Variability in pulmonary vein electrophysiology and fibrosis determines arrhythmia susceptibility and dynamics
Langue
en
Article de revue
Ce document a été publié dans
PLoS Computational Biology. 2018-05-24, vol. 14, n° 5, p. e1006166
Public Library of Science
Résumé en anglais
Success rates for catheter ablation of persistent atrial fibrillation patients are currently low; however, there is a subset of patients for whom electrical isolation of the pulmonary veins alone is a successful treatment ...Lire la suite >
Success rates for catheter ablation of persistent atrial fibrillation patients are currently low; however, there is a subset of patients for whom electrical isolation of the pulmonary veins alone is a successful treatment strategy. It is difficult to identify these patients because there are a multitude of factors affecting arrhythmia susceptibility and maintenance, and the individual contributions of these factors are difficult to determine clinically. We hypothesised that the combination of pulmonary vein (PV) electrophysiology and atrial body fibrosis determine driver location and effectiveness of pulmonary vein isolation (PVI). We used bilayer biatrial computer models based on patient geometries to investigate the effects of PV properties and atrial fibrosis on arrhythmia inducibility, maintenance mechanisms, and the outcome of PVI. Short PV action potential duration (APD) increased arrhythmia susceptibility, while longer PV APD was found to be protective. Arrhythmia inducibility increased with slower conduction velocity (CV) at the LA/PV junction, but not for cases with homogeneous CV changes or slower CV at the distal PV. Phase singularity (PS) density in the PV region for cases with PV fibrosis was increased. Arrhythmia dynamics depend on both PV properties and fibrosis distribution, varying from meandering rotors to PV reentry (in cases with baseline or long APD), to stable rotors at regions of high fibrosis density. Measurement of fibrosis and PV properties may indicate patient specific susceptibility to AF initiation and maintenance. PV PS density before PVI was higher for cases in which AF terminated or converted to a macroreentry; thus, high PV PS density may indicate likelihood of PVI success.< Réduire
Project ANR
Dissection génétique de la Susceptibilité Mendélienne aux infections mycobactériennes chez l'homme - ANR-16-CE17-0005
Stimulation de surface étendue à faible intensité (WAYLESS): une nouvelle thérapie pour terminer les arythmies cardiaques létales - ANR-16-CE19-0009
Stimulation de surface étendue à faible intensité (WAYLESS): une nouvelle thérapie pour terminer les arythmies cardiaques létales - ANR-16-CE19-0009
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