The Rotor Revolution

Zaman, Junaid A.B.; Peters, Nicholas S.

doi:10.1161/circep.114.002201

Cited by 13 publications

(8 citation statements)

References 62 publications

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“…Subsequent clinical driver ablation alone terminated 75% and 15% of PeAF and long-lasting AF, respectively [ 12 ]. However, these AF patterns obtained via the inverse solution are somewhat contradictory to the findings by Narayan et al using a direct contact mapping approach [ 11 ]. Furthermore, the computer model studies by Gonzales et al [ 51 ] and McDowell et al [ 54 ] suggest that rotors tend to be stable and are maintained by structural discontinuity, i.e.…”

Section: The Mechanisms Of Rotorscontrasting

confidence: 79%

“…Narayan et al have recently identified electrical rotors in patients with AF by using 64-channel basket catheters in both atria and demonstrated that it is possible to reverse AF in most of these patients with relatively limited ablation of atrial tissue near the rotor core in their Focal Impulse and Rotor Modulation (FIRM) trials [ 10 ]. It should be noted that their findings have been disputed by others using a variety of other approaches [ 11 , 12 , 13 , 14 , 15 ]. RFCA still requires large atrial tissue ablation near each AF driver [ 7 , 10 ].…”

Section: Introductionmentioning

confidence: 96%

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Optimization of Catheter Ablation of Atrial Fibrillation: Insights Gained from Clinically-Derived Computer Models

Zhao

Kharche

et al. 2015

IJMS

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Atrial fibrillation (AF) is the most common heart rhythm disturbance, and its treatment is an increasing economic burden on the health care system. Despite recent intense clinical, experimental and basic research activity, the treatment of AF with current antiarrhythmic drugs and catheter/surgical therapies remains limited. Radiofrequency catheter ablation (RFCA) is widely used to treat patients with AF. Current clinical ablation strategies are largely based on atrial anatomy and/or substrate detected using different approaches, and they vary from one clinical center to another. The nature of clinical ablation leads to ambiguity regarding the optimal patient personalization of the therapy partly due to the fact that each empirical configuration of ablation lines made in a patient is irreversible during one ablation procedure. To investigate optimized ablation lesion line sets, in silico experimentation is an ideal solution. 3D computer models give us a unique advantage to plan and assess the effectiveness of different ablation strategies before and during RFCA. Reliability of in silico assessment is ensured by inclusion of accurate 3D atrial geometry, realistic fiber orientation, accurate fibrosis distribution and cellular kinetics; however, most of this detailed information in the current computer models is extrapolated from animal models and not from the human heart. The predictive power of computer models will increase as they are validated with human experimental and clinical data. To make the most from a computer model, one needs to develop 3D computer models based on the same functionally and structurally mapped intact human atria with high spatial resolution. The purpose of this review paper is to summarize recent developments in clinically-derived computer models and the clinical insights they provide for catheter ablation.

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Section: The Mechanisms Of Rotorscontrasting

confidence: 79%

Section: Introductionmentioning

confidence: 96%

Optimization of Catheter Ablation of Atrial Fibrillation: Insights Gained from Clinically-Derived Computer Models

Zhao

Kharche

et al. 2015

IJMS

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“…It can provide important quantitative electrophysiological information about the underlying tissue microarchitecture and is widely used in both laboratory [1,2] and clinical electrophysiological studies [3,4] to infer properties of the myocardial substrate and to identify potential mechanisms for arrhythmogenesis [5–7] . Conduction velocity measurements provide an important quantity in identifying potential reentrant circuits and regions of tissue which, for example, might act as an anchor point for rotors [8] . Areas of tissue with slower conduction velocity are widely thought to be in a more diseased state, where either fibrosis or altered cell-to-cell coupling has reduced connectivity [9–22] , or changes in the ionic currents such as the sodium current leads to slower action potential upstroke [23] .…”

Section: Introductionmentioning

confidence: 99%

Techniques for automated local activation time annotation and conduction velocity estimation in cardiac mapping

Cantwell

Roney

et al. 2015

Computers in Biology and Medicine

166

137

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Measurements of cardiac conduction velocity provide valuable functional and structural insight into the initiation and perpetuation of cardiac arrhythmias, in both a clinical and laboratory context. The interpretation of activation wavefronts and their propagation can identify mechanistic properties of a broad range of electrophysiological pathologies. However, the sparsity, distribution and uncertainty of recorded data make accurate conduction velocity calculation difficult. A wide range of mathematical approaches have been proposed for addressing this challenge, often targeted towards specific data modalities, species or recording environments. Many of these algorithms require identification of activation times from electrogram recordings which themselves may have complex morphology or low signal-to-noise ratio. This paper surveys algorithms designed for identifying local activation times and computing conduction direction and speed. Their suitability for use in different recording contexts and applications is assessed.

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“…Narayan et al demonstrated an improved ablation success rate of atrial fibrillation up to 82% [11], fostering intense discussions [28], and reports about case series [29]. These success rates could not be reproduced by all other groups [30, 31].…”

Section: Discussionmentioning

confidence: 99%

Basket-Type Catheters: Diagnostic Pitfalls Caused by Deformation and Limited Coverage

Oesterlein

Frisch

Loewe

et al. 2016

BioMed Research International

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Whole-chamber mapping using a 64-pole basket catheter (BC) has become a featured approach for the analysis of excitation patterns during atrial fibrillation. A flexible catheter design avoids perforation but may lead to spline bunching and influence coverage. We aim to quantify the catheter deformation and endocardial coverage in clinical situations and study the effect of catheter size and electrode arrangement using an in silico basket model. Atrial coverage and spline separation were evaluated quantitatively in an ensemble of clinical measurements. A computational model of the BC was implemented including an algorithm to adapt its shape to the atrial anatomy. Two clinically relevant mapping positions in each atrium were assessed in both clinical and simulated data. The simulation environment allowed varying both BC size and electrode arrangement. Results showed that interspline distances of more than 20 mm are common, leading to a coverage of less than 50% of the left atrial (LA) surface. In an ideal in silico scenario with variable catheter designs, a maximum coverage of 65% could be reached. As spline bunching and insufficient coverage can hardly be avoided, this has to be taken into account for interpretation of excitation patterns and development of new panoramic mapping techniques.

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The Rotor Revolution

Cited by 13 publications

References 62 publications

Optimization of Catheter Ablation of Atrial Fibrillation: Insights Gained from Clinically-Derived Computer Models

Optimization of Catheter Ablation of Atrial Fibrillation: Insights Gained from Clinically-Derived Computer Models

Techniques for automated local activation time annotation and conduction velocity estimation in cardiac mapping

Basket-Type Catheters: Diagnostic Pitfalls Caused by Deformation and Limited Coverage

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