Key result
Computational modeling demonstrated that re-entrant drivers anchor to regions with large wall thickness gradients, but are highly sensitive to fibrotic tissue which can alter anchoring sites.
Why the study?
Does the presence of fibrosis and atrial wall thickness gradients influence the anchoring sites of re-entrant drivers in human atrial models?
Does the presence of fibrosis and atrial wall thickness gradients influence the anchoring sites of re-entrant drivers in human atrial models?
Computational modeling demonstrates that both atrial wall thickness gradients and fibrotic patches significantly influence the anchoring locations of re-entrant drivers, which could help guide patient-specific AF ablation strategies.
Patient-specific models may identify fibrosis- and thickness-dependent re-entrant sites; leaves open whether targeting them improves ablation outcomes.
Catheter ablation is a common treatment for atrial fibrillation (AF), but long-term patient outcomes remain suboptimal. Knowledge of the location of re-entrant drivers (RDs) sustaining AF can help optimize ablation strategies for individual patients. Increasing evidence suggest that both fibrosis and atrial wall thickness (AWT) can influence the RDs dynamics. This study aims to analyse the role of fibrotic patches and AWT in determining RD sites in human right (RA) and left (LA) atrial models.Atrial geometries and fibrosis distribution were obtained from 2 healthy volunteers and 2 AF patients using MR imaging.These 4 subject-specific geometries were integrated into 3D atrial models with the Fenton-Karma model adopted to reproduce atrial electrophysiology.In the RA model without fibrosis, RDs anchored to the crista terminalis (CT) if initiated near a prominent AWT gradient between this bundle and surrounding RA.In the presence of fibrosis, RDs either pinned between the CT and fibrotic patch or anchored to the latter, depending on the distance from their initiation site to the CT.In the LA model without fibrosis, RDs drifted towards the thinner pulmonary veins.However, with fibrotic patches added, RDs either anchored around them or broke down into multiple wavelets.These findings can help identify RD locations from imaging data and guide ablation therapy.
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Roy et al. (2017) studied Atrial Fibrillation (n=4). Presence of fibrosis and atrial wall thickness gradients vs. Absence of fibrosis was evaluated on Re-entrant driver (RD) anchoring locations. Computational modeling demonstrated that re-entrant drivers anchor to regions with large wall thickness gradients, but are highly sensitive to fibrotic tissue which can alter anchoring sites.
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