Fibrosis and Atrial Fibrillation: Computerized and Optical Mapping; A View into the Human Atria at Submillimeter Resolution.
Fibrosis and Atrial Fibrillation: Computerized and Optical Mapping; A View into the Human Atria at Submillimeter Resolution.
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DOI：
10.1016/j.jacep.2017.05.002
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发表时间：
2017-06
期刊：
影响因子：
--
通讯作者：
Fedorov VV
中科院分区：
文献类型：
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作者：
Hansen BJ;Zhao J;Fedorov VV
最近的研究强烈表明，大多数患有诊断或亚临床心脏疾病的房颤（AF）患者已经建立或甚至预先存在纤维化结构重塑，这可能导致维持AF的传导异常和折返活动。由于常规治疗在太多情况下无法治疗AF，因此迫切需要识别特定的结构性致炎性纤维化模式，这可能维持AF，以便识别用于AF治疗的有效消融靶点。然而，现有的挑战是确定复杂的3D人体心房壁内的确切结构重塑是致炎性的，以及将致炎性纤维化与临床环境中AF维持的潜在机制联系起来。本文综述了3D纤维化结构在AF维持机制中的作用，这些机制是通过直接对人类心房进行亚毫米级高分辨率离体成像以及能够克服体内临床局限性的计算机3D计算技术揭示的。离体功能成像和结构成像的系统集成可以为体内电极和结构标测的必要集成提供信息。AF驱动器机制的整体视图可以开始识别折返AF驱动器的定义特征或“指纹”，例如3D纤维化结构，以便设计最佳的患者特异性消融策略。
Recent studies strongly suggest that the majority of atrial fibrillation (AF) patients with diagnosed or subclinical cardiac diseases have established or even pre-existing fibrotic structural remodeling, which may lead to conduction abnormalities and reentrant activity that sustain AF. As conventional treatments fail to treat AF in far too many cases, an urgent need exists to identify specific structural arrhythmogenic fibrosis patterns, which may maintain AF, in order to identify effective ablation targets for AF treatment. However, the existing challenge is to define what exact structural remodeling within the complex 3D human atrial wall is arrhythmogenic, as well as linking arrhythmogenic fibrosis to an underlying mechanism of AF maintenance in the clinical setting. This review is focused on the role of 3D fibrosis architecture in the mechanisms of AF maintenance revealed by submillimeter, high-resolution ex-vivo imaging modalities directly of human atria, as well as from in-silico 3D computational techniques that can be able to overcome in-vivo clinical limitations. The systematic integration of functional and structural imaging ex-vivo may inform the necessary integration of electrode and structural mapping in-vivo. A holistic view of AF driver mechanisms may begin to identify the defining characteristics or “fingerprints” of reentrant AF drivers, such as 3D fibrotic architecture, in order to design optimal patient-specific ablation strategies.