Lack of regional association between atrial late gadolinium enhancement on cardiac magnetic resonance and atrial fibrillation rotors

Chrispin, Jonathan; İpek, Esra Gücük; Zahid, Sohail; Prakosa, Adityo; Habibi, Mehdi; Spragg, David D.; Marine, Joseph E.; Ashikaga, Hiroshi; Rickard, John; Trayanova, Natalia A.; Zimmerman, Stefan L.; Zipunnikov, Vadim; Berger, Ronald D.; Calkins, Hugh; Nazarian, Saman

doi:10.1016/j.hrthm.2015.11.011

Cited by 42 publications

(40 citation statements)

References 34 publications

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“…13 Also, in virtual studies using in silico CMR-based models of patient-specific LA structure and LGE SI, AF was inducible according to the level of LGE SI. 26 Recently, Chrispin et al 27 reported their data about regional association between atrial LGE SI from CMR and AF rotors from a focal impulse and rotor modulation-guided 27 statistical analysis could not detect a significant association between the extent of LGE SI and the presence of rotors in our cohort. This might lead to the suggestion that electroanatomic remodeling in patients with PERS has some different components, which are still not completely understood.…”

Section: Relationship Between Atrial Fibrosis and Rotor Distributionmentioning

confidence: 58%

“…28,29 On the other hand, NEEES and invasive mapping methods identified the presence of electric rotors without any anatomic reference. 27 This could probably be explained by the fact that rotors move and meander around a core 8,9,13 and might therefore not stay stable at the same position during MRI and NEEES. To finally understand that phenomenon, an analysis of rotor stability over the time and its correlation with LGE SI would be essential.…”

Section: Relationship Between Atrial Fibrosis and Rotor Distributionmentioning

confidence: 99%

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First-in-Man Analysis of the Relationship Between Electrical Rotors From Noninvasive Panoramic Mapping and Atrial Fibrosis From Magnetic Resonance Imaging in Patients With Persistent Atrial Fibrillation

Sohns

Lemeš

Metzner

et al. 2017

Circ: Arrhythmia and Electrophysiology

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Background-Late gadolinium enhancement (LGE) cardiovascular magnetic resonance (CMR) imaging can be used to evaluate characteristics of atrial fibrosis. The novel noninvasive epicardial and endocardial electrophysiology system (NEEES) allows for the identification of sources with rotor activity. This study describes a new technique to examine the relationship between rotors and LGE signal intensity in patients with persistent atrial fibrillation (PERS) scheduled for ablation. Methods and Results-Ten consecutive patients underwent pulmonary vein isolation for persistent atrial fibrillation.LGE CMR of both atria was performed, and NEEES-based analysis was conducted to identify rotors. For each mapping point, the intracardiac locations were transferred onto an individual CMR-derived 3-dimensional shell. This allowed the LGE signal intensity to be projected onto the anatomy from the NEEES analysis. NEEES analysis identified a total number of 410 electric rotors, 47.8% were located in the left atrium and 52.2% in the right atrium. Magnetic resonance imaging analysis was performed from 10 right atria and 10 left atria data sets, including 86 axial LGE CMR planes per atrium. The mean LGE burden for left atrium and right atrium was 23.9±1.6% and 15.9±1.8%, respectively. Statistical analysis demonstrated a lack of regional association between the extent of LGE signal intensity and the presence of rotors. Conclusions-This is the first study demonstrating that the presence of rotors based on NEEES analysis is not directly associated with the extent and anatomic location of LGE signal intensity from CMR. Further studies evaluating the relationship between rotors and fibrosis in patients with persistent atrial fibrillation are mandatory and may inform strategies to improve ablation outcome. (Circ Arrhythm Electrophysiol. 2017;10:e004419.

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Section: Relationship Between Atrial Fibrosis and Rotor Distributionmentioning

confidence: 58%

Section: Relationship Between Atrial Fibrosis and Rotor Distributionmentioning

confidence: 99%

First-in-Man Analysis of the Relationship Between Electrical Rotors From Noninvasive Panoramic Mapping and Atrial Fibrosis From Magnetic Resonance Imaging in Patients With Persistent Atrial Fibrillation

Sohns

Lemeš

Metzner

et al. 2017

Circ: Arrhythmia and Electrophysiology

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“…This simulation study demonstrated that fibrosis spatial pattern analysis could be a novel avenue for persistent AF risk stratification. This is particularly noteworthy in light of recent clinical findings that showed a lack of association between the regional or global extent of LGE areas and AF-perpetuating re-entrant drivers, 50 suggesting that more robust quantitative metrics (such as FD m or local maps of FD and FE, as discussed above 44 ) could provide a better indication of the spatial localization of re-entrant drivers in the fibrotic atria.…”

Section: Fibrotic Determinants Of Re-entrant Driver Localizationmentioning

confidence: 91%

“…The latter quantity (total fibrosis burden; FB) has been previously linked to higher risk of persistent AF. 49 Using the same set of patient-specific models described above, the prevalence of regions with highly intermingled fibrotic and non-fibrotic tissue in each case was assessed by median and upper quartile values of each unique FD metric distribution (FD 50 and FD 75 , respectively). Simulations demonstrated that atrial models in which rapid pacing did not induce AF had low both FB ( 11%) and FD 75 ( 0.1) values.…”

Section: Fibrotic Determinants Of Re-entrant Driver Localizationmentioning

confidence: 99%

Towards personalized computational modelling of the fibrotic substrate for atrial arrhythmia

2016

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Atrial arrhythmias involving a fibrotic substrate are an important cause of morbidity and mortality. In many cases, effective treatment of such rhythm disorders is severely hindered by a lack of mechanistic understanding relating features of fibrotic remodelling to dynamics of re-entrant arrhythmia. With the advent of clinical imaging modalities capable of resolving the unique fibrosis spatial pattern present in the atria of each individual patient, a promising new research trajectory has emerged in which personalized computational models are used to analyse mechanistic underpinnings of arrhythmia dynamics based on the distribution of fibrotic tissue. In this review, we first present findings that have yielded a robust and detailed biophysical representation of fibrotic substrate electrophysiological properties. Then, we summarize the results of several recent investigations seeking to use organ-scale models of the fibrotic human atria to derive new insights on mechanisms of arrhythmia perpetuation and to develop novel strategies for model-assisted individualized planning of catheter ablation procedures for atrial arrhythmias.

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“…The results of early clinical trials, have not been replicated in recent studies [14–17]. In addition, there is no spatial correlation between rotors identified clinically and the underlying myocardial scar tissue [18,19]. One potential explanation to account for the apparent contradiction is an error associated with spatial localization of rotors using currently available mapping technologies.…”

Section: Introductionmentioning

confidence: 99%

Impact of number of co-existing rotors and inter-electrode distance on accuracy of rotor localization

Aronis

Ashikaga

2018

Journal of Electrocardiology

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Background Conflicting evidence exists on the efficacy of focal impulse and rotor modulation on atrial fibrillation ablation. A potential explanation is inaccurate rotor localization from multiple rotors coexistence and a relatively large (9–11 mm) inter-electrode distance (IED) of the multi-electrode basket catheter. Methods and results We studied a numerical model of cardiac action potential to reproduce one through seven rotors in a two-dimensional lattice. We estimated rotor location using phase singularity, Shannon entropy and dominant frequency. We then spatially downsampled the time series to create IEDs of 2–30 mm. The error of rotor localization was measured with reference to the dynamics of phase singularity at the original spatial resolution (IED = 1 mm). IED has a significant impact on the error using all the methods. When only one rotor is present, the error increases exponentially as a function of IED. At the clinical IED of 10 mm, the error is 3.8 mm (phase singularity), 3.7 mm (dominant frequency), and 11.8 mm (Shannon entropy). When there are more than one rotors, the error of rotor localization increases 10-fold. The error based on the phase singularity method at the clinical IED of 10 mm ranges from 30.0 mm (two rotors) to 96.1 mm (five rotors). Conclusions The magnitude of error of rotor localization using a clinically available basket catheter, in the presence of multiple rotors might be high enough to impact the accuracy of targeting during AF ablation. Improvement of catheter design and development of high-density mapping catheters may improve clinical outcomes of FIRM-guided AF ablation.

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Lack of regional association between atrial late gadolinium enhancement on cardiac magnetic resonance and atrial fibrillation rotors

Cited by 42 publications

References 34 publications

First-in-Man Analysis of the Relationship Between Electrical Rotors From Noninvasive Panoramic Mapping and Atrial Fibrosis From Magnetic Resonance Imaging in Patients With Persistent Atrial Fibrillation

First-in-Man Analysis of the Relationship Between Electrical Rotors From Noninvasive Panoramic Mapping and Atrial Fibrosis From Magnetic Resonance Imaging in Patients With Persistent Atrial Fibrillation

Towards personalized computational modelling of the fibrotic substrate for atrial arrhythmia

Impact of number of co-existing rotors and inter-electrode distance on accuracy of rotor localization

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