Key result
Prospective, individually optimized linear ablation at a tissue's functional center reduced multiwavelet reentry duration to within 4.4% (95% CI, 3-5.8) of the predicted target in a simulated model.
Why the study?
Does prospective, tissue-specific optimization of ablation reduce multiwavelet reentry duration in a computational model of heterogeneous tissue?
Does prospective, tissue-specific optimization of ablation reduce multiwavelet reentry duration in a computational model of heterogeneous tissue?
A computational model demonstrates that prospectively optimized linear ablation at a tissue's functional center efficiently reduces multiwavelet reentry burden.
May inform ablation targeting in computational reentry models; hypothesis-generating and requires in vivo validation before clinical testing.
BACKGROUND: Treatment of multiwavelet reentry (MWR) remains difficult. We previously developed a metric, the fibrillogenicity index, to assess the propensity of homogeneous, 2-dimensional tissues to support MWR. In this study, we demonstrate a method by which fibrillogenicity index can be generalized to heterogeneous tissues and validate an algorithm for prospective, tissue-specific optimization of ablation to reduce MWR burden. METHODS AND RESULTS: We used a computational model to simulate and measure the duration of MWR in tissues with heterogeneously distributed action potential durations and then assessed the relative efficacy of a variety of ablation strategies for reducing tissues' ability to support MWR. We then derived and tested a strategy in which multiple linear lesions partially divided a fibrillogenic tissue into functionally equivalent subsections. The composite action potential duration of heterogeneous tissue was well approximated by an inverse sum of cellular action potential durations (R(2)=0.82). Linear ablation more efficiently reduced MWR duration than branching ablation patterns and optimally reduced disease burden when positioned at a tissue's functional (rather than geometric) center. The duration of MWR after application of prospective, individually optimized ablation sets fell within 4.4% (95% confidence interval, 3-5.8) of the predicted target. CONCLUSIONS: We think that this study presents a novel approach for (1) quantifying the extent of a tissue's electric derangement, (2) prospectively determining the amount of ablation required to minimize the burden of MWR, and (3) predicting the most efficient distribution of these ablation lesions in tissue refractory to standard ablation strategies.
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Carrick et al. (2016) studied Multiwavelet reentry. Prospective, individually optimized linear ablation vs. Branching ablation patterns was evaluated on Duration of multiwavelet reentry compared to predicted target (95% CI 3-5.8). Prospective, individually optimized linear ablation at a tissue's functional center reduced multiwavelet reentry duration to within 4.4% (95% CI, 3-5.8) of the predicted target in a simulated model.
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