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Medientyp:
E-Artikel
Titel:
Ablation of Multiwavelet Re-entry Guided by Circuit-Density and Distribution : Maximizing the Probability of Circuit Annihilation
:
Maximizing the Probability of Circuit Annihilation
Beteiligte:
Carrick, Richard T.;
Benson, Bryce;
Habel, Nicole;
Bates, Oliver R.J.;
Bates, Jason H.T.;
Spector, Peter S.
Erschienen in:
Circulation: Arrhythmia and Electrophysiology, 6 (2013) 6, Seite 1229-1235
Sprache:
Englisch
DOI:
10.1161/circep.113.000759
ISSN:
1941-3149;
1941-3084
Entstehung:
Anmerkungen:
Beschreibung:
Background— A key mechanism responsible for atrial fibrillation is multiwavelet re-entry (MWR). We have previously demonstrated improved efficiency of ablation when lesions were placed in regions of high circuit-density. In this study, we undertook a quantitative assessment of the relative effect of ablation on the probability of MWR termination and the inducibility of MWR, as a function of lesion length and circuit-density overlap. Methods and Results— We used a computational model to simulate MWR in tissues with (and without) localized regions of decreased action potential duration and increased intercellular resistance. We measured baseline circuit-density and distribution. We then assessed the effect of various ablation lesion sets on the inducibility and duration of MWR as a function of ablation lesion length and overlap with circuit-density. Higher circuit-density reproducibly localized to regions of shorter wavelength. Ablation lines with high circuit-density overlap showed maximum decreases in duration of MWR at lengths equal to the distance from the tissue boundary to the far side of the high circuit-density region (high-overlap, −43.5% [confidence interval, −22.0% to −65.1%] versus low-overlap, −4.4% [confidence interval, 7.3% to −16.0%]). Further ablation (beyond the length required to cross the high circuit-density region) provided minimal further reductions in duration and increased inducibility. Conclusions— Ablation at sites of high circuit-density most efficiently decreased re-entrant duration while minimally increasing inducibility. Ablation lines delivered at sites of low circuit-density minimally decreased duration yet increased inducibility of MWR.