Anti- and pro-fibrillatory effects of pulmonary vein isolation gaps in human atrial fibrillation digital twins
Abstract Although pulmonary vein isolation (PVI) gaps and extrapulmonary vein triggers contribute to recurrence after atrial fibrillation (AF) ablation, their precise mechanisms remain unproven. Our study assessed the impact of PVI gaps on rhythm outcomes using a human AF digital twin. We included 5...
| Main Authors: | , , , , , , , , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Nature Portfolio
2024-03-01
|
| Series: | npj Digital Medicine |
| Online Access: | https://doi.org/10.1038/s41746-024-01075-y |
| _version_ | 1797233233030545408 |
|---|---|
| author | Ze Jin Taehyun Hwang Daehoon Kim Byounghyun Lim Oh-Seok Kwon Sangbin Kim Moon-Hyun Kim Je-Wook Park Hee Tae Yu Tae-Hoon Kim Jae-Sun Uhm Boyoung Joung Moon-Hyoung Lee Hui-Nam Pak |
| author_facet | Ze Jin Taehyun Hwang Daehoon Kim Byounghyun Lim Oh-Seok Kwon Sangbin Kim Moon-Hyun Kim Je-Wook Park Hee Tae Yu Tae-Hoon Kim Jae-Sun Uhm Boyoung Joung Moon-Hyoung Lee Hui-Nam Pak |
| author_sort | Ze Jin |
| collection | DOAJ |
| description | Abstract Although pulmonary vein isolation (PVI) gaps and extrapulmonary vein triggers contribute to recurrence after atrial fibrillation (AF) ablation, their precise mechanisms remain unproven. Our study assessed the impact of PVI gaps on rhythm outcomes using a human AF digital twin. We included 50 patients (76.0% with persistent AF) who underwent catheter ablation with a realistic AF digital twin by integrating computed tomography and electroanatomical mapping. We evaluated the final rhythm status, including AF and atrial tachycardia (AT), across 600 AF episodes, considering factors including PVI level, PVI gap number, and pacing locations. Our findings revealed that antral PVI had a significantly lower ratio of AF at the final rhythm (28% vs. 56%, p = 0.002) than ostial PVI. Increasing PVI gap numbers correlated with an increased ratio of AF at the final rhythm (p < 0.001). Extra-PV induction yielded a higher ratio of AF at the final rhythm than internal PV induction (77.5% vs. 59.0%, p < 0.001). In conclusion, our human AF digital twin model helped assess AF maintenance mechanisms. Clinical trial registration: https://www.clinicaltrials.gov ; Unique identifier: NCT02138695. |
| first_indexed | 2024-04-24T16:12:54Z |
| format | Article |
| id | doaj.art-1e2de4dc806a42b39ecbee8f92304a58 |
| institution | Directory Open Access Journal |
| issn | 2398-6352 |
| language | English |
| last_indexed | 2024-04-24T16:12:54Z |
| publishDate | 2024-03-01 |
| publisher | Nature Portfolio |
| record_format | Article |
| series | npj Digital Medicine |
| spelling | doaj.art-1e2de4dc806a42b39ecbee8f92304a582024-03-31T11:36:19ZengNature Portfolionpj Digital Medicine2398-63522024-03-01711910.1038/s41746-024-01075-yAnti- and pro-fibrillatory effects of pulmonary vein isolation gaps in human atrial fibrillation digital twinsZe Jin0Taehyun Hwang1Daehoon Kim2Byounghyun Lim3Oh-Seok Kwon4Sangbin Kim5Moon-Hyun Kim6Je-Wook Park7Hee Tae Yu8Tae-Hoon Kim9Jae-Sun Uhm10Boyoung Joung11Moon-Hyoung Lee12Hui-Nam Pak13Division of Cardiology, Department of Internal Medicine, Yonsei University College of MedicineDivision of Cardiology, Department of Internal Medicine, Yonsei University College of MedicineDivision of Cardiology, Department of Internal Medicine, Yonsei University College of MedicineDivision of Cardiology, Department of Internal Medicine, Yonsei University College of MedicineDivision of Cardiology, Department of Internal Medicine, Yonsei University College of MedicineDivision of Cardiology, Department of Internal Medicine, Yonsei University College of MedicineDivision of Cardiology, Department of Internal Medicine, Yongin Severance Hospital, Yonsei University College of MedicineDivision of Cardiology, Department of Internal Medicine, Yongin Severance Hospital, Yonsei University College of MedicineDivision of Cardiology, Department of Internal Medicine, Yonsei University College of MedicineDivision of Cardiology, Department of Internal Medicine, Yonsei University College of MedicineDivision of Cardiology, Department of Internal Medicine, Yonsei University College of MedicineDivision of Cardiology, Department of Internal Medicine, Yonsei University College of MedicineDivision of Cardiology, Department of Internal Medicine, Yonsei University College of MedicineDivision of Cardiology, Department of Internal Medicine, Yonsei University College of MedicineAbstract Although pulmonary vein isolation (PVI) gaps and extrapulmonary vein triggers contribute to recurrence after atrial fibrillation (AF) ablation, their precise mechanisms remain unproven. Our study assessed the impact of PVI gaps on rhythm outcomes using a human AF digital twin. We included 50 patients (76.0% with persistent AF) who underwent catheter ablation with a realistic AF digital twin by integrating computed tomography and electroanatomical mapping. We evaluated the final rhythm status, including AF and atrial tachycardia (AT), across 600 AF episodes, considering factors including PVI level, PVI gap number, and pacing locations. Our findings revealed that antral PVI had a significantly lower ratio of AF at the final rhythm (28% vs. 56%, p = 0.002) than ostial PVI. Increasing PVI gap numbers correlated with an increased ratio of AF at the final rhythm (p < 0.001). Extra-PV induction yielded a higher ratio of AF at the final rhythm than internal PV induction (77.5% vs. 59.0%, p < 0.001). In conclusion, our human AF digital twin model helped assess AF maintenance mechanisms. Clinical trial registration: https://www.clinicaltrials.gov ; Unique identifier: NCT02138695.https://doi.org/10.1038/s41746-024-01075-y |
| spellingShingle | Ze Jin Taehyun Hwang Daehoon Kim Byounghyun Lim Oh-Seok Kwon Sangbin Kim Moon-Hyun Kim Je-Wook Park Hee Tae Yu Tae-Hoon Kim Jae-Sun Uhm Boyoung Joung Moon-Hyoung Lee Hui-Nam Pak Anti- and pro-fibrillatory effects of pulmonary vein isolation gaps in human atrial fibrillation digital twins npj Digital Medicine |
| title | Anti- and pro-fibrillatory effects of pulmonary vein isolation gaps in human atrial fibrillation digital twins |
| title_full | Anti- and pro-fibrillatory effects of pulmonary vein isolation gaps in human atrial fibrillation digital twins |
| title_fullStr | Anti- and pro-fibrillatory effects of pulmonary vein isolation gaps in human atrial fibrillation digital twins |
| title_full_unstemmed | Anti- and pro-fibrillatory effects of pulmonary vein isolation gaps in human atrial fibrillation digital twins |
| title_short | Anti- and pro-fibrillatory effects of pulmonary vein isolation gaps in human atrial fibrillation digital twins |
| title_sort | anti and pro fibrillatory effects of pulmonary vein isolation gaps in human atrial fibrillation digital twins |
| url | https://doi.org/10.1038/s41746-024-01075-y |
| work_keys_str_mv | AT zejin antiandprofibrillatoryeffectsofpulmonaryveinisolationgapsinhumanatrialfibrillationdigitaltwins AT taehyunhwang antiandprofibrillatoryeffectsofpulmonaryveinisolationgapsinhumanatrialfibrillationdigitaltwins AT daehoonkim antiandprofibrillatoryeffectsofpulmonaryveinisolationgapsinhumanatrialfibrillationdigitaltwins AT byounghyunlim antiandprofibrillatoryeffectsofpulmonaryveinisolationgapsinhumanatrialfibrillationdigitaltwins AT ohseokkwon antiandprofibrillatoryeffectsofpulmonaryveinisolationgapsinhumanatrialfibrillationdigitaltwins AT sangbinkim antiandprofibrillatoryeffectsofpulmonaryveinisolationgapsinhumanatrialfibrillationdigitaltwins AT moonhyunkim antiandprofibrillatoryeffectsofpulmonaryveinisolationgapsinhumanatrialfibrillationdigitaltwins AT jewookpark antiandprofibrillatoryeffectsofpulmonaryveinisolationgapsinhumanatrialfibrillationdigitaltwins AT heetaeyu antiandprofibrillatoryeffectsofpulmonaryveinisolationgapsinhumanatrialfibrillationdigitaltwins AT taehoonkim antiandprofibrillatoryeffectsofpulmonaryveinisolationgapsinhumanatrialfibrillationdigitaltwins AT jaesunuhm antiandprofibrillatoryeffectsofpulmonaryveinisolationgapsinhumanatrialfibrillationdigitaltwins AT boyoungjoung antiandprofibrillatoryeffectsofpulmonaryveinisolationgapsinhumanatrialfibrillationdigitaltwins AT moonhyounglee antiandprofibrillatoryeffectsofpulmonaryveinisolationgapsinhumanatrialfibrillationdigitaltwins AT huinampak antiandprofibrillatoryeffectsofpulmonaryveinisolationgapsinhumanatrialfibrillationdigitaltwins |