Alliance for Cardiovascular Diagnostic and Treatment Innovation, Johns Hopkins University, Baltimore, Maryland, USA.
Alliance for Cardiovascular Diagnostic and Treatment Innovation, Johns Hopkins University, Baltimore, Maryland, USA; Research Computing, Lehigh University, Bethlehem, Pennsylvania, USA.
JACC Clin Electrophysiol. 2024 Nov;10(11):2347-2358. doi: 10.1016/j.jacep.2024.07.002. Epub 2024 Sep 4.
Although targeting atrial fibrillation (AF) drivers and substrates has been used as an effective adjunctive ablation strategy for patients with persistent AF (PsAF), it can result in iatrogenic scar-related atrial tachycardia (iAT) requiring additional ablation. Personalized atrial digital twins (DTs) have been used preprocedurally to devise ablation targeting that eliminate the fibrotic substrate arrhythmogenic propensity and could potentially be used to predict and prevent postablation iAT.
In this study, the authors sought to explore possible alternative configurations of ablation lesions that could prevent iAT occurrence with the use of biatrial DTs of prospectively enrolled PsAF patients.
Biatrial DTs were generated from late gadolinium enhancement-magnetic resonance images of 37 consecutive PsAF patients, and the fibrotic substrate locations in the DT capable of sustaining reentries were determined. These locations were ablated in DTs by representing a single compound region of ablation with normal power (SSA), and postablation iAT occurrence was determined. At locations of iAT, ablation at the same DT target was repeated, but applying multiple lesions of reduced-strength (MRA) instead of SSA.
Eighty-three locations in the fibrotic substrates of 28 personalized biatrial DTs were capable of sustaining reentries and were thus targeted for SSA ablation. Of these ablations, 45 resulted in iAT. Repeating the ablation at these targets with MRA instead of SSA resulted in the prevention of iAT occurrence at 15 locations (18% reduction in the rate of iAT occurrence).
Personalized atrial DTs enable preprocedure prediction of iAT occurrence after ablation in the fibrotic substrate. It also suggests MRA could be a potential strategy for preventing postablation AT.
虽然针对心房颤动（房颤）的驱动因素和基质已被用作持续性房颤（PsAF）患者的辅助消融策略，但可能会导致医源性瘢痕相关的房性心动过速（iAT），需要额外的消融。个性化心房数字双胞胎（DT）已被用于术前设计消融靶点，以消除纤维性基质的致心律失常倾向，并可能用于预测和预防消融后的 iAT。
本研究旨在探索消融病变的可能替代构型，以使用前瞻性招募的 PsAF 患者的双心房 DT 预防 iAT 的发生。
从 37 例连续的 PsAF 患者的晚期钆增强磁共振图像生成双心房 DT，并确定 DT 中能够维持折返的纤维化基质位置。通过代表单个消融复合区域用正常功率（SSA）对 DT 中的这些位置进行消融，并确定消融后的 iAT 发生情况。在 iAT 位置，在相同的 DT 靶点上重复消融，但应用多个强度降低的病变（MRA）而不是 SSA。
28 个个性化双心房 DT 的纤维化基质中有 83 个位置能够维持折返，因此被确定为 SSA 消融靶点。这些消融中有 45 例导致 iAT。在这些靶点上重复使用 MRA 而不是 SSA 进行消融，导致 15 个部位（iAT 发生率降低 18%）的 iAT 发生得到预防。
个性化心房 DT 能够在纤维化基质消融后预测 iAT 的发生。它还表明 MRA 可能是预防消融后 AT 的一种潜在策略。
