oversampling of PS with longer lifetimes. In APV computational simulations there was a mean PS lifetime shift of +84.9% (95% CI, ± 0.3%) (p < 0.001 for observed vs overall), in Courtmanche-Nattel simulations of AF +692.9% (95% CI, ±57.7%) (p < 0.001), in optically mapped rat AF +374.6% (95% CI, ± 88.5%) (p = 0.052), in human AF mapped with basket catheters +129.2% (95% CI, ±4.1%) (p < 0.05), human AF-HD grid catheters 150.8% (95% CI, ± 9.0%) (p < 0.001), in optically mapped rat VF +171.3% (95% CI, ±15.6%) (p < 0.001), in human epicardial VF 153.5% (95% CI, ±15.7%) (p < 0.001). Conclusion: Visual inspection of phase movies has the potential to systematically oversample longer lasting PS, due to an inspection paradox. An inspection paradox is minimised by consideration of the overall distribution of PS lifetimes.
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Affiliation(s)
- Evan V Jenkins
- College of Medicine and Public Health, Flinders University, Adelaide, SA, Australia
| | - Dhani Dharmaprani
- College of Medicine and Public Health, Flinders University, Adelaide, SA, Australia.,College of Science and Engineering, Flinders University, Adelaide, SA, Australia
| | - Madeline Schopp
- College of Science and Engineering, Flinders University, Adelaide, SA, Australia
| | - Jing Xian Quah
- College of Medicine and Public Health, Flinders University, Adelaide, SA, Australia.,Department of Cardiovascular Medicine, Flinders Medical Centre, Adelaide, SA, Australia
| | - Kathryn Tiver
- Department of Cardiovascular Medicine, Flinders Medical Centre, Adelaide, SA, Australia
| | - Lewis Mitchell
- School of Mathematical Sciences, University of Adelaide, Adelaide, SA, Australia
| | - Feng Xiong
- Montréal Heart Institute and Université de Montréal, Montréal, QC, Canada
| | - Martin Aguilar
- Montréal Heart Institute and Université de Montréal, Montréal, QC, Canada
| | - Kenneth Pope
- College of Science and Engineering, Flinders University, Adelaide, SA, Australia
| | - Fadi G Akar
- School of Medicine, Yale University, New Haven, CT, United States
| | - Caroline H Roney
- School of Engineering and Materials Science, Queen Mary University of London, London, United Kingdom
| | - Steven A Niederer
- School of Biomedical Engineering and Imaging Sciences, Kings College London, London, United Kingdom
| | - Stanley Nattel
- Montréal Heart Institute and Université de Montréal, Montréal, QC, Canada
| | - Martyn P Nash
- Auckland Bioengineering Institute, University of Auckland, Auckland, New Zealand
| | - Richard H Clayton
- Insigneo Institute for in Silico Medicine and Department of Computer Science, University of Sheffield, Sheffield, United Kingdom
| | - Anand N Ganesan
- College of Medicine and Public Health, Flinders University, Adelaide, SA, Australia.,Department of Cardiovascular Medicine, Flinders Medical Centre, Adelaide, SA, Australia
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Lambiase PD. Maximising Opportunities Post Coronavirus Disease 2019: Time to Embrace a New Era of Atrial Fibrillation Research. Arrhythm Electrophysiol Rev 2021; 10:63-64. [PMID: 34401176 PMCID: PMC8353549 DOI: 10.15420/aer.2021.29] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Affiliation(s)
- Pier D Lambiase
- Section Editor, Arrhythmia Risk Stratification, Arrhythmia & Electrophysiology Review Institute of Cardiovascular Science, University College London, London, UK; Barts Heart Centre, West Smithfield, London, UK
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