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Published on: July 15, 2021
Ablation of multi-wavelet re-entry: general principles and in silico analyses
Peter S Spector1, Daniel D Correa de Sa, Ethan S Tischler
1Department of Medicine, University of Vermont College of Burlington, VT 05401, USA. peter.spector@uvm.edu
Summary
Mechanism-based catheter ablation using linear lesions, not focal ones, is crucial for terminating complex cardiac arrhythmias like spiral-wave re-entry. This approach improves treatment efficacy for dynamic substrates.
Area of Science:
- Computational electrophysiology
- Cardiac electrophysiology
- Surface topology in biological systems
Background:
- Catheter ablation is effective for simple cardiac arrhythmias.
- Complex, dynamic arrhythmias pose challenges due to fixed ablation lesions.
- Surface topology offers a new framework for understanding and treating arrhythmias.
Purpose of the Study:
- To test mechanism-based ablation strategies for complex dynamic cardiac substrates.
- To evaluate the efficacy of different ablation approaches using a computational model.
- To establish a theoretical framework for treating re-entrant arrhythmias.
Main Methods:
- Utilized a computational model of excitable tissue to simulate ablation effects.
- Tested ablation strategies on excitation patterns of increasing complexity, from rotors to multi-wavelet re-entry.
- Analyzed the impact of focal and linear lesions on arrhythmia termination.
Main Results:
- Focal ablation at spiral-wave cores failed to terminate arrhythmias.
- Linear lesions from the tissue edge to the spiral-wave core were required for termination.
- Meandering spiral-waves terminated upon encountering boundaries (lesions or edges).
- Multi-wavelet re-entry termination probability correlated with boundary length to tissue area ratio.
- Linear lesion efficacy depended on regional spiral-wave density.
Conclusions:
- Established a theoretical framework for treating re-entrant arrhythmias.
- Demonstrated focal ablation's inadequacy for fixed spiral-waves.
- Provided principles for mechanism-based ablation of multi-wavelet re-entry.
- Highlighted the potential of targeting regional spiral-wave density heterogeneity.
