Marques Victor Gonçalves, Gharaviri Ali, Özgül Ozan, Pezzuto Simone, Auricchio Angelo, Bonizzi Pietro, Zeemering Stef, Schotten Ulrich
Department of Physiology, Maastricht University, Universiteitssingel 50, Maastricht 6229ER, Netherlands.
Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, United Kingdom.
J Mol Cell Cardiol Plus. 2024 Feb 22;7:100065. doi: 10.1016/j.jmccpl.2024.100065. eCollection 2024 Mar.
In persistent atrial fibrillation (AF), localized extra-pulmonary vein sources may contribute to arrhythmia recurrences after pulmonary vein isolation. This in-silico study proposes a high-density sequential mapping strategy to localize such sources.
Catheter repositioning was guided by repetitive conduction patterns, moving against the prevailing conduction direction (upstream) toward the sources. Sources were found either by locally identifying conduction patterns or by encircling the region harboring them. We simulated source tracking in an in-silico atrial model, comparing random vs. upstream-guided catheter repositioning (with and without encircling). To assess performance in increasing AF complexities, we simulated AF in 3 groups: atria with reentry-anchoring scars, without fibrosis, and with severe endomysial fibrosis.
Compared to random mapping, the upstream-guided approach successfully located sources more often (anchored reentries: vs. ; no fibrosis: vs. ; with fibrosis: vs. of tracking procedures, all ), using fewer steps (median [IQR]: 11 [7;23] vs. 26 [13;35]; 10 [6;19] vs. 19 [10;27]; 11 [7;19] vs. 16 [8;30], respectively, all ). Adding source encircling increased source detection (98.1 %, 100 %, and 99.5 %, all vs. local detection only), reducing required steps (9 [6;12], 8 [6;12], and 9 [6;13], all ). In some cases (11.9 %, 17.1 %, and 10.5 % of procedures), the algorithm encircled regions 15 mm from the source.
Moving mapping catheters upstream improves source detection efficiency, even in the presence of severe fibrosis. Encircling sources may help find regions of interest in fewer steps.
在持续性心房颤动（AF）中，局部肺外静脉来源可能导致肺静脉隔离术后心律失常复发。这项计算机模拟研究提出了一种高密度顺序标测策略来定位此类来源。
导管重新定位以重复传导模式为指导，逆着主导传导方向（向上游）朝着来源移动。通过局部识别传导模式或环绕包含来源的区域来发现来源。我们在计算机模拟心房模型中模拟来源追踪，比较随机与上游引导的导管重新定位（有和没有环绕）。为了评估在增加AF复杂性方面的性能，我们在3组中模拟AF：有折返锚定瘢痕的心房、无纤维化的心房和有严重肌内膜纤维化的心房。
与随机标测相比，上游引导方法更常成功定位来源（锚定折返：追踪程序的 对 ；无纤维化： 对 ；有纤维化： 对 ，所有 ），使用的步骤更少（中位数[四分位间距]：分别为11[7；23]对26[13；35]；10[6；19]对19[10；27]；11[7；19]对16[8；30]，所有 ）。添加来源环绕增加了来源检测率（分别为98.1%、100%和99.5%，所有 对仅局部检测），减少了所需步骤（分别为9[6；12]、8[6；12]和9[6；13]，所有 ）。在某些情况下（分别为11.9%、17.1%和10.5%的程序），算法环绕了距离来源15毫米的区域。
将标测导管向上游移动可提高来源检测效率，即使在存在严重纤维化的情况下也是如此。环绕来源可能有助于在更少步骤中找到感兴趣的区域。
