A novel sequential endocardial mapping strategy for locating atrial fibrillation sources based on repetitive conduction patterns: An in-silico study
Background: In persistent atrial fibrillation (AF), localized extra-pulmonary vein sources may contribute to arrhythmia recurrences after pulmonary vein isolation. This in-silico study proposes a high-density sequential mapping strategy to localize such sources. Method: Catheter repositioning was gu...
| Main Authors: | , , , , , , , |
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| Format: | Article |
| Language: | English |
| Published: |
Elsevier
2024-03-01
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| Series: | Journal of Molecular and Cellular Cardiology Plus |
| Subjects: | |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S2772976124000059 |
| _version_ | 1797258636200771584 |
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| author | Victor Gonçalves Marques Ali Gharaviri Ozan Özgül Simone Pezzuto Angelo Auricchio Pietro Bonizzi Stef Zeemering Ulrich Schotten |
| author_facet | Victor Gonçalves Marques Ali Gharaviri Ozan Özgül Simone Pezzuto Angelo Auricchio Pietro Bonizzi Stef Zeemering Ulrich Schotten |
| author_sort | Victor Gonçalves Marques |
| collection | DOAJ |
| description | Background: In persistent atrial fibrillation (AF), localized extra-pulmonary vein sources may contribute to arrhythmia recurrences after pulmonary vein isolation. This in-silico study proposes a high-density sequential mapping strategy to localize such sources. Method: Catheter repositioning was guided by repetitive conduction patterns, moving against the prevailing conduction direction (upstream) toward the sources. Sources were found either by locally identifying conduction patterns or by encircling the region harboring them. We simulated source tracking in an in-silico atrial model, comparing random vs. upstream-guided catheter repositioning (with and without encircling). To assess performance in increasing AF complexities, we simulated AF in 3 groups: atria with reentry-anchoring scars, without fibrosis, and with severe endomysial fibrosis. Results: Compared to random mapping, the upstream-guided approach successfully located sources more often (anchored reentries: 70.6% vs. 10.6%; no fibrosis: 87.9% vs. 22.1%; with fibrosis: 95.0% vs. 60.9% of tracking procedures, all p<0.001), using fewer steps (median [IQR]: 11 [7;23] vs. 26 [13;35]; 10 [6;19] vs. 19 [10;27]; 11 [7;19] vs. 16 [8;30], respectively, all p<0.05). Adding source encircling increased source detection (98.1 %, 100 %, and 99.5 %, all p<0.01 vs. local detection only), reducing required steps (9 [6;12], 8 [6;12], and 9 [6;13], all p<0.05). In some cases (11.9 %, 17.1 %, and 10.5 % of procedures), the algorithm encircled regions >15 mm from the source. Conclusion: Moving mapping catheters upstream improves source detection efficiency, even in the presence of severe fibrosis. Encircling sources may help find regions of interest in fewer steps. |
| first_indexed | 2024-03-07T21:27:28Z |
| format | Article |
| id | doaj.art-13659c9572664f37b86dba1cf735235b |
| institution | Directory Open Access Journal |
| issn | 2772-9761 |
| language | English |
| last_indexed | 2024-04-24T22:56:41Z |
| publishDate | 2024-03-01 |
| publisher | Elsevier |
| record_format | Article |
| series | Journal of Molecular and Cellular Cardiology Plus |
| spelling | doaj.art-13659c9572664f37b86dba1cf735235b2024-03-18T04:34:56ZengElsevierJournal of Molecular and Cellular Cardiology Plus2772-97612024-03-017100065A novel sequential endocardial mapping strategy for locating atrial fibrillation sources based on repetitive conduction patterns: An in-silico studyVictor Gonçalves Marques0Ali Gharaviri1Ozan Özgül2Simone Pezzuto3Angelo Auricchio4Pietro Bonizzi5Stef Zeemering6Ulrich Schotten7Department of Physiology, Maastricht University, Universiteitssingel 50, Maastricht 6229ER, Netherlands; Corresponding author.Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, United KingdomDepartment of Physiology, Maastricht University, Universiteitssingel 50, Maastricht 6229ER, NetherlandsDepartment of Mathematics, Università di Trento, Trento, ItalyEuler Institute, Center for Computational Medicine in Cardiology, Universita della Svizzera Italiana, Lugano, SwitzerlandDepartment of Advanced Computing Sciences, Maastricht University, Maastricht, NetherlandsDepartment of Physiology, Maastricht University, Universiteitssingel 50, Maastricht 6229ER, NetherlandsDepartment of Physiology, Maastricht University, Universiteitssingel 50, Maastricht 6229ER, NetherlandsBackground: In persistent atrial fibrillation (AF), localized extra-pulmonary vein sources may contribute to arrhythmia recurrences after pulmonary vein isolation. This in-silico study proposes a high-density sequential mapping strategy to localize such sources. Method: Catheter repositioning was guided by repetitive conduction patterns, moving against the prevailing conduction direction (upstream) toward the sources. Sources were found either by locally identifying conduction patterns or by encircling the region harboring them. We simulated source tracking in an in-silico atrial model, comparing random vs. upstream-guided catheter repositioning (with and without encircling). To assess performance in increasing AF complexities, we simulated AF in 3 groups: atria with reentry-anchoring scars, without fibrosis, and with severe endomysial fibrosis. Results: Compared to random mapping, the upstream-guided approach successfully located sources more often (anchored reentries: 70.6% vs. 10.6%; no fibrosis: 87.9% vs. 22.1%; with fibrosis: 95.0% vs. 60.9% of tracking procedures, all p<0.001), using fewer steps (median [IQR]: 11 [7;23] vs. 26 [13;35]; 10 [6;19] vs. 19 [10;27]; 11 [7;19] vs. 16 [8;30], respectively, all p<0.05). Adding source encircling increased source detection (98.1 %, 100 %, and 99.5 %, all p<0.01 vs. local detection only), reducing required steps (9 [6;12], 8 [6;12], and 9 [6;13], all p<0.05). In some cases (11.9 %, 17.1 %, and 10.5 % of procedures), the algorithm encircled regions >15 mm from the source. Conclusion: Moving mapping catheters upstream improves source detection efficiency, even in the presence of severe fibrosis. Encircling sources may help find regions of interest in fewer steps.http://www.sciencedirect.com/science/article/pii/S2772976124000059Atrial fibrillationSequential mappingAtrial fibrillation sourcesFibrosisRepetitive conduction patternsComputer models |
| spellingShingle | Victor Gonçalves Marques Ali Gharaviri Ozan Özgül Simone Pezzuto Angelo Auricchio Pietro Bonizzi Stef Zeemering Ulrich Schotten A novel sequential endocardial mapping strategy for locating atrial fibrillation sources based on repetitive conduction patterns: An in-silico study Journal of Molecular and Cellular Cardiology Plus Atrial fibrillation Sequential mapping Atrial fibrillation sources Fibrosis Repetitive conduction patterns Computer models |
| title | A novel sequential endocardial mapping strategy for locating atrial fibrillation sources based on repetitive conduction patterns: An in-silico study |
| title_full | A novel sequential endocardial mapping strategy for locating atrial fibrillation sources based on repetitive conduction patterns: An in-silico study |
| title_fullStr | A novel sequential endocardial mapping strategy for locating atrial fibrillation sources based on repetitive conduction patterns: An in-silico study |
| title_full_unstemmed | A novel sequential endocardial mapping strategy for locating atrial fibrillation sources based on repetitive conduction patterns: An in-silico study |
| title_short | A novel sequential endocardial mapping strategy for locating atrial fibrillation sources based on repetitive conduction patterns: An in-silico study |
| title_sort | novel sequential endocardial mapping strategy for locating atrial fibrillation sources based on repetitive conduction patterns an in silico study |
| topic | Atrial fibrillation Sequential mapping Atrial fibrillation sources Fibrosis Repetitive conduction patterns Computer models |
| url | http://www.sciencedirect.com/science/article/pii/S2772976124000059 |
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