期刊
FRONTIERS IN PHYSIOLOGY
卷 12, 期 -, 页码 -出版社
FRONTIERS MEDIA SA
DOI: 10.3389/fphys.2021.707189
关键词
atrial fibrillation mechanisms; catheter ablation; pulmonary vein isolation; computational modelling; signal processing
类别
资金
- Medical Research Council Skills Development Fellowship [MR/S015086/1]
- UK Engineering and Physical Sciences Research Council [EP/P010741/1, EP/F043929/1, EP/P01268X/1]
- Wellcome Trust Center for Medical at King's College London
- Department of Health via the National Institute for Health Research Biomedical Research Centre award
- King's College Hospital NHS Foundation Trust
- London Medical Imaging and AI Centre for Value-Based Healthcare
- King's College London BHF centre of research excellence
- Wellcome/EPSRC Centre for Medical Engineering [WT 203148/Z/16/Z]
- St Jude Medical (Abbott)
This study identified preferential activation pathways during atrial fibrillation (AF) and demonstrated that targeting patient-specific activation pathways from the pulmonary vein antra to the left atrial body using pulmonary vein isolation (PVI) can result in successful termination of AF during the procedure.
Electrical activation during atrial fibrillation (AF) appears chaotic and disorganised, which impedes characterisation of the underlying substrate and treatment planning. While globally chaotic, there may be local preferential activation pathways that represent potential ablation targets. This study aimed to identify preferential activation pathways during AF and predict the acute ablation response when these are targeted by pulmonary vein isolation (PVI). In patients with persistent AF (n = 14), simultaneous biatrial contact mapping with basket catheters was performed pre-ablation and following each ablation strategy (PVI, roof, and mitral lines). Unipolar wavefront activation directions were averaged over 10 s to identify preferential activation pathways. Clinical cases were classified as responders or non-responders to PVI during the procedure. Clinical data were augmented with a virtual cohort of 100 models. In AF pre-ablation, pathways originated from the pulmonary vein (PV) antra in PVI responders (7/7) but not in PVI non-responders (6/6). We proposed a novel index that measured activation waves from the PV antra into the atrial body. This index was significantly higher in PVI responders than non-responders (clinical: 16.3 vs. 3.7%, p = 0.04; simulated: 21.1 vs. 14.1%, p = 0.02). Overall, this novel technique and proof of concept study demonstrated that preferential activation pathways exist during AF. Targeting patient-specific activation pathways that flowed from the PV antra to the left atrial body using PVI resulted in AF termination during the procedure. These PV activation flow pathways may correspond to the presence of drivers in the PV regions.
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