The role of atrial anatomy in clinical atrial arrhythmias

Lesh, Michael D.; Kalman, Jonathan M.; Olgin, Jeffrey E.; Ellis, Willard S.

doi:10.1016/s0022-0736(96)80039-2

Cited by 18 publications

(10 citation statements)

References 30 publications

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“…6,40 There are a number of well-defined uninsulated bundles in the atrial muscle within which current flow is rapid. 40,41 These bundles include the crista terminalis, the pectinate muscles, Bachmann's bundle, and the limbus of the fossa ovalis.…”

Section: Discussionmentioning

confidence: 99%

“…Each technique, however, is associated with its own set of complications and limitations, exacerbated by the complexity of the atrial anatomical architecture. 5,6 Meanwhile, and in parallel with experimental studies, a number of computer models of atrial conduction have been described. Briefly, they began with the important cellular automaton of Moe et al 7 Later, isotropic cellular automata include descriptions by Macchi 8 (later modified by Kafer 9 ), Lorange and Gulrajani, 10 Wei et al, 11 and Killmann et al 12 Several atrial models have used realistic membrane kinetics.…”

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confidence: 99%

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A Computer Model of Normal Conduction in the Human Atria

Harrild

2000

Circulation Research

190

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Abstract-Although considerable progress has been made in understanding the process of wavefront propagation and arrhythmogenesis in human atria, technical concerns and issues of patient safety have limited experimental investigations. The present work describes a finite volume-based computer model of human atrial activation and current flow to complement these studies. Unlike previous representations, the model is three-dimensional, incorporating both the left and right atria and the major muscle bundles of the atria, including the crista terminalis, pectinate muscles, limbus of the fossa ovalis, and Bachmann's bundle. The bundles are represented as anisotropic structures with fiber directions aligned with the bundle axes. Conductivities are assigned to the model to give realistic local conduction velocities within the bundles and bulk tissue. Results from simulations demonstrate the role of the bundles in a normal sinus rhythm and also reveal the patterns of activation in the septum, where experimental mapping has been extremely challenging. To validate the model, the simulated normal activation sequence and conduction velocities at various locations are compared with experimental observations and data. The model is also used to investigate paced activation, and a mechanism of the relative lengthening of left versus right stimulation is presented. Owing to both the realistic geometry and the bundle structures, the model can be used for further analysis of the normal activation sequence and to examine abnormal conduction, including flutter. The full text of this article is available at http://www.circresaha.org.(Circ Res. 2000;87:e25-e36.)Key Words: atrial computer model Ⅲ cardiac propagation Ⅲ atrial conduction Ⅲ finite volume method A trial arrhythmias are electrical disturbances in the heart that can range in severity from annoying to lifethreatening. The process of understanding these malformed rhythms must begin with a thorough comprehension of the normal spread of activation in the human heart. Experimental techniques, including recordings with microelectrodes 1 and single 2 or multiple 3,4 extracellular electrodes, have yielded a wealth of information. Each technique, however, is associated with its own set of complications and limitations, exacerbated by the complexity of the atrial anatomical architecture. 5,6 Meanwhile, and in parallel with experimental studies, a number of computer models of atrial conduction have been described. Briefly, they began with the important cellular automaton of Moe et al. 7 Later, isotropic cellular automata include descriptions by Macchi 8 (later modified by Kafer 9 ), Lorange and Gulrajani, 10 Wei et al, 11 and Killmann et al. 12 Several atrial models have used realistic membrane kinetics. Winslow et al described a flat, isotropic 2D sheet with an Earm and Noble 13 membrane. Virag et al 14 represented the atria by folding a 2D sheet in space and penetrating it with a series of holes; they used Luo-Rudy I 15 kinetics. Recent reports have also emerged of modeled activity i...

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Section: Discussionmentioning

confidence: 99%

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confidence: 99%

A Computer Model of Normal Conduction in the Human Atria

Harrild

2000

Circulation Research

190

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“…Atrial and ventricular arrhythmias are of great concern in clinical electrocardiology [1,2]. In clinical practice, the localization of the origins of arrhythmias is currently achieved by traditional catheter techniques and by catheter mapping techniques [1,3].…”

Section: Introductionmentioning

confidence: 99%

“…In clinical practice, the localization of the origins of arrhythmias is currently achieved by traditional catheter techniques and by catheter mapping techniques [1,3]. These techniques show significant limitations when it comes to acquiring single-beat activation maps.…”

Section: Introductionmentioning

confidence: 99%

Online Noninvasive Localization of Accessory Pathways in the EP Lab

Seger¹,

Fischer²,

Modre³

et al. 2004

Medical Image Computing and Computer-Assisted Intervention – MICCAI 2004

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Abstract. Inverse electrocardiography has been developing during the last years and is about to become a valuable clinical tool for analyzing arrhythmias and electrical dysfunction in general. By combining measurements obtained by electrocardiographic body surface mapping with three-dimensional anatomical data, the electrical activation sequence of the individual human heart can be imaged noninvasively. This technique was applied on-line in the electrophysiology lab. The results of four patients, who underwent an interventional electrophysiology study, are presented in this paper. The sites of early activation were compared to the locations of successful radio-frequency ablation. The location error was found to be between 13 and 20 mm. This promising finding may bring this noninvasive method closer to clinical application.

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“…When the classification criterion is the duration, atrial arrhythmias may be classified into persistent or permanent (if it is permanently present) and paroxysmal (when it is only present on precise moments). Finally, if the aim is to classify in terms of the electrophysiological mechanisms and the anatomical substrate, arrhythmias may be divided into macro-reentrant (including atrial flutter among other macro-reentrant circuits in the RA and LA), focal tachycardia (due to an automatic trigger from a single site) and atrial fibrillation (Lesh et al 1996).…”

Section: Atrial Electrical Disordersmentioning

confidence: 99%

Three-dimensional Multiscale Modelling and Simulation of Atria and Torso Electrophysiology

Albero¹

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The role of atrial anatomy in clinical atrial arrhythmias

Cited by 18 publications

References 30 publications

A Computer Model of Normal Conduction in the Human Atria

A Computer Model of Normal Conduction in the Human Atria

Online Noninvasive Localization of Accessory Pathways in the EP Lab

Three-dimensional Multiscale Modelling and Simulation of Atria and Torso Electrophysiology

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