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Identifying locations of re-entrant drivers from patient-specific distribution of fibrosis in the left atrium

Clinical evidence suggests a link between fibrosis in the left atrium (LA) and atrial fibrillation (AF), the most common sustained arrhythmia. Image-derived fibrosis is increasingly used for patient stratification and therapy guidance. However, locations of re-entrant drivers (RDs) sustaining AF are...

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Autores principales: Roy, Aditi, Varela, Marta, Chubb, Henry, MacLeod, Robert, Hancox, Jules C., Schaeffter, Tobias, Aslanidi, Oleg
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Public Library of Science 2020
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7535127/
https://www.ncbi.nlm.nih.gov/pubmed/32966275
http://dx.doi.org/10.1371/journal.pcbi.1008086
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author Roy, Aditi
Varela, Marta
Chubb, Henry
MacLeod, Robert
Hancox, Jules C.
Schaeffter, Tobias
Aslanidi, Oleg
author_facet Roy, Aditi
Varela, Marta
Chubb, Henry
MacLeod, Robert
Hancox, Jules C.
Schaeffter, Tobias
Aslanidi, Oleg
author_sort Roy, Aditi
collection PubMed
description Clinical evidence suggests a link between fibrosis in the left atrium (LA) and atrial fibrillation (AF), the most common sustained arrhythmia. Image-derived fibrosis is increasingly used for patient stratification and therapy guidance. However, locations of re-entrant drivers (RDs) sustaining AF are unknown and therapy success rates remain suboptimal. This study used image-derived LA models to explore the dynamics of RD stabilization in fibrotic regions and generate maps of RD locations. LA models with patient-specific geometry and fibrosis distribution were derived from late gadolinium enhanced magnetic resonance imaging of 6 AF patients. In each model, RDs were initiated at multiple locations, and their trajectories were tracked and overlaid on the LA fibrosis distributions to identify the most likely regions where the RDs stabilized. The simulations showed that the RD dynamics were strongly influenced by the amount and spatial distribution of fibrosis. In patients with fibrosis burden greater than 25%, RDs anchored to specific locations near large fibrotic patches. In patients with fibrosis burden below 25%, RDs either moved near small fibrotic patches or anchored to anatomical features. The patient-specific maps of RD locations showed that areas that harboured the RDs were much smaller than the entire fibrotic areas, indicating potential targets for ablation therapy. Ablating the predicted locations and connecting them to the existing pulmonary vein ablation lesions was the most effective in-silico ablation strategy.
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spelling pubmed-75351272020-10-15 Identifying locations of re-entrant drivers from patient-specific distribution of fibrosis in the left atrium Roy, Aditi Varela, Marta Chubb, Henry MacLeod, Robert Hancox, Jules C. Schaeffter, Tobias Aslanidi, Oleg PLoS Comput Biol Research Article Clinical evidence suggests a link between fibrosis in the left atrium (LA) and atrial fibrillation (AF), the most common sustained arrhythmia. Image-derived fibrosis is increasingly used for patient stratification and therapy guidance. However, locations of re-entrant drivers (RDs) sustaining AF are unknown and therapy success rates remain suboptimal. This study used image-derived LA models to explore the dynamics of RD stabilization in fibrotic regions and generate maps of RD locations. LA models with patient-specific geometry and fibrosis distribution were derived from late gadolinium enhanced magnetic resonance imaging of 6 AF patients. In each model, RDs were initiated at multiple locations, and their trajectories were tracked and overlaid on the LA fibrosis distributions to identify the most likely regions where the RDs stabilized. The simulations showed that the RD dynamics were strongly influenced by the amount and spatial distribution of fibrosis. In patients with fibrosis burden greater than 25%, RDs anchored to specific locations near large fibrotic patches. In patients with fibrosis burden below 25%, RDs either moved near small fibrotic patches or anchored to anatomical features. The patient-specific maps of RD locations showed that areas that harboured the RDs were much smaller than the entire fibrotic areas, indicating potential targets for ablation therapy. Ablating the predicted locations and connecting them to the existing pulmonary vein ablation lesions was the most effective in-silico ablation strategy. Public Library of Science 2020-09-23 /pmc/articles/PMC7535127/ /pubmed/32966275 http://dx.doi.org/10.1371/journal.pcbi.1008086 Text en © 2020 Roy et al http://creativecommons.org/licenses/by/4.0/ This is an open access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0/) , which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
spellingShingle Research Article
Roy, Aditi
Varela, Marta
Chubb, Henry
MacLeod, Robert
Hancox, Jules C.
Schaeffter, Tobias
Aslanidi, Oleg
Identifying locations of re-entrant drivers from patient-specific distribution of fibrosis in the left atrium
title Identifying locations of re-entrant drivers from patient-specific distribution of fibrosis in the left atrium
title_full Identifying locations of re-entrant drivers from patient-specific distribution of fibrosis in the left atrium
title_fullStr Identifying locations of re-entrant drivers from patient-specific distribution of fibrosis in the left atrium
title_full_unstemmed Identifying locations of re-entrant drivers from patient-specific distribution of fibrosis in the left atrium
title_short Identifying locations of re-entrant drivers from patient-specific distribution of fibrosis in the left atrium
title_sort identifying locations of re-entrant drivers from patient-specific distribution of fibrosis in the left atrium
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7535127/
https://www.ncbi.nlm.nih.gov/pubmed/32966275
http://dx.doi.org/10.1371/journal.pcbi.1008086
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