Interpreting Activation Mapping of Atrial Fibrillation: A Hybrid Computational/Physiological Study.
Interpreting Activation Mapping of Atrial Fibrillation: A Hybrid Computational/Physiological Study.
复制标题
DOI：
10.1007/s10439-017-1969-3
复制
发表时间：
2018-03
影响因子：
3.8
通讯作者：
Narayan SM
中科院分区：
文献类型：
--
作者：
Sahli Costabal F;Zaman JAB;Kuhl E;Narayan SM
Atrial fibrillation is the most common rhythm disorder of the heart associated with a rapid and irregular beating of the upper chambers. Activation mapping remains the gold standard to diagnose and interpret atrial fibrillation. However, fibrillatory activation maps are highly sensitive to far-field effects, and often disagree with other optical mapping modalities. Here we show that computational modeling can identify spurious non-local components of atrial fibrillation electrograms and improve activation mapping. We motivate our approach with a cohort of patients with potential drivers of persistent atrial fibrillation. In a computational study using a monodomain Maleckar model, we demonstrate that in organized rhythms, electrograms successfully track local activation, whereas in atrial fibrillation, electrograms are sensitive to spiral wave distance and number, spiral tip trajectories, and effects of fibrosis. In a clinical study, we analyzed n=15 patients with persistent atrial fibrillation that was terminated by limited ablation. In five cases, traditional activation maps revealed a spiral wave at sites of termination; in ten cases, electrogram timings were ambiguous and activation maps showed incomplete reentry. By adjusting electrogram timing through computational modeling, we found rotational activation, which was undetectable with conventional methods. Our results demonstrate that computational modeling can identify non-local deflections to improve activation mapping and explain how and where ablation can terminate persistent atrial fibrillation. Our hybrid computational/physiological approach has the potential to optimize map-guided ablation and improve ablation therapy in atrial fibrillation.
登录
查看更多内容
影响因子：
2.7
作者：
Miller JM;Kowal RC;Swarup V;Daubert JP;Daoud EG;Day JD;Ellenbogen KA;Hummel JD;Baykaner T;Krummen DE;Narayan SM;Reddy VY;Shivkumar K;Steinberg JS;Wheelan KR
通讯作者：
Wheelan KR
影响因子：
5.5
作者：
Lau, Dennis H.;Maesen, Bart;Schotten, Ulrich
通讯作者：
Schotten, Ulrich
影响因子：
24
作者：
Narayan, Sanjiv M.;Krummen, David E.;Miller, John M.
通讯作者：
Miller, John M.
影响因子：
4.1
作者：
Baillargeon, Brian;Rebelo, Nuno;Fox, David D.;Taylor, Robert L.;Kuhl, Ellen
通讯作者：
Kuhl, Ellen
影响因子：
3.8
作者：
Chouvarda, I;Maglaveras, N;DeBakker, J
通讯作者：
DeBakker, J