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Pro-Arrhythmogenic Effects of Heterogeneous Tissue Curvature ― A Suggestion for Role of Left Atrial Appendage in Atrial Fibrillation
Background: The arrhythmogenic role of complex atrial morphology has not yet been clearly elucidated. We hypothesized that bumpy tissue geometry can induce action potential duration (APD) dispersion and wavebreak in atrial fibrillation (AF). Methods and Results: We simulated a 2D-bumpy atrial model...
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| Published in: | Circulation Journal 2018/12/25, Vol.83(1), pp.32-40 |
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| Main Authors: | , , , , , , , |
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| cites | cdi_FETCH-LOGICAL-c578t-b229b6baf1663809d3c1a65fe1b8d0362bd76c8c5d03d25ba2a8e30d92ae1243 |
| container_end_page | 40 |
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| container_start_page | 32 |
| container_title | Circulation Journal |
| container_volume | 83 |
| creator | Song, Jun-Seop Kim, Jaehyeok Lim, Byounghyun Lee, Young-Seon Hwang, Minki Joung, Boyoung Shim, Eun Bo Pak, Hui-Nam |
| description | Background: The arrhythmogenic role of complex atrial morphology has not yet been clearly elucidated. We hypothesized that bumpy tissue geometry can induce action potential duration (APD) dispersion and wavebreak in atrial fibrillation (AF). Methods and Results: We simulated a 2D-bumpy atrial model by varying the degree of bumpiness, and 3D-left atrial (LA) models integrated by LA computed tomographic (CT) images taken from 14 patients with persistent AF. We also analyzed wave-dynamic parameters with bipolar electrograms during AF and compared them with LA-CT geometry in 30 patients with persistent AF. In the 2D-bumpy model, APD dispersion increased (P |
| doi_str_mv | 10.1253/circj.CJ-18-0615 |
| format | article |
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We hypothesized that bumpy tissue geometry can induce action potential duration (APD) dispersion and wavebreak in atrial fibrillation (AF). Methods and Results: We simulated a 2D-bumpy atrial model by varying the degree of bumpiness, and 3D-left atrial (LA) models integrated by LA computed tomographic (CT) images taken from 14 patients with persistent AF. We also analyzed wave-dynamic parameters with bipolar electrograms during AF and compared them with LA-CT geometry in 30 patients with persistent AF. In the 2D-bumpy model, APD dispersion increased (P<0.001) and wavebreak occurred spontaneously when the surface bumpiness was greater, showing phase transition-like behavior (P<0.001). The bumpiness gradient 2D-model showed that spiral wave drifted in the direction of higher bumpiness, and phase singularity (PS) points were mostly located in areas with higher bumpiness. In the 3D-LA model, PS density was higher in the LA appendage (LAA) compared with other parts of the LA (P<0.05). In 30 persistent-AF patients, the surface bumpiness of LAA was 5.8-fold that of other LA parts (P<0.001), and exceeded critical bumpiness to induce wavebreak. Wave dynamics complexity parameters were consistently dominant in the LAA (P<0.001). Conclusions: Bumpy tissue geometry promoted APD dispersion, wavebreak, and spiral wave drift in in-silico human atrial tissue, and corresponded to clinical electroanatomical maps.</description><identifier>ISSN: 1346-9843</identifier><identifier>ISSN: 1347-4820</identifier><identifier>EISSN: 1347-4820</identifier><identifier>DOI: 10.1253/circj.CJ-18-0615</identifier><identifier>PMID: 30429429</identifier><language>eng</language><publisher>Japan: The Japanese Circulation Society</publisher><subject>Arrhythmias, Cardiac - diagnostic imaging ; Arrhythmias, Cardiac - pathology ; Arrhythmias, Cardiac - physiopathology ; Atrial Appendage - diagnostic imaging ; Atrial Appendage - pathology ; Atrial Appendage - physiopathology ; Atrial fibrillation ; Atrial Fibrillation - diagnostic imaging ; Atrial Fibrillation - pathology ; Atrial Fibrillation - physiopathology ; Curvature ; Humans ; Left atrial appendage ; Male ; Modeling ; Models, Cardiovascular ; Tomography, X-Ray Computed</subject><ispartof>Circulation Journal, 2018/12/25, Vol.83(1), pp.32-40</ispartof><rights>2019 THE JAPANESE CIRCULATION SOCIETY</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c578t-b229b6baf1663809d3c1a65fe1b8d0362bd76c8c5d03d25ba2a8e30d92ae1243</citedby><cites>FETCH-LOGICAL-c578t-b229b6baf1663809d3c1a65fe1b8d0362bd76c8c5d03d25ba2a8e30d92ae1243</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,780,784,27924,27925</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/30429429$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Song, Jun-Seop</creatorcontrib><creatorcontrib>Kim, Jaehyeok</creatorcontrib><creatorcontrib>Lim, Byounghyun</creatorcontrib><creatorcontrib>Lee, Young-Seon</creatorcontrib><creatorcontrib>Hwang, Minki</creatorcontrib><creatorcontrib>Joung, Boyoung</creatorcontrib><creatorcontrib>Shim, Eun Bo</creatorcontrib><creatorcontrib>Pak, Hui-Nam</creatorcontrib><title>Pro-Arrhythmogenic Effects of Heterogeneous Tissue Curvature ― A Suggestion for Role of Left Atrial Appendage in Atrial Fibrillation</title><title>Circulation Journal</title><addtitle>Circ J</addtitle><description>Background: The arrhythmogenic role of complex atrial morphology has not yet been clearly elucidated. We hypothesized that bumpy tissue geometry can induce action potential duration (APD) dispersion and wavebreak in atrial fibrillation (AF). Methods and Results: We simulated a 2D-bumpy atrial model by varying the degree of bumpiness, and 3D-left atrial (LA) models integrated by LA computed tomographic (CT) images taken from 14 patients with persistent AF. We also analyzed wave-dynamic parameters with bipolar electrograms during AF and compared them with LA-CT geometry in 30 patients with persistent AF. In the 2D-bumpy model, APD dispersion increased (P<0.001) and wavebreak occurred spontaneously when the surface bumpiness was greater, showing phase transition-like behavior (P<0.001). The bumpiness gradient 2D-model showed that spiral wave drifted in the direction of higher bumpiness, and phase singularity (PS) points were mostly located in areas with higher bumpiness. In the 3D-LA model, PS density was higher in the LA appendage (LAA) compared with other parts of the LA (P<0.05). In 30 persistent-AF patients, the surface bumpiness of LAA was 5.8-fold that of other LA parts (P<0.001), and exceeded critical bumpiness to induce wavebreak. Wave dynamics complexity parameters were consistently dominant in the LAA (P<0.001). Conclusions: Bumpy tissue geometry promoted APD dispersion, wavebreak, and spiral wave drift in in-silico human atrial tissue, and corresponded to clinical electroanatomical maps.</description><subject>Arrhythmias, Cardiac - diagnostic imaging</subject><subject>Arrhythmias, Cardiac - pathology</subject><subject>Arrhythmias, Cardiac - physiopathology</subject><subject>Atrial Appendage - diagnostic imaging</subject><subject>Atrial Appendage - pathology</subject><subject>Atrial Appendage - physiopathology</subject><subject>Atrial fibrillation</subject><subject>Atrial Fibrillation - diagnostic imaging</subject><subject>Atrial Fibrillation - pathology</subject><subject>Atrial Fibrillation - physiopathology</subject><subject>Curvature</subject><subject>Humans</subject><subject>Left atrial appendage</subject><subject>Male</subject><subject>Modeling</subject><subject>Models, Cardiovascular</subject><subject>Tomography, X-Ray Computed</subject><issn>1346-9843</issn><issn>1347-4820</issn><issn>1347-4820</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2018</creationdate><recordtype>article</recordtype><recordid>eNpFkMtu2zAQRYkiRfPqvquAy2yU8CHJ1FIQ4jxgoEXjPUFRQ5uGLDokVSA7L_sD-cHkRyLZTgIQQ87g3IvhRegXJVeUZfxaW69XV9VDQkVCcpp9QyeUp5MkFYwc7d55UoiUH6PTEFaEsIJkxQ90zEnKiuGcoP9_vEtK75fPcbl2C-isxjfGgI4BO4PvIIIfx-D6gOc2hB5w1ft_KvYe3rbb1-0LLvFjv1hAiNZ12DiP_7oWRvUMTMRl9Fa1uNxsoGvUArDtPmZTW3vbtmoUnqPvRrUBfh7uMzSf3syru2T2-_a-KmeJziYiJjVjRZ3XytA854IUDddU5ZkBWouG8JzVzSTXQmdD07CsVkwJ4KQpmALKUn6GLve2G--e-mFnubZBw7DE7ouSUc4FSwkfUbJHtXcheDBy4-1a-WdJiRzjl7v4ZfUgqZBj_IPk4uDe12toPgUfeQ_AdA-sQhyy-ASUj1a3cHAUXNKxfDl_AUvlJXT8HcUMnrc</recordid><startdate>20181225</startdate><enddate>20181225</enddate><creator>Song, Jun-Seop</creator><creator>Kim, Jaehyeok</creator><creator>Lim, Byounghyun</creator><creator>Lee, Young-Seon</creator><creator>Hwang, Minki</creator><creator>Joung, Boyoung</creator><creator>Shim, Eun Bo</creator><creator>Pak, Hui-Nam</creator><general>The Japanese Circulation Society</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>20181225</creationdate><title>Pro-Arrhythmogenic Effects of Heterogeneous Tissue Curvature ― A Suggestion for Role of Left Atrial Appendage in Atrial Fibrillation</title><author>Song, Jun-Seop ; Kim, Jaehyeok ; Lim, Byounghyun ; Lee, Young-Seon ; Hwang, Minki ; Joung, Boyoung ; Shim, Eun Bo ; Pak, Hui-Nam</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c578t-b229b6baf1663809d3c1a65fe1b8d0362bd76c8c5d03d25ba2a8e30d92ae1243</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2018</creationdate><topic>Arrhythmias, Cardiac - diagnostic imaging</topic><topic>Arrhythmias, Cardiac - pathology</topic><topic>Arrhythmias, Cardiac - physiopathology</topic><topic>Atrial Appendage - diagnostic imaging</topic><topic>Atrial Appendage - pathology</topic><topic>Atrial Appendage - physiopathology</topic><topic>Atrial fibrillation</topic><topic>Atrial Fibrillation - diagnostic imaging</topic><topic>Atrial Fibrillation - pathology</topic><topic>Atrial Fibrillation - physiopathology</topic><topic>Curvature</topic><topic>Humans</topic><topic>Left atrial appendage</topic><topic>Male</topic><topic>Modeling</topic><topic>Models, Cardiovascular</topic><topic>Tomography, X-Ray Computed</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Song, Jun-Seop</creatorcontrib><creatorcontrib>Kim, Jaehyeok</creatorcontrib><creatorcontrib>Lim, Byounghyun</creatorcontrib><creatorcontrib>Lee, Young-Seon</creatorcontrib><creatorcontrib>Hwang, Minki</creatorcontrib><creatorcontrib>Joung, Boyoung</creatorcontrib><creatorcontrib>Shim, Eun Bo</creatorcontrib><creatorcontrib>Pak, Hui-Nam</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Circulation Journal</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Song, Jun-Seop</au><au>Kim, Jaehyeok</au><au>Lim, Byounghyun</au><au>Lee, Young-Seon</au><au>Hwang, Minki</au><au>Joung, Boyoung</au><au>Shim, Eun Bo</au><au>Pak, Hui-Nam</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Pro-Arrhythmogenic Effects of Heterogeneous Tissue Curvature ― A Suggestion for Role of Left Atrial Appendage in Atrial Fibrillation</atitle><jtitle>Circulation Journal</jtitle><addtitle>Circ J</addtitle><date>2018-12-25</date><risdate>2018</risdate><volume>83</volume><issue>1</issue><spage>32</spage><epage>40</epage><pages>32-40</pages><issn>1346-9843</issn><issn>1347-4820</issn><eissn>1347-4820</eissn><abstract>Background: The arrhythmogenic role of complex atrial morphology has not yet been clearly elucidated. We hypothesized that bumpy tissue geometry can induce action potential duration (APD) dispersion and wavebreak in atrial fibrillation (AF). Methods and Results: We simulated a 2D-bumpy atrial model by varying the degree of bumpiness, and 3D-left atrial (LA) models integrated by LA computed tomographic (CT) images taken from 14 patients with persistent AF. We also analyzed wave-dynamic parameters with bipolar electrograms during AF and compared them with LA-CT geometry in 30 patients with persistent AF. In the 2D-bumpy model, APD dispersion increased (P<0.001) and wavebreak occurred spontaneously when the surface bumpiness was greater, showing phase transition-like behavior (P<0.001). The bumpiness gradient 2D-model showed that spiral wave drifted in the direction of higher bumpiness, and phase singularity (PS) points were mostly located in areas with higher bumpiness. In the 3D-LA model, PS density was higher in the LA appendage (LAA) compared with other parts of the LA (P<0.05). In 30 persistent-AF patients, the surface bumpiness of LAA was 5.8-fold that of other LA parts (P<0.001), and exceeded critical bumpiness to induce wavebreak. Wave dynamics complexity parameters were consistently dominant in the LAA (P<0.001). Conclusions: Bumpy tissue geometry promoted APD dispersion, wavebreak, and spiral wave drift in in-silico human atrial tissue, and corresponded to clinical electroanatomical maps.</abstract><cop>Japan</cop><pub>The Japanese Circulation Society</pub><pmid>30429429</pmid><doi>10.1253/circj.CJ-18-0615</doi><tpages>9</tpages><oa>free_for_read</oa></addata></record> |
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| subjects | Arrhythmias, Cardiac - diagnostic imaging Arrhythmias, Cardiac - pathology Arrhythmias, Cardiac - physiopathology Atrial Appendage - diagnostic imaging Atrial Appendage - pathology Atrial Appendage - physiopathology Atrial fibrillation Atrial Fibrillation - diagnostic imaging Atrial Fibrillation - pathology Atrial Fibrillation - physiopathology Curvature Humans Left atrial appendage Male Modeling Models, Cardiovascular Tomography, X-Ray Computed |
| title | Pro-Arrhythmogenic Effects of Heterogeneous Tissue Curvature ― A Suggestion for Role of Left Atrial Appendage in Atrial Fibrillation |
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