The fibrotic substrate in persistent atrial fibrillation patients: Comparison between predictions from computational modeling and measurements from focal impulse and rotor mapping

Patrick M. Boyle, Joe B. Hakim, Sohail Zahid, William H. Franceschi, Michael J. Murphy, Adityo Prakosa, Konstantinos N. Aronis, Tarek Zghaib, Muhammed Balouch, Esra G. Ipek, Jonathan Chrispin, Ronald D Berger, Hiroshi Ashikaga, Joseph Marine, Hugh Calkins, Saman Nazarian, David D Spragg, Natalia A. Trayanova

Research output: Contribution to journalArticle

Abstract

Focal impulse and rotor mapping (FIRM) involves intracardiac detection and catheter ablation of re-entrant drivers (RDs), some of which may contribute to arrhythmia perpetuation in persistent atrial fibrillation (PsAF). Patient-specific computational models derived from late gadolinium-enhanced magnetic resonance imaging (LGE-MRI) has the potential to non-invasively identify all areas of the fibrotic substrate where RDs could potentially be sustained, including locations where RDs may not manifest during mapped AF episodes. The objective of this study was to carry out multi-modal assessment of the arrhythmogenic propensity of the fibrotic substrate in PsAF patients by comparing locations of RD-harboring regions found in simulations and detected by FIRM (RDsim and RDFIRM) and analyze implications for ablation strategies predicated on targeting RDs. For 11 PsAF patients who underwent pre-procedure LGE-MRI and FIRM-guided ablation, we retrospectively simulated AF in individualized atrial models, with geometry and fibrosis distribution reconstructed from pre-ablation LGE-MRI scans, and identified RDsim sites. Regions harboring RDsim and RDFIRM were compared. RDsim were found in 38 atrial regions (median [inter-quartile range (IQR)] = 4 [3; 4] per model). RDFIRM were identified and subsequently ablated in 24 atrial regions (2 [1; 3] per patient), which was significantly fewer than the number of RDsim-harboring regions in corresponding models (p < 0.05). Computational modeling predicted RDsim in 20 of 24 (83%) atrial regions identified as RDFIRM-harboring during clinical mapping. In a large number of cases, we uncovered RDsim-harboring regions in which RDFIRM were never observed (18/22 regions that differed between the two modalities; 82%); we termed such cases "latent" RDsim sites. During follow-up (230 [180; 326] days), AF recurrence occurred in 7/11 (64%) individuals. Interestingly, latent RDsim sites were observed in all seven computational models corresponding to patients who experienced recurrent AF (2 [2; 2] per patient); in contrast, latent RDsim sites were only discovered in two of four patients who were free from AF during follow-up (0.5 [0; 1.5] per patient; p < 0.05 vs. patients with AF recurrence). We conclude that substrate-based ablation based on computational modeling could improve outcomes.

Original languageEnglish (US)
Article number1151
JournalFrontiers in Physiology
Volume9
Issue numberAUG
DOIs
StatePublished - Aug 29 2018

Fingerprint

Atrial Fibrillation
Gadolinium
Magnetic Resonance Imaging
Furylfuramide
Cardiac Catheters
Recurrence
Catheter Ablation
Cardiac Arrhythmias
Fibrosis

Keywords

  • Ablation
  • Atrial fibrillation
  • Computational modeling
  • Fibrotic remodeling
  • Intracardiac electroanatomic mapping
  • Re-entrant drivers

ASJC Scopus subject areas

  • Physiology
  • Physiology (medical)

Cite this

The fibrotic substrate in persistent atrial fibrillation patients : Comparison between predictions from computational modeling and measurements from focal impulse and rotor mapping. / Boyle, Patrick M.; Hakim, Joe B.; Zahid, Sohail; Franceschi, William H.; Murphy, Michael J.; Prakosa, Adityo; Aronis, Konstantinos N.; Zghaib, Tarek; Balouch, Muhammed; Ipek, Esra G.; Chrispin, Jonathan; Berger, Ronald D; Ashikaga, Hiroshi; Marine, Joseph; Calkins, Hugh; Nazarian, Saman; Spragg, David D; Trayanova, Natalia A.

In: Frontiers in Physiology, Vol. 9, No. AUG, 1151, 29.08.2018.

Research output: Contribution to journalArticle

Boyle, Patrick M. ; Hakim, Joe B. ; Zahid, Sohail ; Franceschi, William H. ; Murphy, Michael J. ; Prakosa, Adityo ; Aronis, Konstantinos N. ; Zghaib, Tarek ; Balouch, Muhammed ; Ipek, Esra G. ; Chrispin, Jonathan ; Berger, Ronald D ; Ashikaga, Hiroshi ; Marine, Joseph ; Calkins, Hugh ; Nazarian, Saman ; Spragg, David D ; Trayanova, Natalia A. / The fibrotic substrate in persistent atrial fibrillation patients : Comparison between predictions from computational modeling and measurements from focal impulse and rotor mapping. In: Frontiers in Physiology. 2018 ; Vol. 9, No. AUG.
@article{f0adedb942f245c4ba5540e0e6f8a7c7,
title = "The fibrotic substrate in persistent atrial fibrillation patients: Comparison between predictions from computational modeling and measurements from focal impulse and rotor mapping",
abstract = "Focal impulse and rotor mapping (FIRM) involves intracardiac detection and catheter ablation of re-entrant drivers (RDs), some of which may contribute to arrhythmia perpetuation in persistent atrial fibrillation (PsAF). Patient-specific computational models derived from late gadolinium-enhanced magnetic resonance imaging (LGE-MRI) has the potential to non-invasively identify all areas of the fibrotic substrate where RDs could potentially be sustained, including locations where RDs may not manifest during mapped AF episodes. The objective of this study was to carry out multi-modal assessment of the arrhythmogenic propensity of the fibrotic substrate in PsAF patients by comparing locations of RD-harboring regions found in simulations and detected by FIRM (RDsim and RDFIRM) and analyze implications for ablation strategies predicated on targeting RDs. For 11 PsAF patients who underwent pre-procedure LGE-MRI and FIRM-guided ablation, we retrospectively simulated AF in individualized atrial models, with geometry and fibrosis distribution reconstructed from pre-ablation LGE-MRI scans, and identified RDsim sites. Regions harboring RDsim and RDFIRM were compared. RDsim were found in 38 atrial regions (median [inter-quartile range (IQR)] = 4 [3; 4] per model). RDFIRM were identified and subsequently ablated in 24 atrial regions (2 [1; 3] per patient), which was significantly fewer than the number of RDsim-harboring regions in corresponding models (p < 0.05). Computational modeling predicted RDsim in 20 of 24 (83{\%}) atrial regions identified as RDFIRM-harboring during clinical mapping. In a large number of cases, we uncovered RDsim-harboring regions in which RDFIRM were never observed (18/22 regions that differed between the two modalities; 82{\%}); we termed such cases {"}latent{"} RDsim sites. During follow-up (230 [180; 326] days), AF recurrence occurred in 7/11 (64{\%}) individuals. Interestingly, latent RDsim sites were observed in all seven computational models corresponding to patients who experienced recurrent AF (2 [2; 2] per patient); in contrast, latent RDsim sites were only discovered in two of four patients who were free from AF during follow-up (0.5 [0; 1.5] per patient; p < 0.05 vs. patients with AF recurrence). We conclude that substrate-based ablation based on computational modeling could improve outcomes.",
keywords = "Ablation, Atrial fibrillation, Computational modeling, Fibrotic remodeling, Intracardiac electroanatomic mapping, Re-entrant drivers",
author = "Boyle, {Patrick M.} and Hakim, {Joe B.} and Sohail Zahid and Franceschi, {William H.} and Murphy, {Michael J.} and Adityo Prakosa and Aronis, {Konstantinos N.} and Tarek Zghaib and Muhammed Balouch and Ipek, {Esra G.} and Jonathan Chrispin and Berger, {Ronald D} and Hiroshi Ashikaga and Joseph Marine and Hugh Calkins and Saman Nazarian and Spragg, {David D} and Trayanova, {Natalia A.}",
year = "2018",
month = "8",
day = "29",
doi = "10.3389/fphys.2018.01151",
language = "English (US)",
volume = "9",
journal = "Frontiers in Physiology",
issn = "1664-042X",
publisher = "Frontiers Research Foundation",
number = "AUG",

}

TY - JOUR

T1 - The fibrotic substrate in persistent atrial fibrillation patients

T2 - Comparison between predictions from computational modeling and measurements from focal impulse and rotor mapping

AU - Boyle, Patrick M.

AU - Hakim, Joe B.

AU - Zahid, Sohail

AU - Franceschi, William H.

AU - Murphy, Michael J.

AU - Prakosa, Adityo

AU - Aronis, Konstantinos N.

AU - Zghaib, Tarek

AU - Balouch, Muhammed

AU - Ipek, Esra G.

AU - Chrispin, Jonathan

AU - Berger, Ronald D

AU - Ashikaga, Hiroshi

AU - Marine, Joseph

AU - Calkins, Hugh

AU - Nazarian, Saman

AU - Spragg, David D

AU - Trayanova, Natalia A.

PY - 2018/8/29

Y1 - 2018/8/29

N2 - Focal impulse and rotor mapping (FIRM) involves intracardiac detection and catheter ablation of re-entrant drivers (RDs), some of which may contribute to arrhythmia perpetuation in persistent atrial fibrillation (PsAF). Patient-specific computational models derived from late gadolinium-enhanced magnetic resonance imaging (LGE-MRI) has the potential to non-invasively identify all areas of the fibrotic substrate where RDs could potentially be sustained, including locations where RDs may not manifest during mapped AF episodes. The objective of this study was to carry out multi-modal assessment of the arrhythmogenic propensity of the fibrotic substrate in PsAF patients by comparing locations of RD-harboring regions found in simulations and detected by FIRM (RDsim and RDFIRM) and analyze implications for ablation strategies predicated on targeting RDs. For 11 PsAF patients who underwent pre-procedure LGE-MRI and FIRM-guided ablation, we retrospectively simulated AF in individualized atrial models, with geometry and fibrosis distribution reconstructed from pre-ablation LGE-MRI scans, and identified RDsim sites. Regions harboring RDsim and RDFIRM were compared. RDsim were found in 38 atrial regions (median [inter-quartile range (IQR)] = 4 [3; 4] per model). RDFIRM were identified and subsequently ablated in 24 atrial regions (2 [1; 3] per patient), which was significantly fewer than the number of RDsim-harboring regions in corresponding models (p < 0.05). Computational modeling predicted RDsim in 20 of 24 (83%) atrial regions identified as RDFIRM-harboring during clinical mapping. In a large number of cases, we uncovered RDsim-harboring regions in which RDFIRM were never observed (18/22 regions that differed between the two modalities; 82%); we termed such cases "latent" RDsim sites. During follow-up (230 [180; 326] days), AF recurrence occurred in 7/11 (64%) individuals. Interestingly, latent RDsim sites were observed in all seven computational models corresponding to patients who experienced recurrent AF (2 [2; 2] per patient); in contrast, latent RDsim sites were only discovered in two of four patients who were free from AF during follow-up (0.5 [0; 1.5] per patient; p < 0.05 vs. patients with AF recurrence). We conclude that substrate-based ablation based on computational modeling could improve outcomes.

AB - Focal impulse and rotor mapping (FIRM) involves intracardiac detection and catheter ablation of re-entrant drivers (RDs), some of which may contribute to arrhythmia perpetuation in persistent atrial fibrillation (PsAF). Patient-specific computational models derived from late gadolinium-enhanced magnetic resonance imaging (LGE-MRI) has the potential to non-invasively identify all areas of the fibrotic substrate where RDs could potentially be sustained, including locations where RDs may not manifest during mapped AF episodes. The objective of this study was to carry out multi-modal assessment of the arrhythmogenic propensity of the fibrotic substrate in PsAF patients by comparing locations of RD-harboring regions found in simulations and detected by FIRM (RDsim and RDFIRM) and analyze implications for ablation strategies predicated on targeting RDs. For 11 PsAF patients who underwent pre-procedure LGE-MRI and FIRM-guided ablation, we retrospectively simulated AF in individualized atrial models, with geometry and fibrosis distribution reconstructed from pre-ablation LGE-MRI scans, and identified RDsim sites. Regions harboring RDsim and RDFIRM were compared. RDsim were found in 38 atrial regions (median [inter-quartile range (IQR)] = 4 [3; 4] per model). RDFIRM were identified and subsequently ablated in 24 atrial regions (2 [1; 3] per patient), which was significantly fewer than the number of RDsim-harboring regions in corresponding models (p < 0.05). Computational modeling predicted RDsim in 20 of 24 (83%) atrial regions identified as RDFIRM-harboring during clinical mapping. In a large number of cases, we uncovered RDsim-harboring regions in which RDFIRM were never observed (18/22 regions that differed between the two modalities; 82%); we termed such cases "latent" RDsim sites. During follow-up (230 [180; 326] days), AF recurrence occurred in 7/11 (64%) individuals. Interestingly, latent RDsim sites were observed in all seven computational models corresponding to patients who experienced recurrent AF (2 [2; 2] per patient); in contrast, latent RDsim sites were only discovered in two of four patients who were free from AF during follow-up (0.5 [0; 1.5] per patient; p < 0.05 vs. patients with AF recurrence). We conclude that substrate-based ablation based on computational modeling could improve outcomes.

KW - Ablation

KW - Atrial fibrillation

KW - Computational modeling

KW - Fibrotic remodeling

KW - Intracardiac electroanatomic mapping

KW - Re-entrant drivers

UR - http://www.scopus.com/inward/record.url?scp=85052800570&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85052800570&partnerID=8YFLogxK

U2 - 10.3389/fphys.2018.01151

DO - 10.3389/fphys.2018.01151

M3 - Article

C2 - 30210356

AN - SCOPUS:85052800570

VL - 9

JO - Frontiers in Physiology

JF - Frontiers in Physiology

SN - 1664-042X

IS - AUG

M1 - 1151

ER -