Lessons from computer simulations of ablation of atrial fibrillation

Abstract

This paper reviews the simulations of catheter ablation in computer models of the atria, from the first attempts to the most recent anatomical models. It describes how postulated substrates of atrial fibrillation can be incorporated into mathematical models, how modelling studies can be designed to test ablation strategies, what their current trade-offs and limitations are, and what clinically relevant lessons can be learnt from these simulations. Drawing a parallel between clinical and modelling studies, six ablation targets are considered: pulmonary vein isolation, linear ablation, ectopic foci, complex fractionated atrial electrogram, rotors and ganglionated plexi. The examples presented for each ablation target illustrate a major advantage of computer models, the ability to identify why a therapy is successful or not in a given atrial fibrillation substrate. The integration of pathophysiological data to create detailed models of arrhythmogenic substrates is expected to solidify the understanding of ablation mechanisms and to provide theoretical arguments supporting substrate-specific ablation strategies.

Three‐dimensional Integrated Functional, Structural, and Computational Mapping to Define the Structural “Fingerprints” of Heart‐Specific Atrial Fibrillation Drivers in Human Heart Ex Vivo

“…Importantly, ablation lesion sets are not reversible, so the success of different procedures can never be compared for the same patient 13, 45. The computer modeling approach is currently the only way to compare a variety of ablation strategies on the same heart and can be used for ablation planning and guidance 14, 36.…”

Improving cardiomyocyte model fidelity and utility via dynamic electrophysiology protocols and optimization algorithms

“… in this issue of The Journal of Physiology for discussions on fibrillation mechanisms). As discussed in yet another article in this issue (Jacquemet, ), model utilizations have focused on simulating radio‐frequency ablation treatment of atrial fibrillation, with the aim of providing a basis for generation of personalized clinical ablation strategies, including decisions on whether atrial fibrillation is terminable in a given patient and where to best place minimal ablation lesions.…”

Anti-arrhythmic strategies for atrial fibrillation

“…Biophysical modeling and simulation strategies have long been used to understand electrical cardioversion and have been reviewed elsewhere (Trayanova et al 2011; Trayanova & Rantner 2014), and in more recent years used to evaluate ablative therapies (Guillem et al 2016; Jacquemet 2016). Here, we offer an overview of how computational modeling has contributed to the research pipeline and new mechanistic insight, as well as novel and improved diagnostics and therapeutics (Fig.…”

“…A comprehensive review of simulations of catheter ablation in computer models of the atria has recently been described elsewhere (Jacquemet 2016). Jacquemet notes that detailed biophysical models can form a platform for integration of pathophysiological data, which can then be used to coalesce understanding of mechanisms and provide theoretical basis for substrate-specific ablation strategies.…”