A Computational Framework to Benchmark Basket Catheter Guided Ablation in Atrial Fibrillation.
A Computational Framework to Benchmark Basket Catheter Guided Ablation in Atrial Fibrillation.
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DOI：
10.3389/fphys.2018.01251
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发表时间：
2018
影响因子：
4
通讯作者：
Severi S
中科院分区：
文献类型：
--
作者：
Alessandrini M;Valinoti M;Unger L;Oesterlein T;Dössel O;Corsi C;Loewe A;Severi S
导管消融术是治疗心房颤动（AF）的有效方法。基于篮状导管测量的旋转源消融已被提议作为持续性AF患者补充肺静脉隔离的有前景的方法。然而，临床报告的成功率是模棱两可的，需要在受控条件下进行机制研究。我们提出了一个计算框架，基准消融策略，考虑从激励传播到电描记图采集和处理到虚拟治疗的整个周期。在患者特定的左心房3D体积模型中诱导了房颤，该模型被均匀重塑以维持折返。考虑到特定的心房解剖结构，使用网格导管模型以及真实变形的篮状导管对所得细胞外电位场进行采样。对虚拟电描记图进行处理，以计算目标转子尖端的相位奇点密度图，最多可进行三次圆形消融。在均匀重塑的心房的不同区域中成功地诱导了稳定的转子，这表明转子不限于独特的解剖结构或位置。仅在分辨率足够（电极间距离≤3 mm）和接近壁（≤10 mm）时，基于导管记录，转子头端轨迹的密度图正确识别和定位转子（偏差< 10 mm）。消融靶向转子部位并不能阻止均匀重塑心房的折返，这与病变大小（1-7 mm半径）、线性连接病变与解剖障碍以及顺序靶向转子数量（≤3）无关。我们的研究结果表明，来自心内电描记图的相位图可以是一个强大的工具来映射心房激动模式，但他们也可以误导，由于不准确的定位转子尖端取决于电极分辨率和距离的墙壁。应考虑避免消融实际上没有房颤转子源的区域。根据我们的经验，转子部位的消融未能成功阻止纤颤。我们的综合模拟框架提供了在考虑基于电描记图的治疗中涉及的所有步骤的情况下，在计算机中对消融策略进行整体基准测试的方法，并且在未来，也可以用于研究更异质的重塑疾病状态。
Catheter ablation is a curative therapeutic approach for atrial fibrillation (AF). Ablation of rotational sources based on basket catheter measurements has been proposed as a promising approach in patients with persistent AF to complement pulmonary vein isolation. However, clinically reported success rates are equivocal calling for a mechanistic investigation under controlled conditions. We present a computational framework to benchmark ablation strategies considering the whole cycle from excitation propagation to electrogram acquisition and processing to virtual therapy. Fibrillation was induced in a patient-specific 3D volumetric model of the left atrium, which was homogeneously remodeled to sustain reentry. The resulting extracellular potential field was sampled using models of grid catheters as well as realistically deformed basket catheters considering the specific atrial anatomy. The virtual electrograms were processed to compute phase singularity density maps to target rotor tips with up to three circular ablations. Stable rotors were successfully induced in different regions of the homogeneously remodeled atrium showing that rotors are not constrained to unique anatomical structures or locations. Density maps of rotor tip trajectories correctly identified and located the rotors (deviation < 10 mm) based on catheter recordings only for sufficient resolution (inter-electrode distance ≤3 mm) and proximity to the wall (≤10 mm). Targeting rotor sites with ablation did not stop reentries in the homogeneously remodeled atria independent from lesion size (1–7 mm radius), from linearly connecting lesions with anatomical obstacles, and from the number of rotors targeted sequentially (≤3). Our results show that phase maps derived from intracardiac electrograms can be a powerful tool to map atrial activation patterns, yet they can also be misleading due to inaccurate localization of the rotor tip depending on electrode resolution and distance to the wall. This should be considered to avoid ablating regions that are in fact free of rotor sources of AF. In our experience, ablation of rotor sites was not successful to stop fibrillation. Our comprehensive simulation framework provides the means to holistically benchmark ablation strategies in silico under consideration of all steps involved in electrogram-based therapy and, in future, could be used to study more heterogeneously remodeled disease states as well.
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影响因子：
158.5
作者：
Kuck, Karl-Heinz;Brugada, Josep;Tondo, Claudio
通讯作者：
Tondo, Claudio
影响因子：
10.6
作者：
Krueger, Martin W.;Seemann, Gunnar;Doessel, Olaf
通讯作者：
Doessel, Olaf
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：
3.7
作者：
Lim B;Hwang M;Song JS;Ryu AJ;Joung B;Shim EB;Ryu H;Pak HN
通讯作者：
Pak HN
DOI：
10.1098/rsta.2011.0139
发表时间：
2011-11-13
影响因子：
5
作者：
Niederer, Steven A.;Kerfoot, Eric;Smith, Nic P.
通讯作者：
Smith, Nic P.