Dataset Information

Atrial fibrillation driver identification through regional mutual information networks: a modeling perspective.

ABSTRACT:

Purpose

Effective identification of electrical drivers within remodeled tissue is a key for improving ablation treatment for atrial fibrillation. We have developed a mutual information, graph-based approach to identify and propose fault tolerance metric of local efficiency as a distinguishing feature of rotational activation and remodeled atrial tissue.

Methods

Voltage data were extracted from atrial tissue simulations (2D Karma, 3D physiological, and the Multiscale Cardiac Simulation Framework (MSCSF)) using multi-spline open and parallel regional mapping catheter geometries. Graphs were generated based on varied mutual information thresholds between electrode pairs and the local efficiency for each graph was calculated.

Results

High-resolution mapping catheter geometries can distinguish between rotational and irregular activation patterns using the derivative of local efficiency as a function of increasing mutual information threshold. The derivative is decreased for rotational activation patterns comparing to irregular activations in both a simplified 2D model (0.0017 ± 1 × 10^-4 vs. 0.0032 ± 1 × 10^-4, p < 0.01) and a more realistic 3D model (0.00092 ± 5 × 10^-5 vs. 0.0014 ± 4 × 10^-5, p < 0.01). Average local efficiency derivative can also distinguish between degrees of remodeling. Simulations using the MSCSF model, with 10 vs. 90% remodeling, display distinct derivatives in the grid design parallel spline catheter configuration (0.0015 ± 5 × 10^-5 vs. 0.0019 ± 6 × 10^-5, p < 0.01) and the flower shaped open spline configuration (0.0011 ± 5 × 10^-5 vs. 0.0016 ± 4 × 10^-5, p < 0.01).

Conclusion

A decreased derivative of local efficiency characterizes rotational activation and varies with atrial remodeling. This suggests a distinct communication pattern in cardiac rotational activation detectable via high-resolution regional mapping and could enable identification of electrical drivers for targeted ablation.

SUBMITTER: Sha Q

PROVIDER: S-EPMC9470649 | biostudies-literature | 2022 Sep

REPOSITORIES: biostudies-literature

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Publications

Atrial fibrillation driver identification through regional mutual information networks: a modeling perspective.

Sha Qun Q Elliott Luizetta L Zhang Xiangming X Levy Tzachi T Sharma Tushar T Abdelaal Ahmed A

Journal of interventional cardiac electrophysiology : an international journal of arrhythmias and pacing 20220104 3

<h4>Purpose</h4>Effective identification of electrical drivers within remodeled tissue is a key for improving ablation treatment for atrial fibrillation. We have developed a mutual information, graph-based approach to identify and propose fault tolerance metric of local efficiency as a distinguishing feature of rotational activation and remodeled atrial tissue.<h4>Methods</h4>Voltage data were extracted from atrial tissue simulations (2D Karma, 3D physiological, and the Multiscale Cardiac Simula ...[more]

PMID: 34981289

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Project description:BackgroundAppropriate thromboprophylaxis for patients with atrial fibrillation or atrial flutter (AF) remains a national challenge. The recent availability of direct oral anticoagulants (DOACs) with comparable efficacy and improved safety compared with warfarin alters the balance between risk factors for stroke and benefit of anticoagulation. Our objective was to examine the impact of DOACs as an alternative to warfarin on the net benefit of oral anticoagulant therapy (OAT) in a real-world population of AF patients.MethodsThis is a retrospective cohort study of patients with paroxysmal or persistent nonvalvular AF. We updated an Atrial Fibrillation Decision Support Tool (AFDST) to include DOACs as treatment options. The tool generates patient-specific recommendations based upon individual patient risk factor profiles for stroke and major bleeding using quality-adjusted life-years (QALYs) calculated for each treatment strategy by a decision analytic model. The setting included inpatient and ambulatory sites in an academic health center in the midwestern United States. The study involved 5,121 adults with nonvalvular AF seen for any ambulatory visit or inpatient hospitalization over the 1-year period (January through December 2016). Outcome measure was net clinical benefit in QALYs.ResultsWhen DOACs are a therapeutic option, the AFDST recommends OAT for 4,134 (81%) patients and no antithrombotic therapy or aspirin for 489 (9%). A strong recommendation for OAT could not be made in 498 (10%) patients. When warfarin is the only option, OAT is recommended for 3,228 (63%) patients and no antithrombotic therapy or aspirin for 973 (19%). A strong recommendation for OAT could not be made in 920 (18%) patients. In total, 1,508 QALYs could be gained if treatment were changed to that recommended by the AFDST.ConclusionsAvailability of DOACs increases the proportion of patients for whom oral anticoagulation therapy is recommended in a real-world cohort of AF patients and increased projected QALYs by more than 1,500 when all patients are receiving thromboprophylaxis as recommended by the AFDST compared with current treatment.

Dataset Information

Atrial fibrillation driver identification through regional mutual information networks: a modeling perspective.

Purpose

Methods

Results

Conclusion

Publications

Atrial fibrillation driver identification through regional mutual information networks: a modeling perspective.

Similar Datasets

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