{"database":"biostudies-literature","file_versions":[],"scores":null,"additional":{"submitter":["Macheret F"],"funding":["NIBIB NIH HHS","NCATS NIH HHS","NHLBI NIH HHS"],"pagination":["2149-2162"],"full_dataset_link":["https://www.ebi.ac.uk/biostudies/studies/S-EPMC10909381"],"repository":["biostudies-literature"],"omics_type":["Unknown"],"volume":["9(10)"],"pubmed_abstract":["<h4>Background</h4>Computational models of fibrosis-mediated, re-entrant left atrial (LA) arrhythmia can identify possible substrate for persistent atrial fibrillation (AF) ablation. Contemporary models use a 1-size-fits-all approach to represent electrophysiological properties, limiting agreement between simulations and patient outcomes.<h4>Objectives</h4>The goal of this study was to test the hypothesis that conduction velocity (ϴ) modulation in persistent AF models can improve simulation agreement with clinical arrhythmias.<h4>Methods</h4>Patients with persistent AF (n = 37) underwent ablation and were followed up for ≥2 years to determine post-ablation outcomes: AF, atrial flutter (AFL), or no recurrence. Patient-specific LA models (n = 74) were constructed using pre-ablation and ≥90 days' post-ablation magnetic resonance imaging data. Simulated pacing gauged in silico arrhythmia inducibility due to AF-like rotors or AFL-like macro re-entrant tachycardias. A physiologically plausible range of ϴ values (±10 or 20% vs. baseline) was tested, and model/clinical agreement was assessed.<h4>Results</h4>Fifteen (41%) patients had a recurrence with AF and 6 (16%) with AFL. Arrhythmia was induced in 1,078 of 5,550 simulations. Using baseline ϴ, model/clinical agreement was 46% (34 of 74 models), improving to 65% (48 of 74) when any possible ϴ value was used (McNemar's test, P = 0.014). ϴ modulation improved model/clinical agreement in both pre-ablation and post-ablation models. Pre-ablation model/clinical agreement was significantly greater for patients with extensive LA fibrosis (>17.2%) and an elevated body mass index (>32.0 kg/m<sup>2</sup>).<h4>Conclusions</h4>Simulations in persistent AF models show a 41% relative improvement in model/clinical agreement when ϴ is modulated. Patient-specific calibration of ϴ values could improve model/clinical agreement and model usefulness, especially in patients with higher body mass index or LA fibrosis burden. This could ultimately facilitate better personalized modeling, with immediate clinical implications."],"journal":["JACC. Clinical electrophysiology"],"pubmed_title":["Comparing Inducibility of Re-Entrant Arrhythmia in Patient-Specific Computational Models to Clinical Atrial Fibrillation Phenotypes."],"pmcid":["PMC10909381"],"funding_grant_id":["R01 HL158667","T32 EB032787","UL1 TR002319"],"pubmed_authors":["Bifulco SF","Scott GD","Boyle PM","Afroze T","Akoum N","Macheret F","McDonagh R","Kwan KT","Chahine Y"],"additional_accession":[]},"is_claimable":false,"name":"Comparing Inducibility of Re-Entrant Arrhythmia in Patient-Specific Computational Models to Clinical Atrial Fibrillation Phenotypes.","description":"<h4>Background</h4>Computational models of fibrosis-mediated, re-entrant left atrial (LA) arrhythmia can identify possible substrate for persistent atrial fibrillation (AF) ablation. Contemporary models use a 1-size-fits-all approach to represent electrophysiological properties, limiting agreement between simulations and patient outcomes.<h4>Objectives</h4>The goal of this study was to test the hypothesis that conduction velocity (ϴ) modulation in persistent AF models can improve simulation agreement with clinical arrhythmias.<h4>Methods</h4>Patients with persistent AF (n = 37) underwent ablation and were followed up for ≥2 years to determine post-ablation outcomes: AF, atrial flutter (AFL), or no recurrence. Patient-specific LA models (n = 74) were constructed using pre-ablation and ≥90 days' post-ablation magnetic resonance imaging data. Simulated pacing gauged in silico arrhythmia inducibility due to AF-like rotors or AFL-like macro re-entrant tachycardias. A physiologically plausible range of ϴ values (±10 or 20% vs. baseline) was tested, and model/clinical agreement was assessed.<h4>Results</h4>Fifteen (41%) patients had a recurrence with AF and 6 (16%) with AFL. Arrhythmia was induced in 1,078 of 5,550 simulations. Using baseline ϴ, model/clinical agreement was 46% (34 of 74 models), improving to 65% (48 of 74) when any possible ϴ value was used (McNemar's test, P = 0.014). ϴ modulation improved model/clinical agreement in both pre-ablation and post-ablation models. Pre-ablation model/clinical agreement was significantly greater for patients with extensive LA fibrosis (>17.2%) and an elevated body mass index (>32.0 kg/m<sup>2</sup>).<h4>Conclusions</h4>Simulations in persistent AF models show a 41% relative improvement in model/clinical agreement when ϴ is modulated. Patient-specific calibration of ϴ values could improve model/clinical agreement and model usefulness, especially in patients with higher body mass index or LA fibrosis burden. This could ultimately facilitate better personalized modeling, with immediate clinical implications.","dates":{"release":"2023-01-01T00:00:00Z","publication":"2023 Oct","modification":"2025-04-22T21:42:23.164Z","creation":"2025-04-06T03:48:18.19Z"},"accession":"S-EPMC10909381","cross_references":{"pubmed":["37656099"],"doi":["10.1016/j.jacep.2023.06.015"]}}