PMID- 29725307
OWN - NLM
STAT- PubMed-not-MEDLINE
LR  - 20220129
IS  - 1664-042X (Print)
IS  - 1664-042X (Electronic)
IS  - 1664-042X (Linking)
VI  - 9
DP  - 2018
TI  - Comparing Reentrant Drivers Predicted by Image-Based Computational Modeling and 
      Mapped by Electrocardiographic Imaging in Persistent Atrial Fibrillation.
PG  - 414
LID - 10.3389/fphys.2018.00414 [doi]
LID - 414
AB  - Electrocardiographic mapping (ECGI) detects reentrant drivers (RDs) that 
      perpetuate arrhythmia in persistent AF (PsAF). Patient-specific computational 
      models derived from late gadolinium-enhanced magnetic resonance imaging (LGE-MRI) 
      identify all latent sites in the fibrotic substrate that could potentially 
      sustain RDs, not just those manifested during mapped AF. The objective of this 
      study was to compare RDs from simulations and ECGI (RD(sim)/RD(ECGI)) and analyze 
      implications for ablation. We considered 12 PsAF patients who underwent RD(ECGI) 
      ablation. For the same cohort, we simulated AF and identified RD(sim) sites in 
      patient-specific models with geometry and fibrosis distribution from pre-ablation 
      LGE-MRI. RD(sim)- and RD(ECGI)-harboring regions were compared, and the extent of 
      agreement between macroscopic locations of RDs identified by simulations and ECGI 
      was assessed. Effects of ablating RD(ECGI)/RD(sim) were analyzed. RD(sim) were 
      predicted in 28 atrial regions (median [inter-quartile range (IQR)] = 3.0 [1.0; 
      3.0] per model). ECGI detected 42 RD(ECGI)-harboring regions (4.0 [2.0; 5.0] per 
      patient). The number of regions with RD(sim) and RD(ECGI) per individual was not 
      significantly correlated (R = 0.46, P = ns). The overall rate of regional 
      agreement was fair (modified Cohen's kappa(0) statistic = 0.11), as expected, based 
      on the different mechanistic underpinning of RD(sim)- and RD(ECGI). nineteen 
      regions were found to harbor both RD(sim) and RD(ECGI), suggesting that a subset 
      of clinically observed RDs was fibrosis-mediated. The most frequent source of 
      differences (23/32 regions) between the two modalities was the presence of 
      RD(ECGI) perpetuated by mechanisms other than the fibrotic substrate. In 6/12 
      patients, there was at least one region where a latent RD was observed in 
      simulations but was not manifested during clinical mapping. Ablation of 
      fibrosis-mediated RD(ECGI) (i.e., targets in regions that also harbored RD(sim)) 
      trended toward a higher rate of positive response compared to ablation of other 
      RD(ECGI) targets (57 vs. 41%, P = ns). Our analysis suggests that RDs in human 
      PsAF are at least partially fibrosis-mediated. Substrate-based ablation combining 
      simulations with ECGI could improve outcomes.
FAU - Boyle, Patrick M
AU  - Boyle PM
AD  - Department of Biomedical Engineering, Institute for Computational Medicine, Johns 
      Hopkins University, Baltimore, MD, United States.
FAU - Hakim, Joe B
AU  - Hakim JB
AD  - Department of Biomedical Engineering, Institute for Computational Medicine, Johns 
      Hopkins University, Baltimore, MD, United States.
FAU - Zahid, Sohail
AU  - Zahid S
AD  - Department of Biomedical Engineering, Institute for Computational Medicine, Johns 
      Hopkins University, Baltimore, MD, United States.
FAU - Franceschi, William H
AU  - Franceschi WH
AD  - Department of Biomedical Engineering, Institute for Computational Medicine, Johns 
      Hopkins University, Baltimore, MD, United States.
FAU - Murphy, Michael J
AU  - Murphy MJ
AD  - Department of Biomedical Engineering, Institute for Computational Medicine, Johns 
      Hopkins University, Baltimore, MD, United States.
FAU - Vigmond, Edward J
AU  - Vigmond EJ
AD  - L'Institut de RYthmologie et Modelisation Cardiaque (IHU-LIRYC), Pessac-Bordeaux, 
      France.
FAU - Dubois, Remi
AU  - Dubois R
AD  - L'Institut de RYthmologie et Modelisation Cardiaque (IHU-LIRYC), Pessac-Bordeaux, 
      France.
FAU - Haissaguerre, Michel
AU  - Haissaguerre M
AD  - L'Institut de RYthmologie et Modelisation Cardiaque (IHU-LIRYC), Pessac-Bordeaux, 
      France.
AD  - Centre Hospitalier Universitaire de Bordeaux, Pessac-Bordeaux, France.
FAU - Hocini, Meleze
AU  - Hocini M
AD  - L'Institut de RYthmologie et Modelisation Cardiaque (IHU-LIRYC), Pessac-Bordeaux, 
      France.
AD  - Centre Hospitalier Universitaire de Bordeaux, Pessac-Bordeaux, France.
FAU - Jais, Pierre
AU  - Jais P
AD  - L'Institut de RYthmologie et Modelisation Cardiaque (IHU-LIRYC), Pessac-Bordeaux, 
      France.
AD  - Centre Hospitalier Universitaire de Bordeaux, Pessac-Bordeaux, France.
FAU - Trayanova, Natalia A
AU  - Trayanova NA
AD  - Department of Biomedical Engineering, Institute for Computational Medicine, Johns 
      Hopkins University, Baltimore, MD, United States.
FAU - Cochet, Hubert
AU  - Cochet H
AD  - L'Institut de RYthmologie et Modelisation Cardiaque (IHU-LIRYC), Pessac-Bordeaux, 
      France.
AD  - Centre Hospitalier Universitaire de Bordeaux, Pessac-Bordeaux, France.
LA  - eng
GR  - 16SDG30440006/AHA/American Heart Association-American Stroke Association/United 
      States
GR  - R01 HL126802/HL/NHLBI NIH HHS/United States
PT  - Journal Article
DEP - 20180419
PL  - Switzerland
TA  - Front Physiol
JT  - Frontiers in physiology
JID - 101549006
PMC - PMC5917348
OTO - NOTNLM
OT  - ablation
OT  - atrial fibrillation
OT  - computational modeling
OT  - electrocardiographic mapping
OT  - fibrotic remodeling
OT  - reentrant drivers
EDAT- 2018/05/05 06:00
MHDA- 2018/05/05 06:01
PMCR- 2018/04/19
CRDT- 2018/05/05 06:00
PHST- 2017/11/19 00:00 [received]
PHST- 2018/04/04 00:00 [accepted]
PHST- 2018/05/05 06:00 [entrez]
PHST- 2018/05/05 06:00 [pubmed]
PHST- 2018/05/05 06:01 [medline]
PHST- 2018/04/19 00:00 [pmc-release]
AID - 10.3389/fphys.2018.00414 [doi]
PST - epublish
SO  - Front Physiol. 2018 Apr 19;9:414. doi: 10.3389/fphys.2018.00414. eCollection 
      2018.