Variability in pulmonary vein electrophysiology and fibrosis determines arrhythmia susceptibility and dynamics.
Variability in pulmonary vein electrophysiology and fibrosis determines arrhythmia susceptibility and dynamics.
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DOI：
10.1371/journal.pcbi.1006166
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发表时间：
2018-05
影响因子：
4.3
通讯作者：
Vigmond EJ
中科院分区：
文献类型：
--
作者：
Roney CH;Bayer JD;Cochet H;Meo M;Dubois R;Jaïs P;Vigmond EJ
持续性房颤患者的导管消融成功率目前较低;然而，对于一部分患者，单独电隔离肺静脉是一种成功的治疗策略。由于影响心律失常易感性和维持的因素众多，并且这些因素的个体贡献难以在临床上确定，因此难以识别这些患者。我们假设肺静脉（PV）电生理学和心房体纤维化的组合决定了肺静脉隔离（PVI）的驱动器位置和有效性。我们使用基于患者几何形状的双层双心房计算机模型来研究肺静脉特性和心房纤维化对心律失常诱导、维持机制和肺静脉隔离结局的影响。短的PV动作电位时程（APD）增加心律失常的易感性，而较长的PV APD被发现是保护性的。在左心房/肺静脉交界处传导速度（CV）减慢时，诱发性心律失常增加，但在远端肺静脉CV变化均匀或CV减慢的病例中则不然。PV纤维化病例的PV区域相位奇异性（PS）密度增加。心律失常动力学取决于肺静脉特性和纤维化分布，从弯曲转子到肺静脉折返（在基线或长APD的情况下），再到高纤维化密度区域的稳定转子。纤维化和肺静脉特性的测量可以指示患者对AF开始和维持的特定易感性。对于AF终止或转为大折返的病例，肺静脉隔离前的肺静脉PS密度较高;因此，高肺静脉PS密度可能表明肺静脉隔离成功的可能性。房颤是最常见的心律失常，影响了相当一部分人群。目前，消融术是最有效的治疗方法，但成功率低于最佳水平，治疗后一年为70%。有一个很大的努力，以找到更好的消融策略，以永久治愈的条件。通过消融进行肺静脉隔离或多或少是护理标准，但仍存在许多问题，因为肺静脉异位本身并不能解释所有的临床成功或失败。我们使用计算机模拟来研究肺静脉的电生理特性如何影响房颤患者转子的形成和维持。我们使用了复杂的，生物物理表示细胞电生理学在高度详细的几何构造从病人扫描。我们不均匀地改变电生理和结构特性，看看它们对转子启动和维护的影响。我们的研究提出了一个指标，表明肺静脉隔离成功的可能性。因此，通过临床测量或运行患者特定模拟来估计该指标可能会建议是否应在肺静脉隔离之外进行消融。我们的研究为该指标的回顾性临床研究或实验研究提供了动力。
Success rates for catheter ablation of persistent atrial fibrillation patients are currently low; however, there is a subset of patients for whom electrical isolation of the pulmonary veins alone is a successful treatment strategy. It is difficult to identify these patients because there are a multitude of factors affecting arrhythmia susceptibility and maintenance, and the individual contributions of these factors are difficult to determine clinically. We hypothesised that the combination of pulmonary vein (PV) electrophysiology and atrial body fibrosis determine driver location and effectiveness of pulmonary vein isolation (PVI). We used bilayer biatrial computer models based on patient geometries to investigate the effects of PV properties and atrial fibrosis on arrhythmia inducibility, maintenance mechanisms, and the outcome of PVI. Short PV action potential duration (APD) increased arrhythmia susceptibility, while longer PV APD was found to be protective. Arrhythmia inducibility increased with slower conduction velocity (CV) at the LA/PV junction, but not for cases with homogeneous CV changes or slower CV at the distal PV. Phase singularity (PS) density in the PV region for cases with PV fibrosis was increased. Arrhythmia dynamics depend on both PV properties and fibrosis distribution, varying from meandering rotors to PV reentry (in cases with baseline or long APD), to stable rotors at regions of high fibrosis density. Measurement of fibrosis and PV properties may indicate patient specific susceptibility to AF initiation and maintenance. PV PS density before PVI was higher for cases in which AF terminated or converted to a macroreentry; thus, high PV PS density may indicate likelihood of PVI success. Atrial fibrillation is the most commonly encountered cardiac arrhythmia, affecting a significant portion of the population. Currently, ablation is the most effective treatment but success rates are less than optimal, being 70% one-year post-treatment. There is a large effort to find better ablation strategies to permanently cure the condition. Pulmonary vein isolation by ablation is more or less the standard of care, but many questions remain since pulmonary vein ectopy by itself does not explain all of the clinical successes or failures. We used computer simulations to investigate how electrophysiological properties of the pulmonary veins can affect rotor formation and maintenance in patients suffering from atrial fibrillation. We used complex, biophysical representations of cellular electrophysiology in highly detailed geometries constructed from patient scans. We heterogeneously varied electrophysiological and structural properties to see their effects on rotor initiation and maintenance. Our study suggests a metric for indicating the likelihood of success of pulmonary vein isolation. Thus either measuring this clinically, or running patient-specific simulations to estimate this metric may suggest whether ablation in addition to pulmonary vein isolation should be performed. Our study provides motivation for a retrospective clinical study or experimental study into this metric.
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用于模拟心脏纤维化裂隙的有效有限元方法。
DOI：
10.1109/tbme.2013.2292320
发表时间：
2014-03
期刊：
IEEE transactions on bio-medical engineering
影响因子：
--
作者：
Costa CM;Campos FO;Prassl AJ;dos Santos RW;Sánchez-Quintana D;Ahammer H;Hofer E;Plank G
通讯作者：
Plank G
影响因子：
3.2
作者：
Krueger, Martin W.;Dorn, Andreas;Doessel, Olaf
通讯作者：
Doessel, Olaf
影响因子：
6.1
作者：
Labarthe, Simon;Bayer, Jason;Vigmond, Edward
通讯作者：
Vigmond, Edward
影响因子：
2.7
作者：
Cochet, Hubert;Mouries, Amaury;Jais, Pierre
通讯作者：
Jais, Pierre
影响因子：
24
作者：
Kumagai, K;Ogawa, M;Saku, K
通讯作者：
Saku, K