Personalized Evaluation of Atrial Complexity of Patients Undergoing Atrial Fibrillation Ablation: A Clinical Computational Study.

Autor:	Sánchez de la Nava AM; Department of Cardiology, Instituto de Investigación Sanitaria Gregorio Marañón (IISGM), Hospital General Universitario Gregorio Marañón, 28009 Madrid, Spain.; CIBERCV, Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares, 28029 Madrid, Spain.; ITACA Institute, Universitat Politécnica de València, 46022 València, Spain., González Mansilla A; Department of Cardiology, Instituto de Investigación Sanitaria Gregorio Marañón (IISGM), Hospital General Universitario Gregorio Marañón, 28009 Madrid, Spain.; CIBERCV, Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares, 28029 Madrid, Spain., González-Torrecilla E; Department of Cardiology, Instituto de Investigación Sanitaria Gregorio Marañón (IISGM), Hospital General Universitario Gregorio Marañón, 28009 Madrid, Spain.; CIBERCV, Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares, 28029 Madrid, Spain.; Facultad de Medicina, Universidad Complutense de Madrid, 28040 Madrid, Spain., Ávila P; Department of Cardiology, Instituto de Investigación Sanitaria Gregorio Marañón (IISGM), Hospital General Universitario Gregorio Marañón, 28009 Madrid, Spain.; CIBERCV, Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares, 28029 Madrid, Spain., Datino T; Department of Cardiology, Instituto de Investigación Sanitaria Gregorio Marañón (IISGM), Hospital General Universitario Gregorio Marañón, 28009 Madrid, Spain.; CIBERCV, Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares, 28029 Madrid, Spain., Bermejo J; Department of Cardiology, Instituto de Investigación Sanitaria Gregorio Marañón (IISGM), Hospital General Universitario Gregorio Marañón, 28009 Madrid, Spain.; CIBERCV, Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares, 28029 Madrid, Spain.; Facultad de Medicina, Universidad Complutense de Madrid, 28040 Madrid, Spain., Arenal Á; Department of Cardiology, Instituto de Investigación Sanitaria Gregorio Marañón (IISGM), Hospital General Universitario Gregorio Marañón, 28009 Madrid, Spain.; CIBERCV, Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares, 28029 Madrid, Spain., Fernández-Avilés F; Department of Cardiology, Instituto de Investigación Sanitaria Gregorio Marañón (IISGM), Hospital General Universitario Gregorio Marañón, 28009 Madrid, Spain.; CIBERCV, Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares, 28029 Madrid, Spain.; Facultad de Medicina, Universidad Complutense de Madrid, 28040 Madrid, Spain., Atienza F; Department of Cardiology, Instituto de Investigación Sanitaria Gregorio Marañón (IISGM), Hospital General Universitario Gregorio Marañón, 28009 Madrid, Spain.; CIBERCV, Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares, 28029 Madrid, Spain.; Facultad de Medicina, Universidad Complutense de Madrid, 28040 Madrid, Spain.
Jazyk:	angličtina
Zdroj:	Biology [Biology (Basel)] 2021 Aug 28; Vol. 10 (9). Date of Electronic Publication: 2021 Aug 28.
DOI:	10.3390/biology10090838
Abstrakt:	Current clinical guidelines establish Pulmonary Vein (PV) isolation as the indicated treatment for Atrial Fibrillation (AF). However, AF can also be triggered or sustained due to atrial drivers located elsewhere in the atria. We designed a new simulation workflow based on personalized computer simulations to characterize AF complexity of patients undergoing PV ablation, validated with non-invasive electrocardiographic imaging and evaluated at one year after ablation. We included 30 patients using atrial anatomies segmented from MRI and simulated an automata model for the electrical modelling, consisting of three states (resting, excited and refractory). In total, 100 different scenarios were simulated per anatomy varying rotor number and location. The 3 states were calibrated with Koivumaki action potential, entropy maps were obtained from the electrograms and compared with ECGi for each patient to analyze PV isolation outcome. The completion of the workflow indicated that successful AF ablation occurred in patients with rotors mainly located at the PV antrum, while unsuccessful procedures presented greater number of driving sites outside the PV area. The number of rotors attached to the PV was significantly higher in patients with favorable long-term ablation outcome (1-year freedom from AF: 1.61 ± 0.21 vs. AF recurrence: 1.40 ± 0.20; p -value = 0.018). The presented workflow could improve patient stratification for PV ablation by screening the complexity of the atria.
Databáze:	MEDLINE
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