Dang L, Virag N, Ihara Z, Jacquemet V, Vesin J M, Schlaepfer J, Ruchat P, Kappenberger L
Signal Processing Institute, Swiss Federal Institute of Technology, Lausanne, Switzerland. lam.dang2epfl.ch
Ann Biomed Eng. 2005 Apr;33(4):465-74. doi: 10.1007/s10439-005-2502-7.
Atrial fibrillation (AF) is the most common form of cardiac arrhythmia. Surgical/Radiofrequency (RF) ablation is a therapeutic procedure that consists of creating lines of conduction block to interrupt AF. The present study evaluated 13 different ablation patterns by means of a biophysical model of the human atria. In this model, ablation lines were abruptly applied transmurally during simulated sustained AF, and success rate, time to AF termination and average beat-to-beat interval were documented. The gold standard Cox's Maze III procedure was taken as reference. The effectiveness of twelve less invasive patterns was compared to it. In some of these incomplete lines (entailing a gap) were simulated. Finally, the computer simulations were compared to clinical data. The results show that the model reproduces observations made in vivo: (1) the Maze III is the most efficient ablation procedure; (2) less invasive patterns should include lines in both right and left atrium; (3) incomplete ablation lines between the pulmonary veins and the mitral valve annulus lead to uncommon flutter; (4) computer simulations of incomplete lines are consistent with clinical results of non-transumural RF ablation. Biophysical modeling may therefore be considered as a useful tool for understanding the mechanisms underlying AF therapies.
心房颤动（AF）是最常见的心律失常形式。外科/射频（RF）消融是一种治疗方法，包括创建传导阻滞线以中断房颤。本研究通过人体心房的生物物理模型评估了13种不同的消融模式。在该模型中，在模拟的持续性房颤期间经壁突然施加消融线，并记录成功率、房颤终止时间和平均逐搏间期。以金标准Cox迷宫III手术作为参考。将12种侵入性较小的模式的有效性与之进行比较。其中一些模拟了不完全线（存在间隙）。最后，将计算机模拟结果与临床数据进行比较。结果表明，该模型再现了体内观察结果：（1）迷宫III是最有效的消融手术；（2）侵入性较小的模式应包括左右心房的线；（3）肺静脉和二尖瓣环之间的不完全消融线会导致罕见的扑动；（4）不完全线的计算机模拟与非透壁射频消融的临床结果一致。因此，生物物理建模可被视为理解房颤治疗潜在机制的有用工具。
