title: Optimization of catheter ablation of atrial fibrillation: insights gained from clinically-derived computer models.
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.
authors.affiliation: Auckland Bioengineering Institute, University of Auckland, Auckland 1142, New Zealand. j.zhao@auckland.ac.nz.
authors.forename: Jichao
authors.initials: J
authors.lastname: Zhao
authors.affiliation: College of Engineering, Mathematics and Physical Sciences, University of Exeter, Exeter EX4 4QF, UK. S.R.Kharche@exeter.ac.uk.|Institute of Cardiovascular Sciences, University of Manchester, Manchester M13 9NT, UK. S.R.Kharche@exeter.ac.uk.
authors.forename: Sanjay R
authors.initials: SR
authors.lastname: Kharche
authors.affiliation: Department of Physiology & Cell Biology and Davis Heart & Lung Research Institute, the Ohio State University Wexner Medical Center, Columbus, OH 43210, USA. hansen.296@buckeyemail.osu.edu.
authors.forename: Brian J
authors.initials: BJ
authors.lastname: Hansen
authors.affiliation: Department of Physiology & Cell Biology and Davis Heart & Lung Research Institute, the Ohio State University Wexner Medical Center, Columbus, OH 43210, USA. csepe.2@buckeyemail.osu.edu.
authors.forename: Thomas A
authors.initials: TA
authors.lastname: Csepe
authors.affiliation: Auckland Bioengineering Institute, University of Auckland, Auckland 1142, New Zealand. ywan520@aucklanduni.ac.nz.
authors.forename: Yufeng
authors.initials: Y
authors.lastname: Wang
authors.affiliation: Department of Cardiology, Waikato Hospital, Hamilton 3240, New Zealand. Martin.Stiles@waikatodhb.health.nz.
authors.forename: Martin K
authors.initials: MK
authors.lastname: Stiles
authors.affiliation: Department of Physiology & Cell Biology and Davis Heart & Lung Research Institute, the Ohio State University Wexner Medical Center, Columbus, OH 43210, USA. vadim.fedorov@osumc.edu.
authors.forename: Vadim V
authors.initials: VV
authors.lastname: Fedorov
mesh_terms: D000818:Animals; D001281:Atrial Fibrillation / Q000601:surgery*; D017115:Catheter Ablation; D003198:Computer Simulation; D005355:Fibrosis; D006801:Humans; D008955:Models, Cardiovascular; D011667:Pulmonary Veins / Q000473:pathology
keywords: atrial fibrillation; cardiac arrhythmias; catheter ablation; computer model; fibrosis; patient specific model; pulmonary vein isolation; re-entry; rotors