Roney, C.H., Child, N., Porter, B. et al. (14 more authors) (2021) Time-averaged wavefront analysis demonstrates preferential pathways of atrial fibrillation, predicting pulmonary vein isolation acute response. Frontiers in Physiology, 12. 707189. ISSN 1664-042X
Abstract
Electrical activation during atrial fibrillation (AF) appears chaotic and disorganised, which impedes characterisation of the underlying substrate and treatment planning. While globally chaotic, there may be local preferential activation pathways that represent potential ablation targets. This study aimed to identify preferential activation pathways during AF and predict the acute ablation response when these are targeted by pulmonary vein isolation (PVI). In patients with persistent AF (n = 14), simultaneous biatrial contact mapping with basket catheters was performed pre-ablation and following each ablation strategy (PVI, roof, and mitral lines). Unipolar wavefront activation directions were averaged over 10 s to identify preferential activation pathways. Clinical cases were classified as responders or non-responders to PVI during the procedure. Clinical data were augmented with a virtual cohort of 100 models. In AF pre-ablation, pathways originated from the pulmonary vein (PV) antra in PVI responders (7/7) but not in PVI non-responders (6/6). We proposed a novel index that measured activation waves from the PV antra into the atrial body. This index was significantly higher in PVI responders than non-responders (clinical: 16.3 vs. 3.7%, p = 0.04; simulated: 21.1 vs. 14.1%, p = 0.02). Overall, this novel technique and proof of concept study demonstrated that preferential activation pathways exist during AF. Targeting patient-specific activation pathways that flowed from the PV antra to the left atrial body using PVI resulted in AF termination during the procedure. These PV activation flow pathways may correspond to the presence of drivers in the PV regions.
Metadata
Item Type: | Article |
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Authors/Creators: | This paper has 17 authors. You can scroll the list below to see them all or them all.
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Copyright, Publisher and Additional Information: | © 2021 Roney, Child, Porter, Sim, Whitaker, Clayton, Laughner, Shuros, Neuzil, Williams, Razavi, O'Neill, Rinaldi, Taggart, Wright, Gill and Niederer. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY) http://creativecommons.org/licenses/by/4.0/. The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms. |
Keywords: | atrial fibrillation mechanisms; catheter ablation; pulmonary vein isolation; computational modelling; signal processing |
Dates: |
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Institution: | The University of Sheffield |
Academic Units: | The University of Sheffield > Faculty of Engineering (Sheffield) > Department of Computer Science (Sheffield) |
Funding Information: | Funder Grant number ENGINEERING AND PHYSICAL SCIENCE RESEARCH COUNCIL EP/P010741/1 |
Depositing User: | Symplectic Sheffield |
Date Deposited: | 18 Oct 2021 10:50 |
Last Modified: | 18 Oct 2021 10:50 |
Status: | Published |
Publisher: | Frontiers Media |
Refereed: | Yes |
Identification Number: | 10.3389/fphys.2021.707189 |
Open Archives Initiative ID (OAI ID): | oai:eprints.whiterose.ac.uk:179299 |