Evaluation of Ablation Patterns Using a Biophysical Model of Atrial Fibrillation

Dang, Lam; Virag, Nathalie; Ihara, Z.; Jacquemet, Vincent; Vesin, J.-M.; Schlaepfer, J.; Ruchat, Patrick; Kappenberger, Lukas

doi:10.1007/s10439-005-2502-7

Cited by 47 publications

(60 citation statements)

References 21 publications

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“…Therefore, a simpler model requiring far less computation effort was designed such that sufficient realism for the particular application was retained. 12 Good agreement was previously obtained between ablation success rates obtained from this computer model and those reported from clinical procedures. 12,13 We have used this biophysical model of AF ablation to systematically study the performance of each ablation line generally performed by surgeons separately, as well as several of their possible combinations.…”

Section: Introductionsupporting

confidence: 69%

“…This line should be transmural to be effective. 12,13 In the case of isolation of pulmonary veins one by one or two by two, the rate of residual atrial flutter is also dependent on the size of the area between ablated zones, as shown in a previous study. 23 Combination of lines in both the right and left atria increased conversion rate in the range 90-100% (assuming perfect transmural lines).…”

Section: Discussionmentioning

confidence: 93%

“…Indeed, previous simulation studies have shown that performance can decrease with Maze III from 100 to 80% for a gap of 3 mm located in the line connecting the pulmonary veins and mitral annulus. 12 This decrease in performance is linked to the apparition of a residual atypical atrial flutter around the mitral valve.…”

Section: Discussionmentioning

confidence: 99%

“…In this monolayer model, this completely blocked propagation across these lines, thus simulating a perfect (transmural) ablation. 12 For testing each of the ablation line patterns, the following procedure was carried out ( Figure 2). As a first step, as described Figure 1 Biophysical model of human atria derived from magnetic resonance images.…”

Section: Testing Of Ablation Patternsmentioning

confidence: 99%

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A biophysical model of atrial fibrillation ablation: what can a surgeon learn from a computer model?

Ruchat¹,

Virag

Dang

et al. 2007

Europace

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Aims Surgical ablation procedures for treating atrial fibrillation have been shown to be highly successful. However, the ideal ablation pattern still remains to be determined. This article reports on a systematic study of the effectiveness of the performance of different ablation line patterns. Methods and results This study of ablation line patterns was performed in a biophysical model of human atria by combining basic lines: (i) in the right atrium: isthmus line, line between vena cavae and appendage line and (ii) in the left atrium: several versions of pulmonary vein isolation, connection of pulmonary veins, isthmus line, and appendage line. Success rates and the presence of residual atrial flutter were documented. Basic patterns yielded conversion rates of only 10-25 and 10-55% in the right and the left atria, respectively. The best result for pulmonary vein isolation was obtained when a single closed line encompassed all veins (55%). Combination of lines in the right/left atrium only led to a success rate of 65/80%. Higher rates, up to 90-100%, could be obtained if right and left lines were combined. The inclusion of a left isthmus line was found to be essential for avoiding uncommon left atrial flutter. Conclusion Some patterns studied achieved a high conversion rate, although using a smaller number of lines than those of the Maze III procedure. The biophysical atrial model is shown to be effective in the search for promising alternative ablation strategies.

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Section: Introductionsupporting

confidence: 69%

Section: Discussionmentioning

confidence: 93%

Section: Discussionmentioning

confidence: 99%

Section: Testing Of Ablation Patternsmentioning

confidence: 99%

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A biophysical model of atrial fibrillation ablation: what can a surgeon learn from a computer model?

Ruchat¹,

Virag

Dang

et al. 2007

Europace

Self Cite

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“…It is important to remember that the tissue geometry in 3 dimensions can be a critical factor in arrhythmogenesis, 11 and even inclusion of a realistic curvature and topology in 2 dimensions has been used to advantage in previous models. 10,12 These various limitations of our model reflect the practical tradeoffs we have made in devising a convenient and manageable teaching tool.…”

Section: Model Limitationsmentioning

confidence: 99%

Emergence of Complex Behavior

Spector

Habel

Sobel

et al. 2011

Circ: Arrhythmia and Electrophysiology

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W e have developed a straightforward, physiologically based mathematical in silico model of cardiac electric activity to facilitate understanding of the fundamental principles that determine how excitation propagates through the heart. Despite its simplicity, the model provides a very powerful teaching tool. In fact, its simplicity is integral to the model's utility. The contrast between the minimal set of rules that govern the model's function and the widely varied complex behaviors it can manifest offers insight into the nature of emergent behavior in wave propagation. Emergence in this context refers to the richness of the tissue activation patterns that arise from the aggregate behavior of the simple cells that comprise the tissue. Each cell can be active, inactive, or refractory and interacts only with its immediate neighbors. From these simple building blocks, very elaborate global behaviors emerge. Model UtilityFrom the perspective of the electrophysiology student, the notion of emergent properties can act as a Rosetta stone for deciphering electrophysiological behavior. The spread of electric excitation through the intricate 3D structure of the heart can take widely varied forms, ranging from the orderly propagation seen during sinus rhythm to the marked disorganization seen during ventricular fibrillation. Observation of the diverse and sometimes complex patterns of conduction (eg, unidirectional block, reentry, spiral waves) as well as the responses to pacing maneuvers (eg, entrainment) suggests to the electrophysiology student a nearly infinite array of possibilities, the mastery of which can be daunting. However, with study, it becomes apparent that one need not memorize every possible cardiac behavior. Instead, there are overarching principles of cardiac excitation and propagation 1 from which these varied phenomena emerge and through which one can understand and predict rather than memorize electrophysiological behavior. Understanding these fundamental principles is integral to mastering electrophysiology.A framework for interpreting clinical observations predicated on these principles has been formalized in the computer model we have developed. The interactive nature of the model provides a substrate for active learning rather than passive observation. The student can simulate complex conduction, such as unidirectional block and reentry. This requires grappling with identification of the conditions that are fundamental to reentry, thereby providing a durable learning experience. Experimentation with the model facilitates learning and appreciation of the principles responsible for electrophysiological behaviors.In the material to follow, we review the conceptual design of our model. We show several examples of how use of the model demonstrates important electrophysiological principles. What is provided, however, is not intended to be an exhaustive review of the lessons that can be learned from use of the model; rather, it serves as an introduction to the ways in which the model can be instructive. ...

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Computer Modeling of Electrical Activation: From Cellular Dynamics to the Whole Heart

Smaill

Hunter²

2010

Cardiac Electrophysiology Methods and Models

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Evaluation of Ablation Patterns Using a Biophysical Model of Atrial Fibrillation

Cited by 47 publications

References 21 publications

A biophysical model of atrial fibrillation ablation: what can a surgeon learn from a computer model?

A biophysical model of atrial fibrillation ablation: what can a surgeon learn from a computer model?

Emergence of Complex Behavior

Computer Modeling of Electrical Activation: From Cellular Dynamics to the Whole Heart

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