Virtual electrophysiological study of atrial fibrillation in fibrotic remodeling. McDowell, K.; Zahid, S.; Vadakkumpadan, F.; Blauer, J.; MacLeod, R.; and Trayanova, N. PLoS One, 10(2):e0117110, 2015. bibtex @Article{RSM:McD2015,
author = "K.S. McDowell and S. Zahid and F. Vadakkumpadan and J.
Blauer and R.S. MacLeod and N.A. Trayanova",
title = "Virtual electrophysiological study of atrial fibrillation
in fibrotic remodeling.",
journal = "PLoS One",
year = "2015",
volume = "10",
number = "2",
pages = "e0117110",
robnote = "We aimed to
provide a proof-of-concept that patient-specific virtual
electrophysiological study that combines i) atrial
structure and fibrosis distribution from clinical MRI and
ii) modeling of atrial electrophysiology, could be used to
predict: (1) how fibrosis distribution determines the
locations from which paced beats degrade into AF; (2) the
dynamic behavior of persistent AF rotors; and (3) the
optimal ablation targets in each patient. Four MRI-based
patient-specific models of fibrotic left atria were
generated, ranging in fibrosis amount. Virtual
electrophysiological studies were performed in these
models, and where AF was inducible, the dynamics of AF
were used to determine the ablation locations that render
AF non-inducible. In 2 of the 4 models patient-specific
models AF was induced; in these models the distance
between a given pacing location and the closest fibrotic
region determined whether AF was inducible from that
particular location, with only the mid-range distances
resulting in arrhythmia. Phase singularities of persistent
rotors were found to move within restricted regions of
tissue, which were independent of the pacing location from
which AF was induced. Electrophysiological sensitivity
analysis demonstrated that these regions changed little
with variations in electrophysiological parameters.
Patient-specific distribution of fibrosis was thus found
to be a critical component of AF initiation and
maintenance. When the restricted regions encompassing the
meander of the persistent phase singularities were modeled
as ablation lesions, AF could no longer be induced. The
study demonstrates that a patient-specific modeling
approach to identify non-invasively AF ablation targets
prior to the clinical procedure is feasible.",
bibdate = "Fri Jun 19 06:43:08 2015",
pmcid = "PMC4333565",
}