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Epicardial Fibrosis Explains Increased Endo–Epicardial Dissociation and Epicardial Breakthroughs in Human Atrial Fibrillation

BACKGROUND: Atrial fibrillation (AF) is accompanied by progressive epicardial fibrosis, dissociation of electrical activity between the epicardial layer and the endocardial bundle network, and transmural conduction (breakthroughs). However, causal relationships between these phenomena have not been...

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Autores principales: Gharaviri, Ali, Bidar, Elham, Potse, Mark, Zeemering, Stef, Verheule, Sander, Pezzuto, Simone, Krause, Rolf, Maessen, Jos G., Auricchio, Angelo, Schotten, Ulrich
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Frontiers Media S.A. 2020
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7047215/
https://www.ncbi.nlm.nih.gov/pubmed/32153419
http://dx.doi.org/10.3389/fphys.2020.00068
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author Gharaviri, Ali
Bidar, Elham
Potse, Mark
Zeemering, Stef
Verheule, Sander
Pezzuto, Simone
Krause, Rolf
Maessen, Jos G.
Auricchio, Angelo
Schotten, Ulrich
author_facet Gharaviri, Ali
Bidar, Elham
Potse, Mark
Zeemering, Stef
Verheule, Sander
Pezzuto, Simone
Krause, Rolf
Maessen, Jos G.
Auricchio, Angelo
Schotten, Ulrich
author_sort Gharaviri, Ali
collection PubMed
description BACKGROUND: Atrial fibrillation (AF) is accompanied by progressive epicardial fibrosis, dissociation of electrical activity between the epicardial layer and the endocardial bundle network, and transmural conduction (breakthroughs). However, causal relationships between these phenomena have not been demonstrated yet. Our goal was to test the hypothesis that epicardial fibrosis suffices to increase endo–epicardial dissociation (EED) and breakthroughs (BT) during AF. METHODS: We simulated the effect of fibrosis in the epicardial layer on EED and BT in a detailed, high-resolution, three-dimensional model of the human atria with realistic electrophysiology. The model results were compared with simultaneous endo–epicardial mapping in human atria. The model geometry, specifically built for this study, was based on MR images and histo-anatomical studies. Clinical data were obtained in four patients with longstanding persistent AF (persAF) and three patients without a history of AF. RESULTS: The AF cycle length (AFCL), conduction velocity (CV), and EED were comparable in the mapping studies and the simulations. EED increased from 24.1 ± 3.4 to 56.58 ± 6.2% (p < 0.05), and number of BTs per cycle from 0.89 ± 0.55 to 6.74 ± 2.11% (p < 0.05), in different degrees of fibrosis in the epicardial layer. In both mapping data and simulations, EED correlated with prevalence of BTs. Fibrosis also increased the number of fibrillation waves per cycle in the model. CONCLUSION: A realistic 3D computer model of AF in which epicardial fibrosis was increased, in the absence of other pathological changes, showed increases in EED and epicardial BT comparable to those in longstanding persAF. Thus, epicardial fibrosis can explain both phenomena.
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spelling pubmed-70472152020-03-09 Epicardial Fibrosis Explains Increased Endo–Epicardial Dissociation and Epicardial Breakthroughs in Human Atrial Fibrillation Gharaviri, Ali Bidar, Elham Potse, Mark Zeemering, Stef Verheule, Sander Pezzuto, Simone Krause, Rolf Maessen, Jos G. Auricchio, Angelo Schotten, Ulrich Front Physiol Physiology BACKGROUND: Atrial fibrillation (AF) is accompanied by progressive epicardial fibrosis, dissociation of electrical activity between the epicardial layer and the endocardial bundle network, and transmural conduction (breakthroughs). However, causal relationships between these phenomena have not been demonstrated yet. Our goal was to test the hypothesis that epicardial fibrosis suffices to increase endo–epicardial dissociation (EED) and breakthroughs (BT) during AF. METHODS: We simulated the effect of fibrosis in the epicardial layer on EED and BT in a detailed, high-resolution, three-dimensional model of the human atria with realistic electrophysiology. The model results were compared with simultaneous endo–epicardial mapping in human atria. The model geometry, specifically built for this study, was based on MR images and histo-anatomical studies. Clinical data were obtained in four patients with longstanding persistent AF (persAF) and three patients without a history of AF. RESULTS: The AF cycle length (AFCL), conduction velocity (CV), and EED were comparable in the mapping studies and the simulations. EED increased from 24.1 ± 3.4 to 56.58 ± 6.2% (p < 0.05), and number of BTs per cycle from 0.89 ± 0.55 to 6.74 ± 2.11% (p < 0.05), in different degrees of fibrosis in the epicardial layer. In both mapping data and simulations, EED correlated with prevalence of BTs. Fibrosis also increased the number of fibrillation waves per cycle in the model. CONCLUSION: A realistic 3D computer model of AF in which epicardial fibrosis was increased, in the absence of other pathological changes, showed increases in EED and epicardial BT comparable to those in longstanding persAF. Thus, epicardial fibrosis can explain both phenomena. Frontiers Media S.A. 2020-02-21 /pmc/articles/PMC7047215/ /pubmed/32153419 http://dx.doi.org/10.3389/fphys.2020.00068 Text en Copyright © 2020 Gharaviri, Bidar, Potse, Zeemering, Verheule, Pezzuto, Krause, Maessen, Auricchio and Schotten. http://creativecommons.org/licenses/by/4.0/ This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
spellingShingle Physiology
Gharaviri, Ali
Bidar, Elham
Potse, Mark
Zeemering, Stef
Verheule, Sander
Pezzuto, Simone
Krause, Rolf
Maessen, Jos G.
Auricchio, Angelo
Schotten, Ulrich
Epicardial Fibrosis Explains Increased Endo–Epicardial Dissociation and Epicardial Breakthroughs in Human Atrial Fibrillation
title Epicardial Fibrosis Explains Increased Endo–Epicardial Dissociation and Epicardial Breakthroughs in Human Atrial Fibrillation
title_full Epicardial Fibrosis Explains Increased Endo–Epicardial Dissociation and Epicardial Breakthroughs in Human Atrial Fibrillation
title_fullStr Epicardial Fibrosis Explains Increased Endo–Epicardial Dissociation and Epicardial Breakthroughs in Human Atrial Fibrillation
title_full_unstemmed Epicardial Fibrosis Explains Increased Endo–Epicardial Dissociation and Epicardial Breakthroughs in Human Atrial Fibrillation
title_short Epicardial Fibrosis Explains Increased Endo–Epicardial Dissociation and Epicardial Breakthroughs in Human Atrial Fibrillation
title_sort epicardial fibrosis explains increased endo–epicardial dissociation and epicardial breakthroughs in human atrial fibrillation
topic Physiology
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7047215/
https://www.ncbi.nlm.nih.gov/pubmed/32153419
http://dx.doi.org/10.3389/fphys.2020.00068
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