A biophysical model of atrial fibrillation to define the appropriate ablation pattern in modified maze

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Serval ID
serval:BIB_1F669EBAB3F4
Type
Article: article from journal or magazin.
Collection
Publications
Institution
Title
A biophysical model of atrial fibrillation to define the appropriate ablation pattern in modified maze
Journal
European Journal of Cardio-Thoracic Surgery
Author(s)
Ruchat  P., Dang  L., Virag  N., Schlaepfer  J., von Segesser  L. K., Kappenberger  L.
ISSN
1010-7940 (Print)
Publication state
Published
Issued date
01/2007
Volume
31
Number
1
Pages
65-9
Notes
Journal Article
Research Support, Non-U.S. Gov't --- Old month value: Jan
Abstract
OBJECTIVE: The surgical Maze III procedure remains the gold standard in treating atrial fibrillation (AF); however due to clinical difficulties and higher risks, less invasive ablation alternatives are clinically investigated. The present study aims to define more efficient ablation patterns of the modified maze procedure using a biophysical model of human atria with chronic AF. METHODS: A three-dimensional model of human atria was developed using both MRI-imaging and a one-layer cellular model reproducing experimentally observed atrial cellular properties. Sustained AF could be induced by a burst-pacing protocol. Ablation lines were implemented in rendering the cardiac cells non-conductive, mimicking transmural lines. Lines were progressively implemented respectively around pulmonary veins (PV), left atrial appendage (LAA), left atrial isthmus (LAI), cavo-tricuspid isthmus (CTI), and intercaval lines (SIVC) in the computer model, defining the following patterns: P1=PV, P2=P1+LAA, P3=P2+LAI, P4=P3+CTI, P5=P3+SIVC, P6=P5+CTI. Forty simulations were done for each pattern and proportion of sinus rhythm (SR) conversion and time-to-AF termination (TAFT) were assessed. RESULTS: The most efficient patterns are P5, P6, and Maze III with 100% success. The main difference is expressed in decreasing mean TAFT with a correlation coefficient R=-0.8. There is an inflexion point for 100% success rate at a 7.5s TAFT, meaning that no additional line is mandatory beyond pattern P5. CONCLUSIONS: Our biophysical model suggests that Maze III could be simplified in his right atrial pattern to a single line joining both vena cavae. This has to be confirmed in clinical settings.
Keywords
Atrial Fibrillation/*physiopathology/*surgery Catheter Ablation/*methods Computer Simulation Electrophysiology Heart Atria/physiopathology Heart Conduction System/physiopathology Humans Imaging, Three-Dimensional/methods Magnetic Resonance Imaging *Models, Cardiovascular
Pubmed
Web of science
Open Access
Yes
Create date
28/01/2008 10:09
Last modification date
25/09/2019 6:08
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