Key result
400 µm mesh computational simulations identify identical re-entrant driver sites as higher-resolution models.
Why the study?
To make computationally guided persistent AF ablation scalable, simulation time and computational cost must be minimized while maintaining predictive accuracy.
Simulations using 400 µm mesh resolution and ~40 pacing sites proximal to fibrosis are sufficient to accurately identify re-entrant driver sites in personalized models of persistent atrial fibrillation, optimizing computational efficiency.
May optimize computational AF modeling efficiency; leaves open human validation of re-entrant driver identification.
AIMS: Computationally guided persistent atrial fibrillation (PsAF) ablation has emerged as an alternative to conventional treatment planning. To make this approach scalable, computational cost and the time required to conduct simulations must be minimized while maintaining predictive accuracy. Here, we assess the sensitivity of the process to finite-element mesh resolution. We also compare methods for pacing site distribution used to evaluate inducibility arrhythmia sustained by re-entrant drivers (RDs). METHODS AND RESULTS: Simulations were conducted in low- and high-resolution models (average edge lengths: 400/350 µm) reconstructed from PsAF patients' late gadolinium enhancement magnetic resonance imaging scans. Pacing was simulated from 80 sites to assess RD inducibility. When pacing from the same site led to different outcomes in low-/high-resolution models, we characterized divergence dynamics by analysing dissimilarity index over time. Pacing site selection schemes prioritizing even spatial distribution and proximity to fibrotic tissue were evaluated. There were no RD sites observed in low-resolution models but not high-resolution models, or vice versa. Dissimilarity index analysis suggested that differences in simulation outcome arising from differences in discretization were the result of isolated conduction block incidents in one model but not the other; this never led to RD sites unique to one mesh resolution. Pacing site selection based on fibrosis proximity led to the best observed trade-off between number of stimulation locations and predictive accuracy. CONCLUSION: Simulations conducted in meshes with 400 µm average edge length and ∼40 pacing sites proximal to fibrosis are sufficient to reveal the most comprehensive possible list of RD sites, given feasibility constraints.
No takes yet. Share an insight, caveat, or question.
Boyle et al. (2020) studied Persistent atrial fibrillation. Low-resolution computational models (400 µm) vs. High-resolution computational models (350 µm) was evaluated on Identification of re-entrant driver (RD) sites. Computational simulations using 400 µm mesh resolution and ~40 pacing sites proximal to fibrosis identified identical re-entrant driver sites as higher resolution models.
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: