Personalized Evaluation of Atrial Complexity of Patients Undergoing Atrial Fibrillation Ablation: A Clinical Computational Study

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Sánchez de la Nava, Ana María and González Mansilla, Ana and González Torrecilla, Esteban and Ávila, Pablo and Datino, Tomás and Bermejo Thomas, Javier and Arenal, Ángel and Fernández-Avilés Díaz, Francisco and Atienza Fernández, Felipe (2021) Personalized Evaluation of Atrial Complexity of Patients Undergoing Atrial Fibrillation Ablation: A Clinical Computational Study. Biology, 10 (9). p. 838. ISSN 2079-7737

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Official URL: https://doi.org/10.3390/biology10090838




Abstract

Current clinical guidelines establish Pulmonary Vein (PV) isolation as the indicated treatment for Atrial Fibrillation (AF). However, AF can also be triggered or sustained due to atrial drivers located elsewhere in the atria. We designed a new simulation workflow based on personalized computer simulations to characterize AF complexity of patients undergoing PV ablation, validated with non-invasive electrocardiographic imaging and evaluated at one year after ablation. We included 30 patients using atrial anatomies segmented from MRI and simulated an automata model for the electrical modelling, consisting of three states (resting, excited and refractory). In total, 100 different scenarios were simulated per anatomy varying rotor number and location. The 3 states were calibrated with Koivumaki action potential, entropy maps were obtained from the electrograms and compared with ECGi for each patient to analyze PV isolation outcome. The completion of the workflow indicated that successful AF ablation occurred in patients with rotors mainly located at the PV antrum, while unsuccessful procedures presented greater number of driving sites outside the PV area. The number of rotors attached to the PV was significantly higher in patients with favorable long-term ablation outcome (1-year freedom from AF: 1.61 ± 0.21 vs. AF recurrence: 1.40 ± 0.20; p-value = 0.018). The presented workflow could improve patient stratification for PV ablation by screening the complexity of the atria.


Item Type:Article
Uncontrolled Keywords:atrial fibrillation; computational models; ablation; personalized models
Subjects:Sciences > Computer science > Bioinformatics
Medical sciences > Medicine > Cardiology
ID Code:70759
Deposited On:25 Feb 2022 14:26
Last Modified:28 Feb 2022 08:48

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