Human Atrial Fibrillation Drivers Resolved With Integrated Functional and Structural Imaging to Benefit Clinical Mapping
| Autor: | Jichao Zhao, Peter J. Mohler, Anna Bratasz, Josh Atwal, Paul M.L. Janssen, Yufeng Wang, Ning Li, Vadim V. Fedorov, John D. Hummel, Katelynn M. Helfrich, Bryan A. Whitson, Orlando P. Simonetti, Kimerly A. Powell, Suhaib H. Abudulwahed, Anuradha Kalyanasundaram, Stanislav O. Zakharkin, Brian J. Hansen, Alexander M. Zolotarev |
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| Rok vydání: | 2018 |
| Předmět: |
medicine.medical_specialty
030204 cardiovascular system & hematology Article 03 medical and health sciences 0302 clinical medicine Internal medicine Optical mapping Atrial Fibrillation Image Interpretation Computer-Assisted Medicine Humans Heart Atria 030212 general & internal medicine business.industry Atrial fibrillation Heart Signal Processing Computer-Assisted medicine.disease Magnetic Resonance Imaging Cardiac Imaging Techniques Catheter Ablation Cardiology business Electrophysiologic Techniques Cardiac human activities Structural imaging |
| Zdroj: | JACC. Clinical electrophysiology. 4(12) |
| ISSN: | 2405-5018 |
| Popis: | BACKGROUND: Clinical multi-electrode mapping of atrial fibrillation (AF) drivers suffers from variable contact, signal processing, and structural complexity within the 3D human atrial wall, raising questions on the validity of such drivers. OBJECTIVES: To improve AF driver identification by integrating clinical multi-electrode mapping with driver fingerprints defined by high-resolution ex-vivo 3D functional and structural imaging. METHODS: Sustained AF was mapped in coronary-perfused explanted human hearts (n=11) with transmural near-infrared optical mapping (NIOM, ~0.3mm(2) resolution). Simultaneously, custom FIRMap catheters (~9×9mm(2) resolution) mapped endocardial and epicardial surfaces, which were analyzed by Focal Impulse and Rotor Mapping (FIRM) activation and Rotational Activity Profile (RAP). Functional maps were integrated with contrast-enhanced MRI (CE-MRI, ~0.1mm(3) resolution) analysis of 3D fibrosis architecture. RESULTS: During sustained AF, NIOM identified 1-2 intramural, spatially stable reentrant AF drivers per heart. Driver targeted ablation affecting 2.2±1.1% of the atrial surface terminated and prevented AF. Driver regions had significantly higher phase singularity density, and dominant frequency versus neighboring non-driver regions. FIRM had 80% sensitivity to NIOM-defined driver locations (16/20), and matched 14/20 driver visualizations: 10/14 reentries seen with RAP, and 4/6 breakthrough/focal patterns. FIRM detected 1.1±0.9 false-positive RAP per recording, but these regions had lower intramural CE-MRI fibrosis than driver regions (14.9±7.9% vs 23.2±10.5%, p |
| Databáze: | OpenAIRE |
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