Department of Biomedical Engineering, University of Utah, Salt Lake City, UT, USA.
Division of Cardiovascular Medicine, Department of Internal Medicine, University of Utah, Salt Lake City, UT, USA.
Ann Biomed Eng. 2023 Feb;51(2):329-342. doi: 10.1007/s10439-022-03029-5. Epub 2022 Aug 5.
Computational models have made it possible to study the effect of fibrosis and scar on atrial fibrillation (AF) and plan future personalized treatments. Here, we study the effect of area available for fibrillatory waves to sustain AF. Then we use it to plan for AF ablation to improve procedural outcomes. CARPentry was used to create patient-specific models to determine the association between the size of residual contiguous areas available for AF wavefronts to propagate and sustain AF [fibrillatory area (FA)] after ablation with procedural outcomes. The FA was quantified in a novel manner accounting for gaps in ablation lines. We selected 30 persistent AF patients with known ablation outcomes. We divided the atrial surface into five areas based on ablation scar pattern and anatomical landmarks and calculated the FAs. We validated the models based on clinical outcomes and suggested future ablation lines that minimize the FAs and terminate rotor activities in simulations. We also simulated the effects of three common antiarrhythmic drugs. In the patient-specific models, the predicted arrhythmias matched the clinical outcomes in 25 of 30 patients (accuracy 83.33%). The average largest FA (FA) in the recurrence group was 8517 ± 1444 vs. 6772 ± 1531 mm in the no recurrence group (p < 0.004). The final FAs after adding the suggested ablation lines in the AF recurrence group reduced the average FA from 8517 ± 1444 to 6168 ± 1358 mm (p < 0.001) and stopped the sustained rotor activity. Simulations also correctly anticipated the effect of antiarrhythmic drugs in 5 out of 6 patients who used drug therapy post unsuccessful ablation (accuracy 83.33%). Sizes of FAs available for AF wavefronts to propagate are important determinants for ablation outcomes. FA size in combination with computational simulations can be used to direct ablation in persistent AF to minimize the critical mass required to sustain recurrent AF.
计算模型使得研究纤维化和瘢痕对心房颤动（AF）的影响并规划未来的个性化治疗成为可能。在这里，我们研究了可用于维持 AF 的纤维颤动波的可用区域的影响。然后，我们使用它来规划 AF 消融以改善手术结果。使用 CARPentry 创建了特定于患者的模型，以确定消融后剩余的可用于 AF 波前传播和维持 AF 的连续区域的大小（纤维颤动面积 [FA]）与手术结果之间的关联。以一种新颖的方式量化 FA，考虑到消融线之间的间隙。我们选择了 30 名具有已知消融结果的持续性 AF 患者。我们根据消融疤痕模式和解剖学标志将心房表面分为五个区域，并计算了 FA。我们基于临床结果验证了模型，并在模拟中提出了最小化 FA 和终止转子活动的未来消融线。我们还模拟了三种常见抗心律失常药物的影响。在特定于患者的模型中，预测的心律失常与 30 名患者中的 25 名（准确性 83.33%）的临床结果相匹配。在复发组中，平均最大 FA（FA）为 8517 ± 1444 与无复发组中的 6772 ± 1531 mm（p < 0.004）。在 AF 复发组中添加建议消融线后，最终 FA 从 8517 ± 1444 减少至 6168 ± 1358 mm（p < 0.001）并停止持续的转子活动。模拟还正确预测了 6 名抗心律失常药物治疗后不成功消融的 5 名患者（准确性 83.33%）药物治疗的效果。可用于 AF 波前传播的 FA 的大小是消融结果的重要决定因素。FA 大小结合计算模拟可用于指导持续性 AF 的消融，以最小化维持复发性 AF 所需的临界质量。
