Personalized Evaluation of Atrial Complexity of Patients Undergoing Atrial Fibrillation Ablation: A Clinical Computational Study

Current clinical guidelines establish Pulmonary Vein (PV) isolation as the indicated treatment for Atrial Fibrillation (AF). However, AF can also be triggered or sustained due to atrial drivers located elsewhere in the atria. We designed a new simulation workflow based on personalized computer simul...

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Authors: Sánchez De La Nava, Ana María, González Mansilla, Ana, González Torrecilla, Esteban, Ávila, Pablo, Datino, Tomás, Bermejo Thomas, Francisco Javier, Arenal, Ángel, Fernández-Avilés Díaz, Francisco Jesús, Atienza Fernández, Felipe
Format: article
Publication Date:2021
Country:España
Institution:Universidad Complutense de Madrid (UCM)
Repository:Docta Complutense
Language:English
OAI Identifier:oai:docta.ucm.es:20.500.14352/4742
Online Access:https://hdl.handle.net/20.500.14352/4742
Access Level:Open access
Keyword:Atrial fibrillation
Computational models
Ablation
Personalized models
Bioinformática
Cardiología
3205.01 Cardiología
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oai_identifier_str oai:docta.ucm.es:20.500.14352/4742
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spelling Personalized Evaluation of Atrial Complexity of Patients Undergoing Atrial Fibrillation Ablation: A Clinical Computational StudySánchez De La Nava, Ana MaríaGonzález Mansilla, AnaGonzález Torrecilla, EstebanÁvila, PabloDatino, TomásBermejo Thomas, Francisco JavierArenal, ÁngelFernández-Avilés Díaz, Francisco JesúsAtienza Fernández, FelipeAtrial fibrillationComputational modelsAblationPersonalized modelsBioinformáticaCardiología3205.01 CardiologíaCurrent clinical guidelines establish Pulmonary Vein (PV) isolation as the indicated treatment for Atrial Fibrillation (AF). However, AF can also be triggered or sustained due to atrial drivers located elsewhere in the atria. We designed a new simulation workflow based on personalized computer simulations to characterize AF complexity of patients undergoing PV ablation, validated with non-invasive electrocardiographic imaging and evaluated at one year after ablation. We included 30 patients using atrial anatomies segmented from MRI and simulated an automata model for the electrical modelling, consisting of three states (resting, excited and refractory). In total, 100 different scenarios were simulated per anatomy varying rotor number and location. The 3 states were calibrated with Koivumaki action potential, entropy maps were obtained from the electrograms and compared with ECGi for each patient to analyze PV isolation outcome. The completion of the workflow indicated that successful AF ablation occurred in patients with rotors mainly located at the PV antrum, while unsuccessful procedures presented greater number of driving sites outside the PV area. The number of rotors attached to the PV was significantly higher in patients with favorable long-term ablation outcome (1-year freedom from AF: 1.61 ± 0.21 vs. AF recurrence: 1.40 ± 0.20; p-value = 0.018). The presented workflow could improve patient stratification for PV ablation by screening the complexity of the atria.MPDIUniversidad Complutense de Madrid20212021-08-2820212021-08-28journal articlehttp://purl.org/coar/resource_type/c_6501info:eu-repo/semantics/articleapplication/pdfhttps://hdl.handle.net/20.500.14352/4742reponame:Docta Complutenseinstname:Universidad Complutense de Madrid (UCM)Inglésengopen accesshttp://purl.org/coar/access_right/c_abf2Atribución 3.0 Españahttps://creativecommons.org/licenses/by/3.0/es/info:eu-repo/semantics/openAccessoai:docta.ucm.es:20.500.14352/47422026-06-02T12:44:21Z
dc.title.none.fl_str_mv Personalized Evaluation of Atrial Complexity of Patients Undergoing Atrial Fibrillation Ablation: A Clinical Computational Study
title Personalized Evaluation of Atrial Complexity of Patients Undergoing Atrial Fibrillation Ablation: A Clinical Computational Study
spellingShingle Personalized Evaluation of Atrial Complexity of Patients Undergoing Atrial Fibrillation Ablation: A Clinical Computational Study
Sánchez De La Nava, Ana María
Atrial fibrillation
Computational models
Ablation
Personalized models
Bioinformática
Cardiología
3205.01 Cardiología
title_short Personalized Evaluation of Atrial Complexity of Patients Undergoing Atrial Fibrillation Ablation: A Clinical Computational Study
title_full Personalized Evaluation of Atrial Complexity of Patients Undergoing Atrial Fibrillation Ablation: A Clinical Computational Study
title_fullStr Personalized Evaluation of Atrial Complexity of Patients Undergoing Atrial Fibrillation Ablation: A Clinical Computational Study
title_full_unstemmed Personalized Evaluation of Atrial Complexity of Patients Undergoing Atrial Fibrillation Ablation: A Clinical Computational Study
title_sort Personalized Evaluation of Atrial Complexity of Patients Undergoing Atrial Fibrillation Ablation: A Clinical Computational Study
dc.creator.none.fl_str_mv Sánchez De La Nava, Ana María
González Mansilla, Ana
González Torrecilla, Esteban
Ávila, Pablo
Datino, Tomás
Bermejo Thomas, Francisco Javier
Arenal, Ángel
Fernández-Avilés Díaz, Francisco Jesús
Atienza Fernández, Felipe
author Sánchez De La Nava, Ana María
author_facet Sánchez De La Nava, Ana María
González Mansilla, Ana
González Torrecilla, Esteban
Ávila, Pablo
Datino, Tomás
Bermejo Thomas, Francisco Javier
Arenal, Ángel
Fernández-Avilés Díaz, Francisco Jesús
Atienza Fernández, Felipe
author_role author
author2 González Mansilla, Ana
González Torrecilla, Esteban
Ávila, Pablo
Datino, Tomás
Bermejo Thomas, Francisco Javier
Arenal, Ángel
Fernández-Avilés Díaz, Francisco Jesús
Atienza Fernández, Felipe
author2_role author
author
author
author
author
author
author
author
dc.contributor.none.fl_str_mv Universidad Complutense de Madrid
dc.subject.none.fl_str_mv Atrial fibrillation
Computational models
Ablation
Personalized models
Bioinformática
Cardiología
3205.01 Cardiología
topic Atrial fibrillation
Computational models
Ablation
Personalized models
Bioinformática
Cardiología
3205.01 Cardiología
description Current clinical guidelines establish Pulmonary Vein (PV) isolation as the indicated treatment for Atrial Fibrillation (AF). However, AF can also be triggered or sustained due to atrial drivers located elsewhere in the atria. We designed a new simulation workflow based on personalized computer simulations to characterize AF complexity of patients undergoing PV ablation, validated with non-invasive electrocardiographic imaging and evaluated at one year after ablation. We included 30 patients using atrial anatomies segmented from MRI and simulated an automata model for the electrical modelling, consisting of three states (resting, excited and refractory). In total, 100 different scenarios were simulated per anatomy varying rotor number and location. The 3 states were calibrated with Koivumaki action potential, entropy maps were obtained from the electrograms and compared with ECGi for each patient to analyze PV isolation outcome. The completion of the workflow indicated that successful AF ablation occurred in patients with rotors mainly located at the PV antrum, while unsuccessful procedures presented greater number of driving sites outside the PV area. The number of rotors attached to the PV was significantly higher in patients with favorable long-term ablation outcome (1-year freedom from AF: 1.61 ± 0.21 vs. AF recurrence: 1.40 ± 0.20; p-value = 0.018). The presented workflow could improve patient stratification for PV ablation by screening the complexity of the atria.
publishDate 2021
dc.date.none.fl_str_mv 2021
2021-08-28
2021
2021-08-28
dc.type.none.fl_str_mv journal article
http://purl.org/coar/resource_type/c_6501
dc.type.openaire.fl_str_mv info:eu-repo/semantics/article
format article
dc.identifier.none.fl_str_mv https://hdl.handle.net/20.500.14352/4742
url https://hdl.handle.net/20.500.14352/4742
dc.language.none.fl_str_mv Inglés
eng
language_invalid_str_mv Inglés
language eng
dc.rights.none.fl_str_mv open access
http://purl.org/coar/access_right/c_abf2
Atribución 3.0 España
https://creativecommons.org/licenses/by/3.0/es/
dc.rights.openaire.fl_str_mv info:eu-repo/semantics/openAccess
rights_invalid_str_mv open access
http://purl.org/coar/access_right/c_abf2
Atribución 3.0 España
https://creativecommons.org/licenses/by/3.0/es/
eu_rights_str_mv openAccess
dc.format.none.fl_str_mv application/pdf
dc.publisher.none.fl_str_mv MPDI
publisher.none.fl_str_mv MPDI
dc.source.none.fl_str_mv reponame:Docta Complutense
instname:Universidad Complutense de Madrid (UCM)
instname_str Universidad Complutense de Madrid (UCM)
reponame_str Docta Complutense
collection Docta Complutense
repository.name.fl_str_mv
repository.mail.fl_str_mv
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score 15,300724

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