Personalized Evaluation of Atrial Complexity of Patients Undergoing Atrial Fibrillation Ablation: A Clinical Computational Study
Current clinical guidelines establish Pulmonary Vein (PV) isolation as the indicated treatment for Atrial Fibrillation (AF). However, AF can also be triggered or sustained due to atrial drivers located elsewhere in the atria. We designed a new simulation workflow based on personalized computer simul...
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| Format: | Article |
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MDPI AG
2021-08-01
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| Series: | Biology |
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| Online Access: | https://www.mdpi.com/2079-7737/10/9/838 |
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| author | Ana María Sánchez de la Nava Ana González Mansilla Esteban González-Torrecilla Pablo Ávila Tomás Datino Javier Bermejo Ángel Arenal Francisco Fernández-Avilés Felipe Atienza |
| author_facet | Ana María Sánchez de la Nava Ana González Mansilla Esteban González-Torrecilla Pablo Ávila Tomás Datino Javier Bermejo Ángel Arenal Francisco Fernández-Avilés Felipe Atienza |
| author_sort | Ana María Sánchez de la Nava |
| collection | DOAJ |
| description | Current clinical guidelines establish Pulmonary Vein (PV) isolation as the indicated treatment for Atrial Fibrillation (AF). However, AF can also be triggered or sustained due to atrial drivers located elsewhere in the atria. We designed a new simulation workflow based on personalized computer simulations to characterize AF complexity of patients undergoing PV ablation, validated with non-invasive electrocardiographic imaging and evaluated at one year after ablation. We included 30 patients using atrial anatomies segmented from MRI and simulated an automata model for the electrical modelling, consisting of three states (resting, excited and refractory). In total, 100 different scenarios were simulated per anatomy varying rotor number and location. The 3 states were calibrated with Koivumaki action potential, entropy maps were obtained from the electrograms and compared with ECGi for each patient to analyze PV isolation outcome. The completion of the workflow indicated that successful AF ablation occurred in patients with rotors mainly located at the PV antrum, while unsuccessful procedures presented greater number of driving sites outside the PV area. The number of rotors attached to the PV was significantly higher in patients with favorable long-term ablation outcome (1-year freedom from AF: 1.61 ± 0.21 vs. AF recurrence: 1.40 ± 0.20; <i>p</i>-value = 0.018). The presented workflow could improve patient stratification for PV ablation by screening the complexity of the atria. |
| first_indexed | 2024-03-10T07:53:41Z |
| format | Article |
| id | doaj.art-e3bcfd3bb1ca4fb0bcb06d9744849ec2 |
| institution | Directory Open Access Journal |
| issn | 2079-7737 |
| language | English |
| last_indexed | 2024-03-10T07:53:41Z |
| publishDate | 2021-08-01 |
| publisher | MDPI AG |
| record_format | Article |
| series | Biology |
| spelling | doaj.art-e3bcfd3bb1ca4fb0bcb06d9744849ec22023-11-22T12:05:03ZengMDPI AGBiology2079-77372021-08-0110983810.3390/biology10090838Personalized Evaluation of Atrial Complexity of Patients Undergoing Atrial Fibrillation Ablation: A Clinical Computational StudyAna María Sánchez de la Nava0Ana González Mansilla1Esteban González-Torrecilla2Pablo Ávila3Tomás Datino4Javier Bermejo5Ángel Arenal6Francisco Fernández-Avilés7Felipe Atienza8Department of Cardiology, Instituto de Investigación Sanitaria Gregorio Marañón (IISGM), Hospital General Universitario Gregorio Marañón, 28009 Madrid, SpainDepartment of Cardiology, Instituto de Investigación Sanitaria Gregorio Marañón (IISGM), Hospital General Universitario Gregorio Marañón, 28009 Madrid, SpainDepartment of Cardiology, Instituto de Investigación Sanitaria Gregorio Marañón (IISGM), Hospital General Universitario Gregorio Marañón, 28009 Madrid, SpainDepartment of Cardiology, Instituto de Investigación Sanitaria Gregorio Marañón (IISGM), Hospital General Universitario Gregorio Marañón, 28009 Madrid, SpainDepartment of Cardiology, Instituto de Investigación Sanitaria Gregorio Marañón (IISGM), Hospital General Universitario Gregorio Marañón, 28009 Madrid, SpainDepartment of Cardiology, Instituto de Investigación Sanitaria Gregorio Marañón (IISGM), Hospital General Universitario Gregorio Marañón, 28009 Madrid, SpainDepartment of Cardiology, Instituto de Investigación Sanitaria Gregorio Marañón (IISGM), Hospital General Universitario Gregorio Marañón, 28009 Madrid, SpainDepartment of Cardiology, Instituto de Investigación Sanitaria Gregorio Marañón (IISGM), Hospital General Universitario Gregorio Marañón, 28009 Madrid, SpainDepartment of Cardiology, Instituto de Investigación Sanitaria Gregorio Marañón (IISGM), Hospital General Universitario Gregorio Marañón, 28009 Madrid, SpainCurrent clinical guidelines establish Pulmonary Vein (PV) isolation as the indicated treatment for Atrial Fibrillation (AF). However, AF can also be triggered or sustained due to atrial drivers located elsewhere in the atria. We designed a new simulation workflow based on personalized computer simulations to characterize AF complexity of patients undergoing PV ablation, validated with non-invasive electrocardiographic imaging and evaluated at one year after ablation. We included 30 patients using atrial anatomies segmented from MRI and simulated an automata model for the electrical modelling, consisting of three states (resting, excited and refractory). In total, 100 different scenarios were simulated per anatomy varying rotor number and location. The 3 states were calibrated with Koivumaki action potential, entropy maps were obtained from the electrograms and compared with ECGi for each patient to analyze PV isolation outcome. The completion of the workflow indicated that successful AF ablation occurred in patients with rotors mainly located at the PV antrum, while unsuccessful procedures presented greater number of driving sites outside the PV area. The number of rotors attached to the PV was significantly higher in patients with favorable long-term ablation outcome (1-year freedom from AF: 1.61 ± 0.21 vs. AF recurrence: 1.40 ± 0.20; <i>p</i>-value = 0.018). The presented workflow could improve patient stratification for PV ablation by screening the complexity of the atria.https://www.mdpi.com/2079-7737/10/9/838atrial fibrillationcomputational modelsablationpersonalized models |
| spellingShingle | Ana María Sánchez de la Nava Ana González Mansilla Esteban González-Torrecilla Pablo Ávila Tomás Datino Javier Bermejo Ángel Arenal Francisco Fernández-Avilés Felipe Atienza Personalized Evaluation of Atrial Complexity of Patients Undergoing Atrial Fibrillation Ablation: A Clinical Computational Study Biology atrial fibrillation computational models ablation personalized models |
| title | Personalized Evaluation of Atrial Complexity of Patients Undergoing Atrial Fibrillation Ablation: A Clinical Computational Study |
| title_full | Personalized Evaluation of Atrial Complexity of Patients Undergoing Atrial Fibrillation Ablation: A Clinical Computational Study |
| title_fullStr | Personalized Evaluation of Atrial Complexity of Patients Undergoing Atrial Fibrillation Ablation: A Clinical Computational Study |
| title_full_unstemmed | Personalized Evaluation of Atrial Complexity of Patients Undergoing Atrial Fibrillation Ablation: A Clinical Computational Study |
| title_short | Personalized Evaluation of Atrial Complexity of Patients Undergoing Atrial Fibrillation Ablation: A Clinical Computational Study |
| title_sort | personalized evaluation of atrial complexity of patients undergoing atrial fibrillation ablation a clinical computational study |
| topic | atrial fibrillation computational models ablation personalized models |
| url | https://www.mdpi.com/2079-7737/10/9/838 |
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