المؤلفون: Meo M; Institute of Electrophysiology and Heart Modeling (IHU Liryc), Foundation Bordeaux University, Bordeaux, France.; Centre de Recherche Cardio-Thoracique de Bordeaux, U1045, University of Bordeaux, Bordeaux, France.; Centre de Recherche Cardio-Thoracique de Bordeaux, U1045, Institut National de la Santé et de la Recherche Médicale, Bordeaux, France., Denis A; Institute of Electrophysiology and Heart Modeling (IHU Liryc), Foundation Bordeaux University, Bordeaux, France.; Electrophysiology and Ablation Unit, Bordeaux University Hospital, Bordeaux, France., Sacher F; Institute of Electrophysiology and Heart Modeling (IHU Liryc), Foundation Bordeaux University, Bordeaux, France.; Electrophysiology and Ablation Unit, Bordeaux University Hospital, Bordeaux, France., Duchâteau J; Institute of Electrophysiology and Heart Modeling (IHU Liryc), Foundation Bordeaux University, Bordeaux, France.; Centre de Recherche Cardio-Thoracique de Bordeaux, U1045, University of Bordeaux, Bordeaux, France.; Centre de Recherche Cardio-Thoracique de Bordeaux, U1045, Institut National de la Santé et de la Recherche Médicale, Bordeaux, France.; Electrophysiology and Ablation Unit, Bordeaux University Hospital, Bordeaux, France., Cheniti G; Institute of Electrophysiology and Heart Modeling (IHU Liryc), Foundation Bordeaux University, Bordeaux, France.; Electrophysiology and Ablation Unit, Bordeaux University Hospital, Bordeaux, France., Puyo S; Institute of Electrophysiology and Heart Modeling (IHU Liryc), Foundation Bordeaux University, Bordeaux, France.; Electrophysiology and Ablation Unit, Bordeaux University Hospital, Bordeaux, France., Bear L; Institute of Electrophysiology and Heart Modeling (IHU Liryc), Foundation Bordeaux University, Bordeaux, France.; Centre de Recherche Cardio-Thoracique de Bordeaux, U1045, University of Bordeaux, Bordeaux, France.; Centre de Recherche Cardio-Thoracique de Bordeaux, U1045, Institut National de la Santé et de la Recherche Médicale, Bordeaux, France., Jaïs P; Institute of Electrophysiology and Heart Modeling (IHU Liryc), Foundation Bordeaux University, Bordeaux, France.; Centre de Recherche Cardio-Thoracique de Bordeaux, U1045, University of Bordeaux, Bordeaux, France.; Centre de Recherche Cardio-Thoracique de Bordeaux, U1045, Institut National de la Santé et de la Recherche Médicale, Bordeaux, France.; Electrophysiology and Ablation Unit, Bordeaux University Hospital, Bordeaux, France., Hocini M; Institute of Electrophysiology and Heart Modeling (IHU Liryc), Foundation Bordeaux University, Bordeaux, France.; Centre de Recherche Cardio-Thoracique de Bordeaux, U1045, University of Bordeaux, Bordeaux, France.; Centre de Recherche Cardio-Thoracique de Bordeaux, U1045, Institut National de la Santé et de la Recherche Médicale, Bordeaux, France.; Electrophysiology and Ablation Unit, Bordeaux University Hospital, Bordeaux, France., Haïssaguerre M; Institute of Electrophysiology and Heart Modeling (IHU Liryc), Foundation Bordeaux University, Bordeaux, France.; Centre de Recherche Cardio-Thoracique de Bordeaux, U1045, University of Bordeaux, Bordeaux, France.; Centre de Recherche Cardio-Thoracique de Bordeaux, U1045, Institut National de la Santé et de la Recherche Médicale, Bordeaux, France.; Electrophysiology and Ablation Unit, Bordeaux University Hospital, Bordeaux, France., Bernus O; Institute of Electrophysiology and Heart Modeling (IHU Liryc), Foundation Bordeaux University, Bordeaux, France.; Centre de Recherche Cardio-Thoracique de Bordeaux, U1045, University of Bordeaux, Bordeaux, France.; Centre de Recherche Cardio-Thoracique de Bordeaux, U1045, Institut National de la Santé et de la Recherche Médicale, Bordeaux, France., Dubois R; Institute of Electrophysiology and Heart Modeling (IHU Liryc), Foundation Bordeaux University, Bordeaux, France.; Centre de Recherche Cardio-Thoracique de Bordeaux, U1045, University of Bordeaux, Bordeaux, France.; Centre de Recherche Cardio-Thoracique de Bordeaux, U1045, Institut National de la Santé et de la Recherche Médicale, Bordeaux, France.

المصدر: Frontiers in physiology [Front Physiol] 2020 Sep 23; Vol. 11, pp. 554838. Date of Electronic Publication: 2020 Sep 23 (Print Publication: 2020).

نوع المنشور: Journal Article

بيانات الدورية: Publisher: Frontiers Research Foundation Country of Publication: Switzerland NLM ID: 101549006 Publication Model: eCollection Cited Medium: Print ISSN: 1664-042X (Print) Linking ISSN: 1664042X NLM ISO Abbreviation: Front Physiol Subsets: PubMed not MEDLINE

مستخلص: Background: Ventricular fibrillation (VF) is the main cause of sudden cardiac death, but its mechanisms are still unclear. We propose a noninvasive approach to describe the progression of VF complexity from body surface potential maps (BSPMs).
Methods: We mapped 252 VF episodes (16 ± 10 s) with a 252-electrode vest in 110 patients (89 male, 47 ± 18 years): 50 terminated spontaneously, otherwise by electrical cardioversion (DCC). Changes in complexity were assessed between the onset ("VF start") and the end ("VF end") of VF by the nondipolar component index ( N D I B S P M ), measuring the fraction of energy nonpreserved by an equivalent 3D dipole from BSPMs. Higher NDI reflected lower VF organization. We also examined other standard body surface markers of VF dynamics, including fibrillatory wave amplitude ( A BSPM ), surface cycle length ( BsCL BSPM ) and Shannon entropy ( S h E n B S P M ). Differences between patients with and without structural heart diseases (SHD, 32 vs. NSHD, 78) were also tested at those stages. Electrocardiographic features were validated with simultaneous endocardium cycle length (CL) in a subset of 30 patients.
Results: All BSPM markers measure an increase in electrical complexity during VF ( p < 0.0001), and more significantly in NSHD patients. Complexity is significantly higher at the end of sustained VF episodes requiring DCC. Intraepisode intracardiac CL shortening (VF start 197 ± 24 vs. VF end 169 ± 20 ms; p < 0.0001) correlates with an increase in NDI, and decline in surface CL, f-wave amplitude, and entropy ( p < 0.0001). In SHD patients VF is initially more complex than in NSHD patients ( N D I B S P M , p = 0.0007; S h E n B S P M , p < 0.0001), with moderately slower ( BsCL BSPM , p = 0.06), low-amplitude f-waves ( A BSPM , p < 0.0001). In this population, lower NDI ( p = 0.004) and slower surface CL ( p = 0.008) at early stage of VF predict self-termination. In the NSHD group, a more abrupt increase in VF complexity is quantified by all BSPM parameters during sustained VF ( p < 0.0001), whereas arrhythmia evolution is stable during self-terminating episodes, hinting at additional mechanisms driving VF dynamics.
Conclusion: Multilead BSPM analysis underlines distinct degrees of VF complexity based on substrate characteristics.
(Copyright © 2020 Meo, Denis, Sacher, Duchâteau, Cheniti, Puyo, Bear, Jaïs, Hocini, Haïssaguerre, Bernus and Dubois.)

المؤلفون: Meo M; Institute of Electrophysiology and Heart Modeling (IHU Liryc), Foundation Bordeaux University, Pessac-Bordeaux, France.; University of Bordeaux, CRCTB, U1045, Bordeaux, France.; INSERM, CRCTB, U1045, Bordeaux, France., Pambrun T; Institute of Electrophysiology and Heart Modeling (IHU Liryc), Foundation Bordeaux University, Pessac-Bordeaux, France.; Bordeaux University Hospital Centre Hospitalier Universitaire, Electrophysiology and Ablation Unit, Pessac, France., Derval N; Institute of Electrophysiology and Heart Modeling (IHU Liryc), Foundation Bordeaux University, Pessac-Bordeaux, France.; Bordeaux University Hospital Centre Hospitalier Universitaire, Electrophysiology and Ablation Unit, Pessac, France., Dumas-Pomier C; CardioInsight, Medtronic, Minneapolis, MN, United States., Puyo S; Institute of Electrophysiology and Heart Modeling (IHU Liryc), Foundation Bordeaux University, Pessac-Bordeaux, France.; Bordeaux University Hospital Centre Hospitalier Universitaire, Electrophysiology and Ablation Unit, Pessac, France., Duchâteau J; Institute of Electrophysiology and Heart Modeling (IHU Liryc), Foundation Bordeaux University, Pessac-Bordeaux, France.; University of Bordeaux, CRCTB, U1045, Bordeaux, France.; INSERM, CRCTB, U1045, Bordeaux, France.; Bordeaux University Hospital Centre Hospitalier Universitaire, Electrophysiology and Ablation Unit, Pessac, France., Jaïs P; Institute of Electrophysiology and Heart Modeling (IHU Liryc), Foundation Bordeaux University, Pessac-Bordeaux, France.; University of Bordeaux, CRCTB, U1045, Bordeaux, France.; INSERM, CRCTB, U1045, Bordeaux, France.; Bordeaux University Hospital Centre Hospitalier Universitaire, Electrophysiology and Ablation Unit, Pessac, France., Hocini M; Institute of Electrophysiology and Heart Modeling (IHU Liryc), Foundation Bordeaux University, Pessac-Bordeaux, France.; University of Bordeaux, CRCTB, U1045, Bordeaux, France.; INSERM, CRCTB, U1045, Bordeaux, France.; Bordeaux University Hospital Centre Hospitalier Universitaire, Electrophysiology and Ablation Unit, Pessac, France., Haïssaguerre M; Institute of Electrophysiology and Heart Modeling (IHU Liryc), Foundation Bordeaux University, Pessac-Bordeaux, France.; University of Bordeaux, CRCTB, U1045, Bordeaux, France.; INSERM, CRCTB, U1045, Bordeaux, France.; Bordeaux University Hospital Centre Hospitalier Universitaire, Electrophysiology and Ablation Unit, Pessac, France., Dubois R; Institute of Electrophysiology and Heart Modeling (IHU Liryc), Foundation Bordeaux University, Pessac-Bordeaux, France.; University of Bordeaux, CRCTB, U1045, Bordeaux, France.; INSERM, CRCTB, U1045, Bordeaux, France.

المصدر: Frontiers in physiology [Front Physiol] 2018 Jul 17; Vol. 9, pp. 929. Date of Electronic Publication: 2018 Jul 17 (Print Publication: 2018).

نوع المنشور: Journal Article

بيانات الدورية: Publisher: Frontiers Research Foundation Country of Publication: Switzerland NLM ID: 101549006 Publication Model: eCollection Cited Medium: Print ISSN: 1664-042X (Print) Linking ISSN: 1664042X NLM ISO Abbreviation: Front Physiol Subsets: PubMed not MEDLINE

مستخلص: Background: The use of surface recordings to assess atrial fibrillation (AF) complexity is still limited in clinical practice. We propose a noninvasive tool to quantify AF complexity from body surface potential maps (BSPMs) that could be used to choose patients who are eligible for AF ablation and assess therapy impact. Methods: BSPMs (mean duration: 7 ± 4 s) were recorded with a 252-lead vest in 97 persistent AF patients (80 male, 64 ± 11 years, duration 9.6 ± 10.4 months) before undergoing catheter ablation. Baseline cycle length (CL) was measured in the left atrial appendage. The procedural endpoint was AF termination. The ablation strategy impact was defined in terms of number of regions ablated, radiofrequency delivery time to achieve AF termination, and acute outcome. The atrial fibrillatory wave signal extracted from BSPMs was divided in 0.5-s consecutive segments, each projected on a 3D subspace determined through principal component analysis (PCA) in the current frame. We introduced the nondipolar component index (NDI) that quantifies the fraction of energy retained after subtracting an equivalent PCA dipolar approximation of heart electrical activity. AF complexity was assessed by the NDI averaged over the entire recording and compared to ablation strategy. Results: AF terminated in 77 patients (79%), whose baseline AF CL was 177 ± 40 ms, whereas it was 157 ± 26 ms in patients with unsuccessful ablation outcome ( p = 0.0586). Mean radiofrequency emission duration was 35 ± 21 min; 4 ± 2 regions were targeted. Long-lasting AF patients (≥12 months) exhibited higher complexity, with higher NDI values (≥12 months: 0.12 ± 0.04 vs. <12 months: 0.09 ± 0.03, p < 0.01) and short CLs (<160 ms: 0.12 ± 0.03 vs. between 160 and 180 ms: 0.10 ± 0.03 vs. >180 ms: 0.09 ± 0.03, p < 0.01). More organized AF as measured by lower NDI was associated with successful ablation outcome (termination: 0.10 ± 0.03 vs. no termination: 0.12 ± 0.04, p < 0.01), shorter procedures (<30 min: 0.09 ± 0.04 vs. ≥30 min: 0.11 ± 0.03, p < 0.001) and fewer ablation targets (<4: 0.09 ± 0.03 vs. ≥4: 0.11 ± 0.04, p < 0.01). Conclusions: AF complexity can be noninvasively quantified by PCA in BSPMs and correlates with ablation outcome and AF pathophysiology.

المؤلفون: Boyle PM; Department of Biomedical Engineering, Institute for Computational Medicine, Johns Hopkins University, Baltimore, MD, United States., Hakim JB; Department of Biomedical Engineering, Institute for Computational Medicine, Johns Hopkins University, Baltimore, MD, United States., Zahid S; Department of Biomedical Engineering, Institute for Computational Medicine, Johns Hopkins University, Baltimore, MD, United States., Franceschi WH; Department of Biomedical Engineering, Institute for Computational Medicine, Johns Hopkins University, Baltimore, MD, United States., Murphy MJ; Department of Biomedical Engineering, Institute for Computational Medicine, Johns Hopkins University, Baltimore, MD, United States., Vigmond EJ; L'Institut de RYthmologie et Modélisation Cardiaque (IHU-LIRYC), Pessac-Bordeaux, France., Dubois R; L'Institut de RYthmologie et Modélisation Cardiaque (IHU-LIRYC), Pessac-Bordeaux, France., Haïssaguerre M; L'Institut de RYthmologie et Modélisation Cardiaque (IHU-LIRYC), Pessac-Bordeaux, France.; Centre Hospitalier Universitaire de Bordeaux, Pessac-Bordeaux, France., Hocini M; L'Institut de RYthmologie et Modélisation Cardiaque (IHU-LIRYC), Pessac-Bordeaux, France.; Centre Hospitalier Universitaire de Bordeaux, Pessac-Bordeaux, France., Jaïs P; L'Institut de RYthmologie et Modélisation Cardiaque (IHU-LIRYC), Pessac-Bordeaux, France.; Centre Hospitalier Universitaire de Bordeaux, Pessac-Bordeaux, France., Trayanova NA; Department of Biomedical Engineering, Institute for Computational Medicine, Johns Hopkins University, Baltimore, MD, United States., Cochet H; L'Institut de RYthmologie et Modélisation Cardiaque (IHU-LIRYC), Pessac-Bordeaux, France.; Centre Hospitalier Universitaire de Bordeaux, Pessac-Bordeaux, France.

المصدر: Frontiers in physiology [Front Physiol] 2018 Apr 19; Vol. 9, pp. 414. Date of Electronic Publication: 2018 Apr 19 (Print Publication: 2018).

نوع المنشور: Journal Article

بيانات الدورية: Publisher: Frontiers Research Foundation Country of Publication: Switzerland NLM ID: 101549006 Publication Model: eCollection Cited Medium: Print ISSN: 1664-042X (Print) Linking ISSN: 1664042X NLM ISO Abbreviation: Front Physiol Subsets: PubMed not MEDLINE

مستخلص: Electrocardiographic mapping (ECGI) detects reentrant drivers (RDs) that perpetuate arrhythmia in persistent AF (PsAF). Patient-specific computational models derived from late gadolinium-enhanced magnetic resonance imaging (LGE-MRI) identify all latent sites in the fibrotic substrate that could potentially sustain RDs, not just those manifested during mapped AF. The objective of this study was to compare RDs from simulations and ECGI (RD sim /RD ECGI ) and analyze implications for ablation. We considered 12 PsAF patients who underwent RD ECGI ablation. For the same cohort, we simulated AF and identified RD sim sites in patient-specific models with geometry and fibrosis distribution from pre-ablation LGE-MRI. RD sim - and RD ECGI -harboring regions were compared, and the extent of agreement between macroscopic locations of RDs identified by simulations and ECGI was assessed. Effects of ablating RD ECGI /RD sim were analyzed. RD sim were predicted in 28 atrial regions (median [inter-quartile range (IQR)] = 3.0 [1.0; 3.0] per model). ECGI detected 42 RD ECGI -harboring regions (4.0 [2.0; 5.0] per patient). The number of regions with RD sim and RD ECGI per individual was not significantly correlated ( R = 0.46, P = ns). The overall rate of regional agreement was fair (modified Cohen's κ 0 statistic = 0.11), as expected, based on the different mechanistic underpinning of RD sim - and RD ECGI . nineteen regions were found to harbor both RD sim and RD ECGI , suggesting that a subset of clinically observed RDs was fibrosis-mediated. The most frequent source of differences (23/32 regions) between the two modalities was the presence of RD ECGI perpetuated by mechanisms other than the fibrotic substrate. In 6/12 patients, there was at least one region where a latent RD was observed in simulations but was not manifested during clinical mapping. Ablation of fibrosis-mediated RD ECGI (i.e., targets in regions that also harbored RD sim ) trended toward a higher rate of positive response compared to ablation of other RD ECGI targets (57 vs. 41%, P = ns). Our analysis suggests that RDs in human PsAF are at least partially fibrosis-mediated. Substrate-based ablation combining simulations with ECGI could improve outcomes.

المؤلفون: Bayer JD; Electrophysiology and Heart Modeling Institute (LIRYC), Bordeaux University FoundationPessac, France; Cardiothoracic Research Center of Bordeaux (Inserm U 1045), University of BordeauxBordeaux, France., Roney CH; Electrophysiology and Heart Modeling Institute (LIRYC), Bordeaux University FoundationPessac, France; Institute of Mathematics of Bordeaux (IMB), University of BordeauxTalence, France., Pashaei A; Electrophysiology and Heart Modeling Institute (LIRYC), Bordeaux University FoundationPessac, France; Institute of Mathematics of Bordeaux (IMB), University of BordeauxTalence, France., Jaïs P; Electrophysiology and Heart Modeling Institute (LIRYC), Bordeaux University FoundationPessac, France; Cardiothoracic Research Center of Bordeaux (Inserm U 1045), University of BordeauxBordeaux, France; Haut-Lévêque Cardiology Hospital, University Hospital Center (CHU) of BordeauxPessac, France., Vigmond EJ; Electrophysiology and Heart Modeling Institute (LIRYC), Bordeaux University FoundationPessac, France; Institute of Mathematics of Bordeaux (IMB), University of BordeauxTalence, France.

المصدر: Frontiers in physiology [Front Physiol] 2016 Apr 12; Vol. 7, pp. 108. Date of Electronic Publication: 2016 Apr 12 (Print Publication: 2016).

نوع المنشور: Journal Article

بيانات الدورية: Publisher: Frontiers Research Foundation Country of Publication: Switzerland NLM ID: 101549006 Publication Model: eCollection Cited Medium: Print ISSN: 1664-042X (Print) Linking ISSN: 1664042X NLM ISO Abbreviation: Front Physiol Subsets: PubMed not MEDLINE

مستخلص: Pulmonary vein isolation (PVI) with radiofrequency ablation (RFA) is the cornerstone of atrial fibrillation (AF) therapy, but few strategies exist for when it fails. To guide RFA, phase singularity (PS) mapping locates reentrant electrical waves (rotors) that perpetuate AF. The goal of this study was to test existing and develop new RFA strategies for terminating rotors identified with PS mapping. It is unsafe to test experimental RFA strategies in patients, so they were evaluated in silico using a bilayer computer model of the human atria with persistent AF (pAF) electrical (ionic) and structural (fibrosis) remodeling. pAF was initiated by rapidly pacing the right (RSPV) and left (LSPV) superior pulmonary veins during sinus rhythm, and rotor dynamics quantified by PS analysis. Three RFA strategies were studied: (i) PVI, roof, and mitral lines; (ii) circles, perforated circles, lines, and crosses 0.5-1.5 cm in diameter/length administered near rotor locations/pathways identified by PS mapping; and (iii) 4-8 lines streamlining the sequence of electrical activation during sinus rhythm. As in pAF patients, 2 ± 1 rotors with cycle length 185 ± 4 ms and short PS duration 452 ± 401 ms perpetuated simulated pAF. Spatially, PS density had weak to moderate positive correlations with fibrosis density (RSPV: r = 0.38, p = 0.35, LSPV: r = 0.77, p = 0.02). RFA PVI, mitral, and roof lines failed to terminate pAF, but RFA perforated circles and lines 1.5 cm in diameter/length terminated meandering rotors from RSPV pacing when placed at locations with high PS density. Similarly, RFA circles, perforated circles, and crosses 1.5 cm in diameter/length terminated stationary rotors from LSPV pacing. The most effective strategy for terminating pAF was to streamline the sequence of activation during sinus rhythm with >4 RFA lines. These results demonstrate that co-localizing 1.5 cm RFA lesions with locations of high PS density is a promising strategy for terminating pAF rotors. For patients immune to PVI, roof, mitral, and PS guided RFA strategies, streamlining patient-specific activation sequences during sinus rhythm is a robust but challenging alternative.