Feasibility of using patient-specific models and the "minimum cut" algorithm to predict optimal ablation targets for left atrial flutter.
Left atrial flutter (LAFL) occurs in patients after atrial fibrillation ablation. Identification of optimal ablation targets to terminate LAFL remains challenging.



The purpose of this study was to use patient-specific models to simulate LAFL and predict optimal ablation targets using a novel approach based on flow network theory.



Late gadolinium-enhanced cardiac magnetic resonance scans from 10 patients with LAFL were used to construct atrial models incorporating fibrosis by investigators blinded to procedural findings. Rapid pacing was applied in silico to induce LAFL. In each LAFL, we represented reentrant wave propagation as an electric flow network and identified the "minimum cut" (MC), which was the smallest amount of tissue that separated the flow into 2 discontinuous components. In silico ablation was applied at MCs, and targets were compared to those that terminated LAFL during catheter ablation.



Patient-specific atrial models were successfully generated from patient scans. LAFL was induced in 7 of 10 models. Ablation of MCs terminated LAFL in 4 models and produced new, slower LAFL morphologies in the other 3. For the latter cases, flow analysis was repeated to identify MCs of emergent LAFLs. Ablation of these MCs terminated emergent LAFLs. The MC-based ablation lesions in simulations were similar in length and location to ablation targets that terminated LAFL during catheter ablation for these 7 patients.



Personalized atrial simulations can predict ablation targets for LAFL. These simulations provide a powerful tool for planning ablation procedures and may reduce procedural times and complications.
Institute for Computational Medicine, Department of Biomedical Engineering, Johns Hopkins University, Baltimore, Maryland.
Sohail
S
Zahid
Institute for Computational Medicine, Department of Biomedical Engineering, Johns Hopkins University, Baltimore, Maryland.
Kaitlyn N
KN
Whyte
Institute for Computational Medicine, Department of Biomedical Engineering, Johns Hopkins University, Baltimore, Maryland.
Erica L
EL
Schwarz
CardioSolv Ablation Technologies Inc, Baltimore, Maryland.
Robert C
RC
Blake
Institute for Computational Medicine, Department of Biomedical Engineering, Johns Hopkins University, Baltimore, Maryland.
Patrick M
PM
Boyle
Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland.
Jonathan
J
Chrispin
Institute for Computational Medicine, Department of Biomedical Engineering, Johns Hopkins University, Baltimore, Maryland.
Adityo
A
Prakosa
Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland.
Esra G
EG
Ipek
Institute for Computational Medicine, Department of Biomedical Engineering, Johns Hopkins University, Baltimore, Maryland.
Farhad
F
Pashakhanloo
Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland.
Henry R
HR
Halperin
Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland.
Hugh
H
Calkins
Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland.
Ronald D
RD
Berger
Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland; Department of Epidemiology, Johns Hopkins University School of Medicine, Baltimore, Maryland.
Saman
S
Nazarian
Institute for Computational Medicine, Department of Biomedical Engineering, Johns Hopkins University, Baltimore, Maryland; Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland. Electronic address: ntrayanova@jhu.edu.
Natalia A
NA
Trayanova
D000368:Aged; D000465:Algorithms; D001282:Atrial Flutter / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery*; D017115:Catheter Ablation / Q000379:methods*; D003198:Computer Simulation; D004562:Electrocardiography; D005240:Feasibility Studies; D005260:Female; D006325:Heart Atria / Q000503:physiopathology; D006329:Heart Conduction System / Q000000981:diagnostic imaging / Q000503:physiopathology* / Q000601:surgery; D006801:Humans; D019028:Magnetic Resonance Imaging, Cine; D008297:Male
Ablation target; Fibrosis; Left atrial flutter; Network theory; Patient-specific atrial model