A Computational Framework to Benchmark Basket Catheter Guided Ablation in Atrial Fibrillation
Catheter ablation is a curative therapeutic approach for atrial fibrillation (AF). Ablation of rotational sources based on basket catheter measurements has been proposed as a promising approach in patients with persistent AF to complement pulmonary vein isolation. However, clinically reported succes...
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| Format: | Article |
| Language: | English |
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Frontiers Media S.A.
2018-09-01
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| Series: | Frontiers in Physiology |
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| Online Access: | https://www.frontiersin.org/article/10.3389/fphys.2018.01251/full |
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| author | Martino Alessandrini Maddalena Valinoti Laura Unger Tobias Oesterlein Olaf Dössel Cristiana Corsi Axel Loewe Stefano Severi |
| author_facet | Martino Alessandrini Maddalena Valinoti Laura Unger Tobias Oesterlein Olaf Dössel Cristiana Corsi Axel Loewe Stefano Severi |
| author_sort | Martino Alessandrini |
| collection | DOAJ |
| description | Catheter ablation is a curative therapeutic approach for atrial fibrillation (AF). Ablation of rotational sources based on basket catheter measurements has been proposed as a promising approach in patients with persistent AF to complement pulmonary vein isolation. However, clinically reported success rates are equivocal calling for a mechanistic investigation under controlled conditions. We present a computational framework to benchmark ablation strategies considering the whole cycle from excitation propagation to electrogram acquisition and processing to virtual therapy. Fibrillation was induced in a patient-specific 3D volumetric model of the left atrium, which was homogeneously remodeled to sustain reentry. The resulting extracellular potential field was sampled using models of grid catheters as well as realistically deformed basket catheters considering the specific atrial anatomy. The virtual electrograms were processed to compute phase singularity density maps to target rotor tips with up to three circular ablations. Stable rotors were successfully induced in different regions of the homogeneously remodeled atrium showing that rotors are not constrained to unique anatomical structures or locations. Density maps of rotor tip trajectories correctly identified and located the rotors (deviation < 10 mm) based on catheter recordings only for sufficient resolution (inter-electrode distance ≤3 mm) and proximity to the wall (≤10 mm). Targeting rotor sites with ablation did not stop reentries in the homogeneously remodeled atria independent from lesion size (1–7 mm radius), from linearly connecting lesions with anatomical obstacles, and from the number of rotors targeted sequentially (≤3). Our results show that phase maps derived from intracardiac electrograms can be a powerful tool to map atrial activation patterns, yet they can also be misleading due to inaccurate localization of the rotor tip depending on electrode resolution and distance to the wall. This should be considered to avoid ablating regions that are in fact free of rotor sources of AF. In our experience, ablation of rotor sites was not successful to stop fibrillation. Our comprehensive simulation framework provides the means to holistically benchmark ablation strategies in silico under consideration of all steps involved in electrogram-based therapy and, in future, could be used to study more heterogeneously remodeled disease states as well. |
| first_indexed | 2024-12-10T09:50:04Z |
| format | Article |
| id | doaj.art-1e7874a180af410fb33909e3fb219f38 |
| institution | Directory Open Access Journal |
| issn | 1664-042X |
| language | English |
| last_indexed | 2024-12-10T09:50:04Z |
| publishDate | 2018-09-01 |
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| series | Frontiers in Physiology |
| spelling | doaj.art-1e7874a180af410fb33909e3fb219f382022-12-22T01:53:41ZengFrontiers Media S.A.Frontiers in Physiology1664-042X2018-09-01910.3389/fphys.2018.01251402791A Computational Framework to Benchmark Basket Catheter Guided Ablation in Atrial FibrillationMartino Alessandrini0Maddalena Valinoti1Laura Unger2Tobias Oesterlein3Olaf Dössel4Cristiana Corsi5Axel Loewe6Stefano Severi7Department of Electronic Engineering and Information Technology, University of Bologna, Cesena, ItalyDepartment of Electronic Engineering and Information Technology, University of Bologna, Cesena, ItalyInstitute of Biomedical Engineering, Karlsruhe Institute of Technology, Karlsruhe, GermanyInstitute of Biomedical Engineering, Karlsruhe Institute of Technology, Karlsruhe, GermanyInstitute of Biomedical Engineering, Karlsruhe Institute of Technology, Karlsruhe, GermanyDepartment of Electronic Engineering and Information Technology, University of Bologna, Cesena, ItalyInstitute of Biomedical Engineering, Karlsruhe Institute of Technology, Karlsruhe, GermanyInstitute of Biomedical Engineering, Karlsruhe Institute of Technology, Karlsruhe, GermanyCatheter ablation is a curative therapeutic approach for atrial fibrillation (AF). Ablation of rotational sources based on basket catheter measurements has been proposed as a promising approach in patients with persistent AF to complement pulmonary vein isolation. However, clinically reported success rates are equivocal calling for a mechanistic investigation under controlled conditions. We present a computational framework to benchmark ablation strategies considering the whole cycle from excitation propagation to electrogram acquisition and processing to virtual therapy. Fibrillation was induced in a patient-specific 3D volumetric model of the left atrium, which was homogeneously remodeled to sustain reentry. The resulting extracellular potential field was sampled using models of grid catheters as well as realistically deformed basket catheters considering the specific atrial anatomy. The virtual electrograms were processed to compute phase singularity density maps to target rotor tips with up to three circular ablations. Stable rotors were successfully induced in different regions of the homogeneously remodeled atrium showing that rotors are not constrained to unique anatomical structures or locations. Density maps of rotor tip trajectories correctly identified and located the rotors (deviation < 10 mm) based on catheter recordings only for sufficient resolution (inter-electrode distance ≤3 mm) and proximity to the wall (≤10 mm). Targeting rotor sites with ablation did not stop reentries in the homogeneously remodeled atria independent from lesion size (1–7 mm radius), from linearly connecting lesions with anatomical obstacles, and from the number of rotors targeted sequentially (≤3). Our results show that phase maps derived from intracardiac electrograms can be a powerful tool to map atrial activation patterns, yet they can also be misleading due to inaccurate localization of the rotor tip depending on electrode resolution and distance to the wall. This should be considered to avoid ablating regions that are in fact free of rotor sources of AF. In our experience, ablation of rotor sites was not successful to stop fibrillation. Our comprehensive simulation framework provides the means to holistically benchmark ablation strategies in silico under consideration of all steps involved in electrogram-based therapy and, in future, could be used to study more heterogeneously remodeled disease states as well.https://www.frontiersin.org/article/10.3389/fphys.2018.01251/fullatrial fibrillationablationbasket cathetercomputational modelingrotor |
| spellingShingle | Martino Alessandrini Maddalena Valinoti Laura Unger Tobias Oesterlein Olaf Dössel Cristiana Corsi Axel Loewe Stefano Severi A Computational Framework to Benchmark Basket Catheter Guided Ablation in Atrial Fibrillation Frontiers in Physiology atrial fibrillation ablation basket catheter computational modeling rotor |
| title | A Computational Framework to Benchmark Basket Catheter Guided Ablation in Atrial Fibrillation |
| title_full | A Computational Framework to Benchmark Basket Catheter Guided Ablation in Atrial Fibrillation |
| title_fullStr | A Computational Framework to Benchmark Basket Catheter Guided Ablation in Atrial Fibrillation |
| title_full_unstemmed | A Computational Framework to Benchmark Basket Catheter Guided Ablation in Atrial Fibrillation |
| title_short | A Computational Framework to Benchmark Basket Catheter Guided Ablation in Atrial Fibrillation |
| title_sort | computational framework to benchmark basket catheter guided ablation in atrial fibrillation |
| topic | atrial fibrillation ablation basket catheter computational modeling rotor |
| url | https://www.frontiersin.org/article/10.3389/fphys.2018.01251/full |
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