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An K, Li H, Yu C, Zheng Z. Surface electrocardiogram f wave analysis in patients with atrial fibrillation undergoing thoracoscopic epicardial ablation. INTERDISCIPLINARY CARDIOVASCULAR AND THORACIC SURGERY 2024; 38:ivae057. [PMID: 38775401 PMCID: PMC11128095 DOI: 10.1093/icvts/ivae057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Revised: 02/25/2024] [Accepted: 05/20/2024] [Indexed: 05/27/2024]
Abstract
OBJECTIVES To investigate the predictive values of surface electrocardiogram-derived parameters in patients with atrial fibrillation who underwent thoracoscopic epicardial ablation. METHODS The present study included 102 patients with atrial fibrillation who underwent thoracoscopic epicardial ablation and whose baseline 12-lead electrocardiograms were available. Frequency domain analysis was performed to calculate the electrocardiogram-derived parameters. Cox proportional hazards regression was used to identify predictive risk factors for postoperative recurrence. RESULTS At 36-month interval, the overall rate of freedom from atrial tachyarrhythmia without antiarrhythmic drugs was 58.5%. The results of the univariable and multivariable analyses showed that larger left atrial diameter (hazard ratio: 1.074, 95% confidence interval: 1.021-1.130, P = 0.006) was an independent risk factor for atrial fibrillation recurrence, while higher fibrillatory wave amplitude was a protective factor (hazard ratio: 0.292, 95% confidence interval: 0.157-0.542, P < 0.001). The associations were clarified by the restricted cubic splines. The dominant frequency and organization index were not identified as statistically significant parameters. CONCLUSIONS The fibrillatory wave amplitude has the highest predictive value for atrial fibrillation recurrence in electrocardiogram-derived parameters. Together with left atrial diameter, it may help identify patients in whom thoracoscopic ablation is likely to be effective.
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Affiliation(s)
- Kang An
- Department of Cardiovascular Surgery, National Center for Cardiovascular Disease, Beijing, China
- Department of Cardiovascular Surgery, Fuwai Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Haojie Li
- Department of Cardiovascular Surgery, National Center for Cardiovascular Disease, Beijing, China
- Department of Cardiovascular Surgery, Fuwai Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Chunyu Yu
- Department of Cardiovascular Surgery, National Center for Cardiovascular Disease, Beijing, China
- Department of Cardiovascular Surgery, Fuwai Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Zhe Zheng
- Department of Cardiovascular Surgery, National Center for Cardiovascular Disease, Beijing, China
- Department of Cardiovascular Surgery, Fuwai Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
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Saha S, Linz D, Saha D, McEwan A, Baumert M. Overcoming Uncertainties in Electrogram-Based Atrial Fibrillation Mapping: A Review. Cardiovasc Eng Technol 2024; 15:52-64. [PMID: 37962813 DOI: 10.1007/s13239-023-00696-w] [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: 05/22/2023] [Accepted: 10/31/2023] [Indexed: 11/15/2023]
Abstract
In clinical rhythmology, intracardiac bipolar electrograms (EGMs) play a critical role in investigating the triggers and substrates inducing and perpetuating atrial fibrillation (AF). However, the interpretation of bipolar EGMs is ambiguous due to several aspects of electrodes, mapping algorithms and wave propagation dynamics, so it requires several variables to describe the effects of these uncertainties on EGM analysis. In this narrative review, we critically evaluate the potential impact of such uncertainties on the design of cardiac mapping tools on AF-related substrate characterization. Literature suggest uncertainties are due to several variables, including the wave propagation vector, the wave's incidence angle, inter-electrode spacing, electrode size and shape, and tissue contact. The preprocessing of the EGM signals and mapping density will impact the electro-anatomical representation and the features extracted from the local electrical activities. The superposition of multiple waves further complicates EGM interpretation. The inclusion of these uncertainties is a nontrivial problem but their consideration will yield a better interpretation of the intra-atrial dynamics in local activation patterns. From a translational perspective, this review provides a concise but complete overview of the critical variables for developing more precise cardiac mapping tools.
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Affiliation(s)
- Simanto Saha
- School of Biomedical Engineering, The University of Sydney, Sydney, NSW, 2008, Australia.
| | - Dominik Linz
- Centre for Heart Rhythm Disorders, The University of Adelaide, Adelaide, SA, 5000, Australia
| | - Dyuti Saha
- Kumudini Women's Medical College, The University of Dhaka, Tangail, 1940, Dhaka, Bangladesh
| | - Alistair McEwan
- School of Biomedical Engineering, The University of Sydney, Sydney, NSW, 2008, Australia
| | - Mathias Baumert
- School of Electrical and Mechanical Engineering, The University of Adelaide, Adelaide, SA, 5000, Australia
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Shi X, Sau A, Li X, Patel K, Bajaj N, Varela M, Wu H, Handa B, Arnold A, Shun-Shin M, Keene D, Howard J, Whinnett Z, Peters N, Christensen K, Jensen HJ, Ng FS. Information theory-based direct causality measure to assess cardiac fibrillation dynamics. J R Soc Interface 2023; 20:20230443. [PMID: 37817583 PMCID: PMC10565370 DOI: 10.1098/rsif.2023.0443] [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: 08/01/2023] [Accepted: 09/19/2023] [Indexed: 10/12/2023] Open
Abstract
Understanding the mechanism sustaining cardiac fibrillation can facilitate the personalization of treatment. Granger causality analysis can be used to determine the existence of a hierarchical fibrillation mechanism that is more amenable to ablation treatment in cardiac time-series data. Conventional Granger causality based on linear predictability may fail if the assumption is not met or given sparsely sampled, high-dimensional data. More recently developed information theory-based causality measures could potentially provide a more accurate estimate of the nonlinear coupling. However, despite their successful application to linear and nonlinear physical systems, their use is not known in the clinical field. Partial mutual information from mixed embedding (PMIME) was implemented to identify the direct coupling of cardiac electrophysiology signals. We show that PMIME requires less data and is more robust to extrinsic confounding factors. The algorithms were then extended for efficient characterization of fibrillation organization and hierarchy using clinical high-dimensional data. We show that PMIME network measures correlate well with the spatio-temporal organization of fibrillation and demonstrated that hierarchical type of fibrillation and drivers could be identified in a subset of ventricular fibrillation patients, such that regions of high hierarchy are associated with high dominant frequency.
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Affiliation(s)
- Xili Shi
- National Heart and Lung Institute, Imperial College London, London, UK
| | - Arunashis Sau
- National Heart and Lung Institute, Imperial College London, London, UK
- Department of Cardiology, Imperial College Healthcare NHS Trust, London, UK
| | - Xinyang Li
- National Heart and Lung Institute, Imperial College London, London, UK
| | - Kiran Patel
- National Heart and Lung Institute, Imperial College London, London, UK
- Department of Cardiology, Imperial College Healthcare NHS Trust, London, UK
| | - Nikesh Bajaj
- National Heart and Lung Institute, Imperial College London, London, UK
| | - Marta Varela
- National Heart and Lung Institute, Imperial College London, London, UK
| | - Huiyi Wu
- National Heart and Lung Institute, Imperial College London, London, UK
| | - Balvinder Handa
- National Heart and Lung Institute, Imperial College London, London, UK
- Department of Cardiology, Imperial College Healthcare NHS Trust, London, UK
| | - Ahran Arnold
- National Heart and Lung Institute, Imperial College London, London, UK
- Department of Cardiology, Imperial College Healthcare NHS Trust, London, UK
| | - Matthew Shun-Shin
- National Heart and Lung Institute, Imperial College London, London, UK
- Department of Cardiology, Imperial College Healthcare NHS Trust, London, UK
| | - Daniel Keene
- National Heart and Lung Institute, Imperial College London, London, UK
- Department of Cardiology, Imperial College Healthcare NHS Trust, London, UK
| | - James Howard
- National Heart and Lung Institute, Imperial College London, London, UK
- Department of Cardiology, Imperial College Healthcare NHS Trust, London, UK
| | - Zachary Whinnett
- National Heart and Lung Institute, Imperial College London, London, UK
- Department of Cardiology, Imperial College Healthcare NHS Trust, London, UK
| | - Nicholas Peters
- National Heart and Lung Institute, Imperial College London, London, UK
- Department of Cardiology, Imperial College Healthcare NHS Trust, London, UK
| | - Kim Christensen
- Department of Physics, Imperial College London, London, UK
- Centre for Complexity Science, Imperial College London, London, UK
| | - Henrik Jeldtoft Jensen
- Department of Mathematics, Imperial College London, London, UK
- Centre for Complexity Science, Imperial College London, London, UK
- Institute of Innovative Research, Tokyo Institute of Technology, Yokohama, Japan
| | - Fu Siong Ng
- National Heart and Lung Institute, Imperial College London, London, UK
- Department of Cardiology, Imperial College Healthcare NHS Trust, London, UK
- Department of Cardiology, Chelsea and Westminster NHS Foundation Trust, London, UK
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4
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Halfar R, Lawson BAJ, Dos Santos RW, Burrage K. Recurrence quantification analysis for fine-scale characterisation of arrhythmic patterns in cardiac tissue. Sci Rep 2023; 13:11828. [PMID: 37481668 PMCID: PMC10363137 DOI: 10.1038/s41598-023-38256-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Accepted: 07/05/2023] [Indexed: 07/24/2023] Open
Abstract
This paper uses recurrence quantification analysis (RQA) combined with entropy measures and organization indices to characterize arrhythmic patterns and dynamics in computer simulations of cardiac tissue. We performed different simulations of cardiac tissues of sizes comparable to the human heart atrium. In these simulations, we observed four classic arrhythmic patterns: a spiral wave anchored to a highly fibrotic region resulting in sustained re-entry, a meandering spiral wave, fibrillation, and a spiral wave anchored to a scar region that breaks up into wavelets away from the main rotor. A detailed analysis revealed that, within the same simulation, maps of RQA metrics could differentiate regions with regular AP propagation from ones with chaotic activity. In particular, the combination of two RQA metrics, the length of the longest diagonal string of recurrence points and the mean length of diagonal lines, was able to identify the location of rotor tips, which are the active elements that maintain spiral waves and fibrillation. By proposing low-dimensional models based on the mean value and spatial correlation of metrics calculated from membrane potential time series, we identify RQA-based metrics that successfully separate the four different types of cardiac arrhythmia into distinct regions of the feature space, and thus might be used for automatic classification, in particular distinguishing between fibrillation driven by self-sustaining chaos and that created by a persistent rotor and wavebreak. We also discuss the practical applicability of such an approach.
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Affiliation(s)
- Radek Halfar
- IT4Innovations, VSB - Technical University of Ostrava, 708 00, Ostrava, Czech Republic.
| | - Brodie A J Lawson
- ARC Centre of Excellence for Plant Success in Nature and Agriculture, Queensland University of Technology, Brisbane, 4000, Australia
- Centre for Data Science, Queensland Univeristy of Technology, Brisbane, 4000, Australia
| | - Rodrigo Weber Dos Santos
- Graduate Program in Computational Modeling, Universidade Federal de Juiz de Fora, Juiz de Fora, 36036-330, Brazil
| | - Kevin Burrage
- ARC Centre of Excellence for Plant Success in Nature and Agriculture, Queensland University of Technology, Brisbane, 4000, Australia
- Department of Computer Science, University of Oxford, Oxford, UK
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Theofilis P, Oikonomou E, Antonopoulos AS, Siasos G, Tsioufis K, Tousoulis D. Percutaneous Treatment Approaches in Atrial Fibrillation: Current Landscape and Future Perspectives. Biomedicines 2022; 10:biomedicines10092268. [PMID: 36140368 PMCID: PMC9496262 DOI: 10.3390/biomedicines10092268] [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] [Received: 08/11/2022] [Revised: 09/03/2022] [Accepted: 09/09/2022] [Indexed: 11/17/2022] Open
Abstract
Atrial fibrillation (AF), the most common sustained arrhythmia in clinical practice, represents a major cause of morbidity and mortality, with an increasing prevalence. Pharmacologic treatment remains the cornerstone of its management through rhythm and rate control, as well as the prevention of thromboembolism with the use of oral anticoagulants. Recent progress in percutaneous interventional approaches have provided additional options in the therapeutic arsenal, however. The use of the different catheter ablation techniques can now lead to long arrhythmia-free intervals and significantly lower AF burden, thus reducing the rate of its complications. Particularly encouraging evidence is now available for patients with persistent AF or concomitant heart failure, situations in which catheter ablation could even be a first-line option. In the field of stroke prevention, targeting the left atrial appendage with percutaneous device implantation may reduce the risk of thromboembolism to lower rates than that predicted with conventional ischemic risk scores. Left atrial appendage occlusion through the approved Watchman or Amplatzer devices is a well-established, efficacious, and safe method, especially in high-ischemic and bleeding risk patients with contraindications for oral anticoagulation.
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Affiliation(s)
- Panagiotis Theofilis
- First Department of Cardiology, “Hippokration” General Hospital, University of Athens Medical School, 11527 Athens, Greece
| | - Evangelos Oikonomou
- Third Department of Cardiology, Thoracic Diseases General Hospital “Sotiria”, University of Athens Medical School, 11527 Athens, Greece
| | - Alexios S. Antonopoulos
- First Department of Cardiology, “Hippokration” General Hospital, University of Athens Medical School, 11527 Athens, Greece
| | - Gerasimos Siasos
- Third Department of Cardiology, Thoracic Diseases General Hospital “Sotiria”, University of Athens Medical School, 11527 Athens, Greece
| | - Konstantinos Tsioufis
- First Department of Cardiology, “Hippokration” General Hospital, University of Athens Medical School, 11527 Athens, Greece
| | - Dimitris Tousoulis
- First Department of Cardiology, “Hippokration” General Hospital, University of Athens Medical School, 11527 Athens, Greece
- Correspondence:
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Correlation between conduction velocity and frequency analysis in patients with atrial fibrillation using high-density charge mapping. Med Biol Eng Comput 2022; 60:3081-3090. [DOI: 10.1007/s11517-022-02659-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2022] [Accepted: 08/22/2022] [Indexed: 10/14/2022]
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Azzolin L, Eichenlaub M, Nagel C, Nairn D, Sanchez J, Unger L, Dössel O, Jadidi A, Loewe A. Personalized ablation vs. conventional ablation strategies to terminate atrial fibrillation and prevent recurrence. Europace 2022; 25:211-222. [PMID: 35943361 PMCID: PMC9907752 DOI: 10.1093/europace/euac116] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Accepted: 06/17/2022] [Indexed: 11/14/2022] Open
Abstract
AIMS The long-term success rate of ablation therapy is still sub-optimal in patients with persistent atrial fibrillation (AF), mostly due to arrhythmia recurrence originating from arrhythmogenic sites outside the pulmonary veins. Computational modelling provides a framework to integrate and augment clinical data, potentially enabling the patient-specific identification of AF mechanisms and of the optimal ablation sites. We developed a technology to tailor ablations in anatomical and functional digital atrial twins of patients with persistent AF aiming to identify the most successful ablation strategy. METHODS AND RESULTS Twenty-nine patient-specific computational models integrating clinical information from tomographic imaging and electro-anatomical activation time and voltage maps were generated. Areas sustaining AF were identified by a personalized induction protocol at multiple locations. State-of-the-art anatomical and substrate ablation strategies were compared with our proposed Personalized Ablation Lines (PersonAL) plan, which consists of iteratively targeting emergent high dominant frequency (HDF) regions, to identify the optimal ablation strategy. Localized ablations were connected to the closest non-conductive barrier to prevent recurrence of AF or atrial tachycardia. The first application of the HDF strategy had a success of >98% and isolated only 5-6% of the left atrial myocardium. In contrast, conventional ablation strategies targeting anatomical or structural substrate resulted in isolation of up to 20% of left atrial myocardium. After a second iteration of the HDF strategy, no further arrhythmia episode could be induced in any of the patient-specific models. CONCLUSION The novel PersonAL in silico technology allows to unveil all AF-perpetuating areas and personalize ablation by leveraging atrial digital twins.
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Affiliation(s)
- Luca Azzolin
- Corresponding author. Tel: +393381319986, E-mail address:
| | | | - Claudia Nagel
- Institute of Biomedical Engineering at Karlsruhe Institute of Technology, Building 30.33, Fritz-Haber-Weg 1, 76131 Karlsruhe, Germany
| | - Deborah Nairn
- Institute of Biomedical Engineering at Karlsruhe Institute of Technology, Building 30.33, Fritz-Haber-Weg 1, 76131 Karlsruhe, Germany
| | - Jorge Sanchez
- Institute of Biomedical Engineering at Karlsruhe Institute of Technology, Building 30.33, Fritz-Haber-Weg 1, 76131 Karlsruhe, Germany
| | - Laura Unger
- Institute of Biomedical Engineering at Karlsruhe Institute of Technology, Building 30.33, Fritz-Haber-Weg 1, 76131 Karlsruhe, Germany
| | - Olaf Dössel
- Institute of Biomedical Engineering at Karlsruhe Institute of Technology, Building 30.33, Fritz-Haber-Weg 1, 76131 Karlsruhe, Germany
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8
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Chu GS, Li X, Stafford PJ, Vanheusden FJ, Salinet JL, Almeida TP, Dastagir N, Sandilands AJ, Kirchhof P, Schlindwein FS, Ng GA. Simultaneous Whole-Chamber Non-contact Mapping of Highest Dominant Frequency Sites During Persistent Atrial Fibrillation: A Prospective Ablation Study. Front Physiol 2022; 13:826449. [PMID: 35370796 PMCID: PMC8966840 DOI: 10.3389/fphys.2022.826449] [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: 11/30/2021] [Accepted: 02/21/2022] [Indexed: 12/02/2022] Open
Abstract
Purpose Sites of highest dominant frequency (HDF) are implicated by many proposed mechanisms underlying persistent atrial fibrillation (persAF). We hypothesized that prospectively identifying and ablating dynamic left atrial HDF sites would favorably impact the electrophysiological substrate of persAF. We aim to assess the feasibility of prospectively identifying HDF sites by global simultaneous left atrial mapping. Methods PersAF patients with no prior ablation history underwent global simultaneous left atrial non-contact mapping. 30 s of electrograms recorded during AF were exported into a bespoke MATLAB interface to identify HDF regions, which were then targeted for ablation, prior to pulmonary vein isolation. Following ablation of each region, change in AF cycle length (AFCL) was documented (≥ 10 ms considered significant). Baseline isopotential maps of ablated regions were retrospectively analyzed looking for rotors and focal activation or extinction events. Results A total of 51 HDF regions were identified and ablated in 10 patients (median DF 5.8Hz, range 4.4-7.1Hz). An increase in AFCL of was seen in 20 of the 51 regions (39%), including AF termination in 4 patients. 5 out of 10 patients (including the 4 patients where AF termination occurred with HDF-guided ablation) were free from AF recurrence at 1 year. The proportion of HDF occurrences in an ablated region was not associated with change in AFCL (τ = 0.11, p = 0.24). Regions where AFCL decreased by 10 ms or more (i.e., AF disorganization) after ablation also showed lowest baseline spectral organization (p < 0.033 for any comparison). Considering all ablated regions, the average proportion of HDF events which were also HRI events was 8.0 ± 13%. Focal activations predominated (537/1253 events) in the ablated regions on isopotential maps, were modestly associated with the proportion of HDF occurrences represented by the ablated region (Kendall's τ = 0.40, p < 0.0001), and very strongly associated with focal extinction events (τ = 0.79, p < 0.0001). Rotors were rare (4/1253 events). Conclusion Targeting dynamic HDF sites is feasible and can be efficacious, but lacks specificity in identifying relevant human persAF substrate. Spectral organization may have an adjunctive role in preventing unnecessary substrate ablation. Dynamic HDF sites are not associated with observable rotational activity on isopotential mapping, but epi-endocardial breakthroughs could be contributory.
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Affiliation(s)
- Gavin S. Chu
- Department of Cardiovascular Science, University of Leicester, Leicester, United Kingdom
- Lancashire Cardiac Centre, Blackpool Teaching Hospitals NHS Foundation Trust, Blackpool, United Kingdom
| | - Xin Li
- Department of Cardiovascular Science, University of Leicester, Leicester, United Kingdom
- School of Engineering, University of Leicester, Leicester, United Kingdom
| | - Peter J. Stafford
- National Institute for Health Research Leicester Cardiovascular Biomedical Research Centre, Glenfield Hospital, Leicester, United Kingdom
| | | | - João L. Salinet
- Center for Engineering, Modeling and Applied Social Sciences, University Federal of ABC, Santo André, Brazil
| | - Tiago P. Almeida
- Department of Cardiovascular Science, University of Leicester, Leicester, United Kingdom
- School of Engineering, University of Leicester, Leicester, United Kingdom
| | - Nawshin Dastagir
- Department of International Foundation, Massey University, Auckland, New Zealand
| | - Alastair J. Sandilands
- National Institute for Health Research Leicester Cardiovascular Biomedical Research Centre, Glenfield Hospital, Leicester, United Kingdom
| | - Paulus Kirchhof
- University Heart and Vascular Centre, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Fernando S. Schlindwein
- School of Engineering, University of Leicester, Leicester, United Kingdom
- National Institute for Health Research Leicester Cardiovascular Biomedical Research Centre, Glenfield Hospital, Leicester, United Kingdom
| | - G. André Ng
- Department of Cardiovascular Science, University of Leicester, Leicester, United Kingdom
- National Institute for Health Research Leicester Cardiovascular Biomedical Research Centre, Glenfield Hospital, Leicester, United Kingdom
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Park JW, Lim B, Hwang I, Kwon OS, Yu HT, Kim TH, Uhm JS, Joung B, Lee MH, Pak HN. Restitution Slope Affects the Outcome of Dominant Frequency Ablation in Persistent Atrial Fibrillation: CUVIA-AF2 Post-Hoc Analysis Based on Computational Modeling Study. Front Cardiovasc Med 2022; 9:838646. [PMID: 35310982 PMCID: PMC8927985 DOI: 10.3389/fcvm.2022.838646] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2021] [Accepted: 01/28/2022] [Indexed: 11/13/2022] Open
Abstract
IntroductionAlthough the dominant frequency (DF) localizes the reentrant drivers and the maximal slope of the action potential duration (APD) restitution curve (Smax) reflects the tendency of the wave-break, their interaction has never been studied. We hypothesized that DF ablation has different effects on atrial fibrillation (AF) depending on Smax.MethodsWe studied the DF and Smax in 25 realistic human persistent AF model samples (68% male, 60 ± 10 years old). Virtual AF was induced by ramp pacing measuring Smax, followed by spatiotemporal DF evaluation for 34 s. We assessed the DF ablation effect depending on Smax in both computational modeling and a previous clinical trial, CUVIA-AF (170 patients with persistent AF, 70.6% male, 60 ± 11 years old).ResultsMean DF had an inverse relationship with Smax regardless of AF acquisition timing (p < 0.001). Virtual DF ablations increased the defragmentation rate compared to pulmonary vein isolation (PVI) alone (p = 0.015), especially at Smax <1 (61.5 vs. 7.7%, p = 0.011). In post-DF ablation defragmentation episodes, DF was significantly higher (p = 0.002), and Smax was lower (p = 0.003) than in episodes without defragmentation. In the post-hoc analysis of CUVIA-AF2, we replicated the inverse relationship between Smax and DF (r = −0.47, p < 0.001), and we observed better rhythm outcomes of clinical DF ablations in addition to a PVI than of empirical PVI at Smax <1 [hazard ratio 0.45, 95% CI (0.22–0.89), p = 0.022; log-rank p = 0.021] but not at ≥ 1 (log-rank p = 0.177).ConclusionWe found an inverse relationship between DF and Smax and the outcome of DF ablation after PVI was superior at the condition with Smax <1 in both in-silico and clinical trials.
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10
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Kotb A, Chin SH, Ng GA. Recent advances in the tools available for atrial fibrillation ablation. Expert Rev Med Devices 2022; 19:141-154. [PMID: 35188431 DOI: 10.1080/17434440.2022.2038564] [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: 11/26/2021] [Accepted: 02/02/2022] [Indexed: 11/04/2022]
Abstract
INTRODUCTION Atrial fibrillation (AF) is the commonest arrhythmia in clinical practice with significant detrimental health impacts. Much effort has been spent in mapping AF, determine its triggers and drivers, and how to develop tools to eliminate these triggers. AREAS COVERED In this state of-the-art review article, we aim to highlight the recent techniques in catheter-based management of Atrial Fibrillation; including new advancements either in the catheter design or the software used. This includes a comprehensive summary of the most recent tools used in AF mapping and subsequent ablation. EXPERT OPINION Electrical isolation of the pulmonary veins has been developed and established as the cornerstone in AF ablation with good results in patients with paroxysmal AF (PAF) whilst new ablation tools are aimed at streamlining the procedure. However, the quest for persistent AF (PeAF) remains. The future of AF ablation, we believe, lies in identifying AF drivers by means of the new developing mapping tools and altering their electrical properties in a safe, reproducible, and effective manner.
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Affiliation(s)
- Ahmed Kotb
- Department of Cardiovascular Sciences, University of Leicester, Leicester, UK
- Department of Cardiology, University Hospitals of Leicester NHS Trust, Leicester, UK
| | - Shui Hao Chin
- Department of Cardiovascular Sciences, University of Leicester, Leicester, UK
- Department of Cardiology, University Hospitals of Leicester NHS Trust, Leicester, UK
| | - G Andre Ng
- Department of Cardiovascular Sciences, University of Leicester, Leicester, UK
- Department of Cardiology, University Hospitals of Leicester NHS Trust, Leicester, UK
- National Institute for Health Research Leicester Biomedical Research Centre, Leicester, UK
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