Unmasking Arrhythmogenic Hubs of Reentry Driving Persistent Atrial Fibrillation for Patient‐Specific Treatment
| Autor: | Ning Li, Alexander Iancau, Muhammad R. Afzal, Roshan Sharma, Mustafa M. Houmsse, Nahush A. Mokadam, John D. Hummel, Brian J. Hansen, Bryan A. Whitson, Anuradha Kalyanasundaram, Alexander M. Zolotarev, Vadim V. Fedorov, Katelynn M. Helfrich, Paul M.L. Janssen, Omar Kahaly, Megan Subr, Nicholas Salgia, Esthela J. Artiga, Stanislav O. Zakharkin, Jichao Zhao, Nawshin Dastagir, Peter J. Mohler, Orlando P. Simonetti |
|---|---|
| Jazyk: | angličtina |
| Rok vydání: | 2020 |
| Předmět: |
Adult
Male medicine.medical_specialty Adenosine Translational Studies Refractory period medicine.medical_treatment Magnetic Resonance Imaging (MRI) Imaging Three-Dimensional Internal medicine Optical mapping Atrial Fibrillation medicine magnetic resonance imaging Humans Arrhythmia and Electrophysiology near‐infrared optical mapping Heart Atria Original Research multielectrode mapping business.industry Myocardium fibrosis Atrial fibrillation Heart Reentry Patient specific Middle Aged Ablation medicine.disease Voltage-Sensitive Dye Imaging Cardiology cardiovascular system Female Cardiology and Cardiovascular Medicine business Microelectrodes Ex vivo medicine.drug |
| Zdroj: | Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease |
| ISSN: | 2047-9980 |
| Popis: | Background Atrial fibrillation (AF) driver mechanisms are obscured to clinical multielectrode mapping approaches that provide partial, surface‐only visualization of unstable 3‐dimensional atrial conduction. We hypothesized that transient modulation of refractoriness by pharmacologic challenge during multielectrode mapping improves visualization of hidden paths of reentrant AF drivers for targeted ablation. Methods and Results Pharmacologic challenge with adenosine was tested in ex vivo human hearts with a history of AF and cardiac diseases by multielectrode and high‐resolution subsurface near‐infrared optical mapping, integrated with 3‐dimensional structural imaging and heart‐specific computational simulations. Adenosine challenge was also studied on acutely terminated AF drivers in 10 patients with persistent AF. Ex vivo, adenosine stabilized reentrant driver paths within arrhythmogenic fibrotic hubs and improved visualization of reentrant paths, previously seen as focal or unstable breakthrough activation pattern, for targeted AF ablation. Computational simulations suggested that shortening of atrial refractoriness by adenosine may (1) improve driver stability by annihilating spatially unstable functional blocks and tightening reentrant circuits around fibrotic substrates, thus unmasking the common reentrant path; and (2) destabilize already stable reentrant drivers along fibrotic substrates by accelerating competing fibrillatory wavelets or secondary drivers. In patients with persistent AF, adenosine challenge unmasked hidden common reentry paths (9/15 AF drivers, 41±26% to 68±25% visualization), but worsened visualization of previously visible reentry paths (6/15, 74±14% to 34±12%). AF driver ablation led to acute termination of AF. Conclusions Our ex vivo to in vivo human translational study suggests that transiently altering atrial refractoriness can stabilize reentrant paths and unmask arrhythmogenic hubs to guide targeted AF driver ablation treatment. |
| Databáze: | OpenAIRE |
| Externí odkaz: |
|
Plný text