Key result
In a computational model of cardiac arrhythmias, focal ablation at a spiral-wave core failed to terminate re-entry, whereas termination required linear lesions from the tissue edge to the core.
Why the study?
Do linear lesions terminate multi-wavelet re-entry more effectively than focal ablation in a computational model of electrically excitable tissue?
Do linear lesions terminate multi-wavelet re-entry more effectively than focal ablation in a computational model of electrically excitable tissue?
In silico modeling demonstrates that focal ablation is inadequate for terminating spatially fixed spiral-waves, establishing a theoretical framework that linear lesions are required for successful treatment of multi-wavelet re-entry.
Focal ablation should not yet guide practice; hypothesis-generating for linear lesions in multi-wavelet re-entry.
AIMS: Catheter ablation strategies for treatment of cardiac arrhythmias are quite successful when targeting spatially constrained substrates. Complex, dynamic, and spatially varying substrates, however, pose a significant challenge for ablation, which delivers spatially fixed lesions. We describe tissue excitation using concepts of surface topology which provides a framework for addressing this challenge. The aim of this study was to test the efficacy of mechanism-based ablation strategies in the setting of complex dynamic substrates. METHODS AND RESULTS: We used a computational model of propagation through electrically excitable tissue to test the effects of ablation on excitation patterns of progressively greater complexity, from fixed rotors to multi-wavelet re-entry. Our results indicate that (i) focal ablation at a spiral-wave core does not result in termination; (ii) termination requires linear lesions from the tissue edge to the spiral-wave core; (iii) meandering spiral-waves terminate upon collision with a boundary (linear lesion or tissue edge); (iv) the probability of terminating multi-wavelet re-entry is proportional to the ratio of total boundary length to tissue area; (v) the efficacy of linear lesions varies directly with the regional density of spiral-waves. CONCLUSION: We establish a theoretical framework for re-entrant arrhythmias that explains the requirements for their successful treatment. We demonstrate the inadequacy of focal ablation for spatially fixed spiral-waves. Mechanistically guided principles for ablating multi-wavelet re-entry are provided. The potential to capitalize upon regional heterogeneity of spiral-wave density for improved ablation efficacy is described.
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Spector et al. (2012) studied Cardiac arrhythmias. Ablation strategies (focal and linear lesions) was evaluated on Termination of multi-wavelet re-entry. In a computational model of cardiac arrhythmias, focal ablation at a spiral-wave core failed to terminate re-entry, whereas termination required linear lesions from the tissue edge to the core.
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