Characterizing Conduction Channels in Postinfarction Patients Using a Personalized Virtual Heart
Characterizing Conduction Channels in Postinfarction Patients Using a Personalized Virtual Heart
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DOI：
10.1016/j.bpj.2019.07.024
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发表时间：
2019-12-17
影响因子：
3.4
通讯作者：
Trayanova, Natalia A.
中科院分区：
文献类型：
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作者：
Deng, Dongdong;Prakosa, Adityo;Trayanova, Natalia A.
心肌梗死患者有丰富的传导通道（CC）；然而，这些cc中只有一小部分维持室性心动过速（VT）。在临床中识别这些关键的cc (CCCs)，以便通过消融来靶向它们仍然是一个重大的挑战。本研究的目的是使用个性化的虚拟心脏方法对这些患者中维持不同形态室速的CCCs进行三维（3D）评估，研究其三维结构特征，并确定每个室速的最佳消融策略。为了实现这些目标，通过对6例梗死后患者的增强磁共振成像构建心室模型。各模型均有快速起搏诱导的VTs。鉴定出维持不同VT形态的CCCs。检测了CCCs的三维结构和类型以及由此产生的旋转电活动。在每个CCC的最佳部位进行消融，旨在以最小的病变大小终止每个VT。预测消融位置与临床比较。分析模拟结果，我们发现每个患者模型中观察到的VTs由有限数量的CCCs（2.7 +/- 1.2）维持。此外，我们确定了三种类型的CCCs维持vt: i型和t型通道，所有通道分支都以疤痕为界，以及功能性再入通道，全部或部分由传导阻滞表面为界。不同类型的CCCs分别占所有CCCs的43.8%、18.8%和37.4%。CCCs或CCCs分支的平均最窄宽度为9.7±3.6 mm。消融每个CCC的最窄部分足以终止室速。我们的结果表明，个性化的虚拟心脏方法可以确定每个患者可能的室速形态，并确定维持再入的CCCs。该方法可以帮助临床医生准确地确定梗死后患者的最佳VT消融目标。
Patients with myocardial infarction have an abundance of conduction channels (CC); however, only a small subset of these CCs sustain ventricular tachycardia (VT). Identifying these critical CCs (CCCs) in the clinic so that they can be targeted by ablation remains a significant challenge. The objective of this study is to use a personalized virtual-heart approach to conduct a three-dimensional (3D) assessment of CCCs sustaining VTs of different morphologies in these patients, to investigate their 3D structural features, and to determine the optimal ablation strategy for each VT. To achieve these goals, ventricular models were constructed from contrast enhanced magnetic resonance imagings of six postinfarction patients. Rapid pacing induced VTs in each model. CCCs that sustained different VT morphologies were identified. CCCs' 3D structure and type and the resulting rotational electrical activity were examined. Ablation was performed at the optimal part of each CCC, aiming to terminate each VT with a minimal lesion size. Predicted ablation locations were compared to clinical. Analyzing the simulation results, we found that the observed VTs in each patient model were sustained by a limited number (2.7 +/- 1.2) of CCCs. Further, we identified three types of CCCs sustaining VTs: I-type and T-type channels, with all channel branches bounded by scar, and functional reentry channels, which were fully or partially bounded by conduction block surfaces. The different types of CCCs accounted for 43.8, 18.8, and 37.4% of all CCCs, respectively. The mean narrowest width of CCCs or a branch of CCC was 9.7 +/- 3.6 mm. Ablation of the narrowest part of each CCC was sufficient to terminate VT. Our results demonstrate that a personalized virtual-heart approach can determine the possible VT morphologies in each patient and identify the CCCs that sustain reentry. The approach can aid clinicians in identifying accurately the optimal VT ablation targets in postinfarction patients.