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Lim B, Kim J, Hwang M, Song JS, Lee JK, Yu HT, Kim TH, Uhm JS, Joung B, Lee MH, Pak HN. In situ procedure for high-efficiency computational modeling of atrial fibrillation reflecting personal anatomy, fiber orientation, fibrosis, and electrophysiology. Sci Rep 2020; 10:2417. [PMID: 32051487 PMCID: PMC7016008 DOI: 10.1038/s41598-020-59372-x] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2019] [Accepted: 11/06/2019] [Indexed: 12/22/2022] Open
Abstract
We previously reported the feasibility and efficacy of a simulation-guided clinical catheter ablation of atrial fibrillation (AF) in an in-silico AF model. We developed a highly efficient realistic AF model reflecting the patient endocardial voltage and local conduction and tested its clinical feasibility. We acquired > 500 endocardial bipolar electrograms during right atrial pacing at the beginning of the AF ablation procedures. Based on the clinical bipolar electrograms, we generated simulated voltage maps by applying fibrosis and local activation maps adjusted for the fiber orientation. The software's accuracy (CUVIA2.5) was retrospectively tested in 17 patients and feasibility prospectively in 10 during clinical AF ablation. Results: We found excellent correlations between the clinical and simulated voltage maps (R = 0.933, p < 0.001) and clinical and virtual local conduction (R = 0.958, p < 0.001). The proportion of virtual local fibrosis was 15.4, 22.2, and 36.9% in the paroxysmal AF, persistent AF, and post-pulmonary vein isolation (PVI) states, respectively. The reconstructed virtual bipolar electrogram exhibited a relatively good similarities of morphology to the local clinical bipolar electrogram (R = 0.60 ± 0.08, p < 0.001). Feasibility testing revealed an in situ procedural computing time from the clinical data acquisition to wave-dynamics analyses of 48.2 ± 4.9 min. All virtual analyses were successfully achieved during clinical PVI procedures. We developed a highly efficient, realistic, in situ procedural simulation model reflective of individual anatomy, fiber orientation, fibrosis, and electrophysiology that can be applied during AF ablation.
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Affiliation(s)
- Byounghyun Lim
- Yonsei University Health System, Seoul, Republic of Korea
| | - Jaehyeok Kim
- Yonsei University Health System, Seoul, Republic of Korea
| | - Minki Hwang
- Yonsei University Health System, Seoul, Republic of Korea
| | - Jun-Seop Song
- Yonsei University Health System, Seoul, Republic of Korea
| | - Jung Ki Lee
- Yonsei University Health System, Seoul, Republic of Korea
| | - Hee-Tae Yu
- Yonsei University Health System, Seoul, Republic of Korea
| | - Tae-Hoon Kim
- Yonsei University Health System, Seoul, Republic of Korea
| | - Jae-Sun Uhm
- Yonsei University Health System, Seoul, Republic of Korea
| | - Boyoung Joung
- Yonsei University Health System, Seoul, Republic of Korea
| | - Moon-Hyung Lee
- Yonsei University Health System, Seoul, Republic of Korea
| | - Hui-Nam Pak
- Yonsei University Health System, Seoul, Republic of Korea.
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Maille B, Das M, Hussein A, Shaw M, Chaturvedi V, Morgan M, Ronayne C, Snowdon RL, Gupta D. Accuracy of left atrial bipolar voltages obtained by ConfiDENSE multielectrode mapping in patients with persistent atrial fibrillation. J Cardiovasc Electrophysiol 2018; 29:881-888. [DOI: 10.1111/jce.13472] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2017] [Revised: 01/25/2018] [Accepted: 02/20/2018] [Indexed: 01/10/2023]
Affiliation(s)
- Baptiste Maille
- Institute of Cardiovascular Medicine and Science, Department of Cardiology; Liverpool Heart and Chest Hospital; Thomas Drive Liverpool L14 3PE UK
| | - Moloy Das
- Department of Cardiology; Freeman Hospital; Freeman Road Newcastle upon Tyne NE7 7DN UK
| | - Ahmed Hussein
- Institute of Cardiovascular Medicine and Science, Department of Cardiology; Liverpool Heart and Chest Hospital; Thomas Drive Liverpool L14 3PE UK
| | - Matthew Shaw
- Institute of Cardiovascular Medicine and Science, Department of Cardiology; Liverpool Heart and Chest Hospital; Thomas Drive Liverpool L14 3PE UK
| | - Vivek Chaturvedi
- Institute of Cardiovascular Medicine and Science, Department of Cardiology; Liverpool Heart and Chest Hospital; Thomas Drive Liverpool L14 3PE UK
| | - Maureen Morgan
- Institute of Cardiovascular Medicine and Science, Department of Cardiology; Liverpool Heart and Chest Hospital; Thomas Drive Liverpool L14 3PE UK
| | - Christina Ronayne
- Institute of Cardiovascular Medicine and Science, Department of Cardiology; Liverpool Heart and Chest Hospital; Thomas Drive Liverpool L14 3PE UK
| | - Richard L. Snowdon
- Institute of Cardiovascular Medicine and Science, Department of Cardiology; Liverpool Heart and Chest Hospital; Thomas Drive Liverpool L14 3PE UK
| | - Dhiraj Gupta
- Institute of Cardiovascular Medicine and Science, Department of Cardiology; Liverpool Heart and Chest Hospital; Thomas Drive Liverpool L14 3PE UK
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Lim B, Hwang M, Song JS, Ryu AJ, Joung B, Shim EB, Ryu H, Pak HN. Effectiveness of atrial fibrillation rotor ablation is dependent on conduction velocity: An in-silico 3-dimensional modeling study. PLoS One 2017; 12:e0190398. [PMID: 29287119 PMCID: PMC5747478 DOI: 10.1371/journal.pone.0190398] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2017] [Accepted: 12/14/2017] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND We previously reported that stable rotors are observed in in-silico human atrial fibrillation (AF) models, and are well represented by a dominant frequency (DF). In the current study, we hypothesized that the outcome of DF ablation is affected by conduction velocity (CV) conditions and examined this hypothesis using in-silico 3D-AF modeling. METHODS We integrated 3D CT images of left atrium obtained from 10 patients with persistent AF (80% male, 61.8±13.5 years old) into in-silico AF model. We compared AF maintenance durations (max 300s), spatiotemporal stabilities of DF, phase singularity (PS) number, life-span of PS, and AF termination or defragmentation rates after virtual DF ablation with 5 different CV conditions (0.2, 0.3, 0.4, 0.5, and 0.6m/s). RESULTS 1. AF maintenance duration (p<0.001), spatiotemporal mean variance of DF (p<0.001), and the number of PS (p = 0.023) showed CV dependent bimodal patterns (highest at CV0.4m/s and lowest at CV0.6m/s) consistently. 2. After 10% highest DF ablation, AF defragmentation rates were the lowest at CV0.4m/s (37.8%), but highest at CV0.5 and 0.6m/s (all 100%, p<0.001). 3. In the episodes with AF termination or defragmentation followed by 10% highest DF ablation, baseline AF maintenance duration was shorter (p<0.001), spatiotemporal mean variance of DF was lower (p = 0.014), and the number of PS was lower (p = 0.004) than those with failed AF defragmentation after DF ablation. CONCLUSION Virtual ablation of DF, which may indicate AF driver, was more likely to terminate or defragment AF with spatiotemporally stable DF, but not likely to do so in long-lasting and sustained AF conditions, depending on CV.
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Affiliation(s)
- Byounghyun Lim
- Yonsei University Health System, Seoul, Republic of Korea
| | - Minki Hwang
- Yonsei University Health System, Seoul, Republic of Korea
| | - Jun-Seop Song
- Yonsei University Health System, Seoul, Republic of Korea
| | - Ah-Jin Ryu
- Department of Mechanical and Biomedical Engineering, Kangwon National University, Chuncheon, Ganwon-do, Republic of Korea
| | - Boyoung Joung
- Yonsei University Health System, Seoul, Republic of Korea
| | - Eun Bo Shim
- Department of Mechanical and Biomedical Engineering, Kangwon National University, Chuncheon, Ganwon-do, Republic of Korea
| | - Hyungon Ryu
- NVIDIA, Yonsei University, Department of Mathematics, Seoul, Republic of Korea
| | - Hui-Nam Pak
- Yonsei University Health System, Seoul, Republic of Korea
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Shim J, Hwang M, Song JS, Lim B, Kim TH, Joung B, Kim SH, Oh YS, Nam GB, On YK, Oh S, Kim YH, Pak HN. Virtual In-Silico Modeling Guided Catheter Ablation Predicts Effective Linear Ablation Lesion Set for Longstanding Persistent Atrial Fibrillation: Multicenter Prospective Randomized Study. Front Physiol 2017; 8:792. [PMID: 29075201 PMCID: PMC5641589 DOI: 10.3389/fphys.2017.00792] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2017] [Accepted: 09/27/2017] [Indexed: 11/13/2022] Open
Abstract
Objective: Radiofrequency catheter ablation for persistent atrial fibrillation (PeAF) still has a substantial recurrence rate. This study aims to investigate whether an AF ablation lesion set chosen using in-silico ablation (V-ABL) is clinically feasible and more effective than an empirically chosen ablation lesion set (Em-ABL) in patients with PeAF. Methods: We prospectively included 108 patients with antiarrhythmic drug-resistant PeAF (77.8% men, age 60.8 ± 9.9 years), and randomly assigned them to the V-ABL (n = 53) and Em-ABL (n = 55) groups. Five different in-silico ablation lesion sets [1 pulmonary vein isolation (PVI), 3 linear ablations, and 1 electrogram-guided ablation] were compared using heart-CT integrated AF modeling. We evaluated the feasibility, safety, and efficacy of V-ABL compared with that of Em-ABL. Results: The pre-procedural computing time for five different ablation strategies was 166 ± 11 min. In the Em-ABL group, the earliest terminating blinded in-silico lesion set matched with the Em-ABL lesion set in 21.8%. V-ABL was not inferior to Em-ABL in terms of procedure time (p = 0.403), ablation time (p = 0.510), and major complication rate (p = 0.900). During 12.6 ± 3.8 months of follow-up, the clinical recurrence rate was 14.0% in the V-ABL group and 18.9% in the Em-ABL group (p = 0.538). In Em-ABL group, clinical recurrence rate was significantly lower after PVI+posterior box+anterior linear ablation, which showed the most frequent termination during in-silico ablation (log-rank p = 0.027). Conclusions: V-ABL was feasible in clinical practice, not inferior to Em-ABL, and predicts the most effective ablation lesion set in patients who underwent PeAF ablation.
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Affiliation(s)
- Jaemin Shim
- Cardiovascular Center, Korea University, Seoul, South Korea
| | - Minki Hwang
- Division of Cardiology, Yonsei University Health System, Seoul, South Korea
| | - Jun-Seop Song
- Division of Cardiology, Yonsei University Health System, Seoul, South Korea
| | - Byounghyun Lim
- Division of Cardiology, Yonsei University Health System, Seoul, South Korea
| | - Tae-Hoon Kim
- Division of Cardiology, Yonsei University Health System, Seoul, South Korea
| | - Boyoung Joung
- Division of Cardiology, Yonsei University Health System, Seoul, South Korea
| | - Sung-Hwan Kim
- Division of Cardiology, Catholic University of Korea, Seoul, South Korea
| | - Yong-Seog Oh
- Division of Cardiology, Catholic University of Korea, Seoul, South Korea
| | - Gi-Byung Nam
- Asan Medical Center, University of Ulsan, Seoul, South Korea
| | - Young Keun On
- Samsung Medical Center, Sungkyunkwan University, Seoul, South Korea
| | - Seil Oh
- Division of Cardiology, Seoul National University, Seoul, South Korea
| | - Young-Hoon Kim
- Cardiovascular Center, Korea University, Seoul, South Korea
| | - Hui-Nam Pak
- Division of Cardiology, Yonsei University Health System, Seoul, South Korea
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Song JS, Wi J, Lee HJ, Hwang M, Lim B, Kim TH, Uhm J, Joung B, Lee M, Seo JW, Pak HN. Role of atrial wall thickness in wave-dynamics of atrial fibrillation. PLoS One 2017; 12:e0182174. [PMID: 28827810 PMCID: PMC5565105 DOI: 10.1371/journal.pone.0182174] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2017] [Accepted: 07/13/2017] [Indexed: 01/13/2023] Open
Abstract
Background/Aims Atrial anatomy and thickness may affect the electrical wave-dynamics of atrial fibrillation (AF). We explored the relationship between left atrial (LA) wall thickness (LAWT) or LA geometry and AF wave-dynamics. Methods We included 15 patients with persistent AF (age, 62.3 ± 11.9 years) who underwent AF catheter ablation. We measured the LAWT, LA endocardial curvature, and SD-curvature (surface bumpiness) from preprocedural computed tomography images. We compared those anatomical characteristics with electrophysiologic parameters such as dominant frequency (DF), Shannon entropy (ShEn), or complex fractionated atrial electrogram (CFAE)-cycle length (CL), calculated from intracardiac bipolar electrograms (300–500 points, 5 s), acquired during ablation procedures. Results 1. LAWT (excluding fat) varied widely among patients, locations, and types of AF. LAWT was inversely correlated with LA volume (r = -0.565, p = 0.028) and positively correlated with SD-curvature (r = 0.272, p < 0.001). 2. LAWT was positively correlated with ShEn (r = 0.233, p < 0.001) and negatively correlated with CFAE-CL (r = -0.107, p = 0.038). 3. In the multivariate linear regression analyses for AF wave-dynamics parameters, DF (β = -0.29 [95% CI -0.44–-0.14], p < 0.001), ShEn (β = 0.19 [95% CI 0.12–0.25], p < 0.001), and CFAE-CL (β = 7.49 [95% CI 0.65–14.34], p = 0.032) were independently associated with LAWT. Conclusion Regional LAWT is associated with LA structural features, and has significant correlations with the wave-dynamics parameters associated with electrical wavebreaks or rotors in patients with persistent AF.
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Affiliation(s)
- Jun-Seop Song
- Yonsei University Health System, Seoul, Republic of Korea
| | - Jin Wi
- Yonsei University Health System, Seoul, Republic of Korea
| | - Hye-Jeong Lee
- Yonsei University Health System, Seoul, Republic of Korea
| | - Minki Hwang
- Yonsei University Health System, Seoul, Republic of Korea
| | - Byounghyun Lim
- Yonsei University Health System, Seoul, Republic of Korea
| | - Tae-Hoon Kim
- Yonsei University Health System, Seoul, Republic of Korea
| | - Jae‐Sun Uhm
- Yonsei University Health System, Seoul, Republic of Korea
| | - Boyoung Joung
- Yonsei University Health System, Seoul, Republic of Korea
| | | | - Jeong-Wook Seo
- Department of Pathology, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Hui-Nam Pak
- Yonsei University Health System, Seoul, Republic of Korea
- * E-mail:
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