Key result
Personalized computational models based on LGE-MRI successfully predicted clinically observed atypical left atrial flutter circuits, leading to flutter termination at model-predicted isthmus sites.
Why the study?
Atypical atrial flutter seen post-ablation can be challenging to map.
Does a personalized computational model using LGE-MRI scar information predict atypical left atrial flutter circuits and guide successful ablation in patients with prior left-atrial ablation?
Case Report (n=4)
No
Does a personalized computational model using LGE-MRI scar information predict atypical left atrial flutter circuits and guide successful ablation in patients with prior left-atrial ablation?
A personalized computational model based entirely on non-invasive LGE-MRI can prospectively predict atypical left atrial flutter circuits and successfully guide ablation.
Hypothesis-generating for LGE-MRI model-guided ablation in post-ablation flutter; leaves open validation in larger prospective studies.
Atypical atrial flutter is seen post-ablation in patients, and it can be challenging to map. These flutters are typically set up around areas of scar in the left atrium. MRI can reliably identify left atrial scar. We propose a personalized computational model using patient specific scar information, to generate a monodomain model. In the model conductivities are adjusted for different tissue regions and flutter was induced with a premature pacing protocol. The model was tested prospectively in patients undergoing atypical flutter ablation. The simulation-predicted flutters were visualized and presented to clinicians. Validation of the computational model was motivated by recording from electroanatomical mapping. These personalized models successfully predicted clinically observed atypical flutter circuits and at times even better than invasive maps leading to flutter termination at isthmus sites predicted by the model.
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Lange et al. (2022) conducted a case report in Atypical left atrial flutter (n=4). Personalized computational model guided ablation was evaluated on Prediction of left atrial flutter circuits. Personalized computational models based on LGE-MRI successfully predicted clinically observed atypical left atrial flutter circuits, leading to flutter termination at model-predicted isthmus sites.
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