Feasibility of using patient-specific models and the "minimum cut" algorithm to predict optimal ablation targets for left atrial flutter.
Feasibility of using patient-specific models and the "minimum cut" algorithm to predict optimal ablation targets for left atrial flutter.
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DOI：
10.1016/j.hrthm.2016.04.009
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发表时间：
2016-08
期刊：
影响因子：
5.5
通讯作者：
Trayanova NA
中科院分区：
文献类型：
--
作者：
Zahid S;Whyte KN;Schwarz EL;Blake RC 3rd;Boyle PM;Chrispin J;Prakosa A;Ipek EG;Pashakhanloo F;Halperin HR;Calkins H;Berger RD;Nazarian S;Trayanova NA
左心房扑动（LAFL）发生在心房颤动消融后的患者。确定终止LAFL的最佳消融目标仍然具有挑战性。本研究的目的是使用基于血流网络理论的新方法，使用患者特异性模型来模拟LAFL并预测最佳消融目标。10名LAFL患者的晚期钆增强心脏磁共振扫描被盲法研究人员用于构建合并纤维化的心房模型。采用芯片快速起搏诱导LAFL。在每个LAFL中，我们将可重入波传播表示为一个电流网络，并确定了“最小切割”（MC），这是将电流分成2个不连续组分的最小组织。在MCs中应用硅消融，并将目标与导管消融期间终止LAFL的目标进行比较。通过患者扫描成功生成了患者特异性心房模型。10只模型中有7只产生LAFL。MCs消融在4个模型中终止了LAFL，在另外3个模型中产生了新的、较慢的LAFL形态。对于后一种情况，重复流动分析以确定紧急lafl的MCs。消融这些MCs可终止发生的lafl。模拟中基于mc的消融病灶在长度和位置上与这7例患者在导管消融期间终止LAFL的消融靶点相似。个性化心房模拟可以预测LAFL的消融目标。这些模拟为规划消融手术提供了有力的工具，可以减少手术时间和并发症。
Left atrial flutter (LAFL) occurs in patients after atrial fibrillation ablation. Identification of optimal ablation targets to terminate LAFL remains challenging. The purpose of this study was to use patient-specific models to simulate LAFL and predict optimal ablation targets using a novel approach based on flow network theory. Late gadolinium-enhanced cardiac magnetic resonance scans from 10 patients with LAFL were used to construct atrial models incorporating fibrosis by investigators blinded to procedural findings. Rapid pacing was applied in silico to induce LAFL. In each LAFL, we represented reentrant wave propagation as an electric flow network and identified the “minimum cut” (MC), which was the smallest amount of tissue that separated the flow into 2 discontinuous components. In silico ablation was applied at MCs, and targets were compared to those that terminated LAFL during catheter ablation. Patient-specific atrial models were successfully generated from patient scans. LAFL was induced in 7 of 10 models. Ablation of MCs terminated LAFL in 4 models and produced new, slower LAFL morphologies in the other 3. For the latter cases, flow analysis was repeated to identify MCs of emergent LAFLs. Ablation of these MCs terminated emergent LAFLs. The MC-based ablation lesions in simulations were similar in length and location to ablation targets that terminated LAFL during catheter ablation for these 7 patients. Personalized atrial simulations can predict ablation targets for LAFL. These simulations provide a powerful tool for planning ablation procedures and may reduce procedural times and complications.
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影响因子：
8.4
作者：
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影响因子：
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作者：
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DOI：
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发表时间：
2004-09-01
影响因子：
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作者：
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通讯作者：
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