Mapping and Targeting Focal Sources Before and After Surgical Ablation of Atrial Fibrillation

心房颤动手术消融前后的标测和定位焦点源

• 批准号: 10613372
• 负责人: Seungyup Lee
• 金额: $ 36.23万
• 依托单位: CASE WESTERN RESERVE UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2019
• 资助国家: 美国
• 起止时间: 2019-07-01 至 2025-03-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10613372
• 关键词: Ablation; Age; American; Area; Atrial Fibrillation; Behavior; Cardiac Surgery procedures; Cardiac ablation; Caring; Clinical; Clinical Trials; Data; Diagnosis; Disease; Electrodes; Electrophysiology (science); Epicardium; Freedom; Frequencies; Gender; Heart Atrium; Heart Diseases; Heart failure; Interruption; Lead; Left atrial structure; Lesion; Location; Maps; Morphology; Operative Surgical Procedures; Outcome; Pacemakers; Patients; Pattern; Procedures; Pulmonary veins; Recurrence; Research Proposals; Right atrial structure; Sequence Analysis; Site; Source; Surface; Surgeon; Tachyarrhythmias; Testing; Therapeutic; Tissues; Western World; comorbidity; density; epicardial mapping; heart rhythm; implantation; improved; insight; mortality; patient safety; premature; prevent; stroke risk; voltage

Project Summary/Abstract Atrial fibrillation (AF) is the most common tachyarrhythmia, with the number of Americans diagnosed estimated at more than six million. It is associated with an increased risk of stroke, heart failure, and all-cause mortality. In patients with paroxysmal AF, which most often is initiated by triggers from the pulmonary veins (PVs), pulmonary vein isolation (PVI) has been relatively effective in treating AF. However, in patients with persistent and long-standing persistent (LSP) AF, ablation treatment of AF, which includes PVI, has been only modestly effective because of the lack of patient-specific “mechanistic” targets to ablate. As a result, the ablation procedure is largely an empiric “one size fits all” approach. To emphasize that fact, recent clinical trials in patients with persistent and LSP AF involving endocardial catheter ablation or surgical ablation showed that there was no significant difference in the rate of freedom from AF between patients who underwent PVI alone and those who underwent PVI plus additional empiric ablation lesion sets. Furthermore, ablation lesions beyond the PVI significantly increased the need for implantation of a permanent pacemaker. All this supports the need for 1) identifying the mechanism(s) that maintain AF by activation pattern; 2) understanding the effects of each ablation lesion set on atrial activation patterns responsible for maintaining AF so that we can determine what changes in activation patterns created by the ablation lesion are critical for terminating AF and preventing its recurrence. Thereby, ablation therapy of persistent and LSP AF could change from a largely empiric approach to a patient-specific targeted approach. Our recent studies using simultaneous, biatrial, high density (510 - 512 electrodes), epicardial contact mapping in patients with persistent and LSP AF undergoing open heart surgery found that wave fronts emanating from focal sources and breakthrough sites maintained AF. Also, our preliminary studies in patients with persistent and LSP AF showed that AF was still present immediately after surgical ablation, and was associated with continued activation patterns described above. The central hypothesis of this proposal is that persistent AF after surgical ablation is due to the continuation of baseline focal sources maintaining AF, and that interrupting their activation will terminate AF. The hypothesis to be tested has three specific aims: Aim 1 is to identify focal sources in patients with persistent and LSP AF. Aim 2 is to test the hypothesis that a continuation of wave fronts emanating from focal sources after surgical ablation (PVI ± additional linear ablation lines) maintains AF. We will investigate the effects of each ablation lesion set on the activation behavior of baseline focal sources and breakthrough sites. Aim 3 is to test the hypothesis that targeted ablation of focal sources will reliably terminate AF. We will develop an efficient ablation strategy for targeting focal sources to improve patient safety by decreasing the amount of tissue ablated permanently. Insights provided by data from our proposed study should contribute importantly to the ablative approach, the improvement of both care and clinical outcomes in patients with persistent and LSP AF.

项目总结/文摘

项目成果

New Insights Into Understanding Rotor Versus Focal Activation in Patients With Persistent Atrial Fibrillation.

• DOI: 10.1016/j.jacep.2020.12.010
• 发表时间: 2021-07
• 期刊: JACC. Clinical electrophysiology
• 作者: Lee S;Khrestian CM;Sahadevan J;Markowitz A;Waldo AL
• 通讯作者: Waldo AL

An Evaluation of Phase Analysis to Interpret Atrial Activation Patterns during Persistent Atrial Fibrillation for Targeted Ablation.

• DOI: 10.3390/jcm11195807
• 发表时间: 2022-09-30
• 期刊: Journal of clinical medicine
• 影响因子: 3.9
• 作者: Lee S;Khrestian CM;Sahadevan J;Waldo AL
• 通讯作者: Waldo AL

Reconsidering the multiple wavelet hypothesis of atrial fibrillation.

• DOI: 10.1016/j.hrthm.2020.06.017
• 发表时间: 2020-11
• 期刊: Heart rhythm
• 影响因子: 5.5
• 作者: Lee S;Khrestian CM;Sahadevan J;Waldo AL
• 通讯作者: Waldo AL

Reliable pace termination of postoperative atrial fibrillation in the canine sterile pericarditis model: Implications for atypical atrial flutter.

• DOI: 10.1016/j.hroo.2022.01.003
• 发表时间: 2022-03
• 期刊: Heart rhythm O2
• 作者: Lee S;Vitebskiy S;Goldstein RN;Khrestian CM;Waldo AL
• 通讯作者: Waldo AL

Validation of a new species for studying postoperative atrial fibrillation: Swine sterile pericarditis model.

验证用于研究术后心房颤动的新物种：猪无菌心包炎模型。

• DOI: 10.1111/pace.14765
• 发表时间: 2023
• 期刊: Pacing and clinical electrophysiology : PACE
• 作者: Lee,Seungyup;Khrestian,Celeen;Laurita,Daniel;Juzbasich,Dragan;Wallick,Don;Waldo,Albert
• 通讯作者: Waldo,Albert