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Int. J. Mol. Sci. 2015, 16(5), 10834-10854; doi:10.3390/ijms160510834

Optimization of Catheter Ablation of Atrial Fibrillation: Insights Gained from Clinically-Derived Computer Models

1
Auckland Bioengineering Institute, University of Auckland, Auckland 1142, New Zealand
2
College of Engineering, Mathematics and Physical Sciences, University of Exeter, Exeter EX4 4QF, UK
3
Institute of Cardiovascular Sciences, University of Manchester, Manchester M13 9NT, UK
4
Department of Physiology & Cell Biology and Davis Heart & Lung Research Institute, the Ohio State University Wexner Medical Center, Columbus, OH 43210, USA
5
Department of Cardiology, Waikato Hospital, Hamilton 3240, New Zealand
*
Author to whom correspondence should be addressed.
Academic Editor: H. W. M. Niessen
Received: 18 March 2015 / Revised: 3 May 2015 / Accepted: 6 May 2015 / Published: 13 May 2015
(This article belongs to the Special Issue Improvement of Cardiac Function in Heart Failure)
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Abstract

Atrial fibrillation (AF) is the most common heart rhythm disturbance, and its treatment is an increasing economic burden on the health care system. Despite recent intense clinical, experimental and basic research activity, the treatment of AF with current antiarrhythmic drugs and catheter/surgical therapies remains limited. Radiofrequency catheter ablation (RFCA) is widely used to treat patients with AF. Current clinical ablation strategies are largely based on atrial anatomy and/or substrate detected using different approaches, and they vary from one clinical center to another. The nature of clinical ablation leads to ambiguity regarding the optimal patient personalization of the therapy partly due to the fact that each empirical configuration of ablation lines made in a patient is irreversible during one ablation procedure. To investigate optimized ablation lesion line sets, in silico experimentation is an ideal solution. 3D computer models give us a unique advantage to plan and assess the effectiveness of different ablation strategies before and during RFCA. Reliability of in silico assessment is ensured by inclusion of accurate 3D atrial geometry, realistic fiber orientation, accurate fibrosis distribution and cellular kinetics; however, most of this detailed information in the current computer models is extrapolated from animal models and not from the human heart. The predictive power of computer models will increase as they are validated with human experimental and clinical data. To make the most from a computer model, one needs to develop 3D computer models based on the same functionally and structurally mapped intact human atria with high spatial resolution. The purpose of this review paper is to summarize recent developments in clinically-derived computer models and the clinical insights they provide for catheter ablation. View Full-Text
Keywords: cardiac arrhythmias; atrial fibrillation; catheter ablation; computer model; patient specific model; rotors; re-entry; fibrosis; pulmonary vein isolation cardiac arrhythmias; atrial fibrillation; catheter ablation; computer model; patient specific model; rotors; re-entry; fibrosis; pulmonary vein isolation
This is an open access article distributed under the Creative Commons Attribution License which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. (CC BY 4.0).

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MDPI and ACS Style

Zhao, J.; Kharche, S.R.; Hansen, B.J.; Csepe, T.A.; Wang, Y.; Stiles, M.K.; Fedorov, V.V. Optimization of Catheter Ablation of Atrial Fibrillation: Insights Gained from Clinically-Derived Computer Models. Int. J. Mol. Sci. 2015, 16, 10834-10854.

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