Abstract 11299: Ablation of Persistent Atrial Fibrillation Abolishes Fibrotic Substrate for Rotors Perpetuation but Creates Substrate for Macro-Reentrant Flutter: Insights from Patient-Specific Computational Modeling
| Autor: | Savannah Bifulco, Fima Macheret, Griffin Scott, Nazem W Akoum, Patrick M Boyle |
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| Rok vydání: | 2021 |
| Předmět: | |
| Zdroj: | Circulation. 144 |
| ISSN: | 1524-4539 0009-7322 |
| DOI: | 10.1161/circ.144.suppl_1.11299 |
| Popis: | Introduction: Arrhythmia recurrence after ablation in persistent AF (PsAF) is common, often presenting as atrial flutter (AFL). Fibrotic remodeling is known to exacerbate arrhythmic activity in PsAF and can play a key role in sustaining rotors, but the synergy between non-conductive ablation-induced scar and native fibrosis is poorly understood. Hypothesis: We used computational simulations in left atrial models reconstructed from late gadolinium enhanced (LGE)-MRI to test the hypothesis that ablation in PsAF abolishes fibrotic substrate for rotor perpetuation, but also creates new substrate conducive to macro-reentrant AFL (MRs). Methods: LGE-MRI was performed on 24 PsAF patients pre- and 3-6 months post-ablation. Post-ablation scar was mapped into pre-ablation models (Fig A). A standardized approach was used to test inducibility. Arrhythmia episodes were classified as MR (i.e., conduction around vein, lesion, or mitral valve) or rotor-driven (i.e., rotational sources localized to compact areas of fibrotic substrate). Summary data are presented as median[IQR]. Results: For many 13/24 pre-ablation models in which induced arrhythmias were predominantly rotor-driven, activity in the corresponding post-ablation models was primarily sustained by MR (Fig B; left and right panels, respectively). There were significantly more unique rotor sites in pre- vs. post-ablation models (Fig C, P Conclusions: In this modeling study, pre-ablation arrhythmias sustained by native fibrosis alone were more likely to be rotor-driven. In contrast, MRs were more common in models incorporating both scar from ablation and residual fibrosis. This suggests PsAF ablation may transform substrate that favors rotor perpetuation into one that is more conducive to AFL. Comparing these findings to recurrence outcomes is a crucial next step. |
| Databáze: | OpenAIRE |
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