Atrial fibrillation septal pacing: translation of modelling results

Aims Atrial fibrillation (AF) septal pacing consists of rapid pacing from a ring of electrodes around the atrial septum, leading to local capture of both atria during AF. The present model-based study evaluated the impact of the number of stimulation electrodes in the septal ring on AF capture for different types of sustained AF dynamics. Methods and results Using a biophysical model of AF based on CT scans from an AF patient, models with different AF substrates (Cholinergic AF and Meandering Wavelets) were created by varying the atrial membrane kinetics. Rapid pacing was applied from the septum area with a ring of 1, 2, 3, 4, 6, 8, or 12 electrodes during 20 seconds at a pacing cycle lengths (PCLs) in the range 60–100% of AF cycle length (AFCL), in 4% steps. Percentage of captured tissue during rapid pacing was determined using 24 sensing electrode pairs evenly distributed on the atrial surface. Results were averaged over 10 AF simulations. For Cholinergic AF, the number of stimulation electrodes on the septal ring had no significant impact on AF capture independently of AF dynamics. For Meandering Wavelets, more electrodes were needed to achieve AF capture in the presence of complex AF. Conclusion Changes in AF substrate significantly impacted septal pacing outcomes and response to rapid AF pacing may similarly vary patient-to-patient. The number of stimulation electrodes had a lesser impact, suggesting that the design of a ring with 3–4 electrodes around the septum would be sufficient for most AF dynamics.

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A Simple Porcine Model of Inducible Sustained Atrial Fibrillation

Innovations Technology and Techniques in Cardiothoracic and Vascular Surgery ◽

10.1097/imi.0000000000000230 ◽

2016 ◽

Vol 11 (1) ◽

pp. 76-78 ◽

Cited By ~ 1

Author(s):

Anson M. Lee ◽

Jacob R. Miller ◽

Rochus K. Voeller ◽

Andreas Zierer ◽

Shelly C. Lall ◽

...

Keyword(s):

Atrial Fibrillation ◽

Animal Model ◽

Cycle Length ◽

Porcine Model ◽

New Technologies ◽

Median Sternotomy ◽

Manual Stimulation ◽

History Of ◽

Cycle Lengths ◽

Rapid Pacing

The surgical management of atrial fibrillation (AF) is an evolving field with a history of testing various lesion sets and ablation technologies. Previous animal models of AF require a chronic intervention to make AF reliably inducible. Our objective was to create an acute, reliable, and reproducible porcine model of sustained AF. To accomplish this, 21 adult domestic pigs underwent median sternotomy. Methods to induce AF were then performed sequentially: manual stimulation, rapid pacing (200 beats per minute), and then rapid pacing of 8 beats with a cycle length of 300 milliseconds, followed by an extra stimulus at decreasing cycle lengths. If AF was not induced, burst pacing was performed at a cycle length of 90 milliseconds for 30 seconds. If AF was still not induced, intravenous neostigmine was administered, and the process was repeated. Atrial fibrillation was considered sustained after 1 minute. Attempts at AF induction were successful in 18 (86%) of 21. Atrial fibrillation was induced during manual stimulation in four (19%), during rapid pacing in five (24%), during burst pacing in five (24%), and after the administration of neostigmine in four (19%). Mean (SD) duration of AF was 3.6 (2.6) minutes. Of the 18, 14 (78%) reverted to sinus rhythm spontaneously and 4 (22%) required an antiarrhythmic. This technique of inducing AF can easily be used to evaluate new technologies and lesion sets without the need for creating a chronic animal model.

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Atrial septal pacing for the termination of atrial fibrillation: study in a biophysical model of human atria

EP Europace ◽

10.1093/europace/eus279 ◽

2012 ◽

Vol 14 (suppl 5) ◽

pp. v112-v120 ◽

Cited By ~ 12

Author(s):

L. Uldry ◽

N. Virag ◽

F. Lindemans ◽

J.-M. Vesin ◽

L. Kappenberger

Keyword(s):

Atrial Fibrillation ◽

Biophysical Model ◽

Septal Pacing

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Optimizing Local Capture of Atrial Fibrillation by Rapid Pacing: Study of the Influence of Tissue Dynamics

Annals of Biomedical Engineering ◽

10.1007/s10439-010-0122-3 ◽

2010 ◽

Vol 38 (12) ◽

pp. 3664-3673 ◽

Cited By ~ 12

Author(s):

Laurent Uldry ◽

Nathalie Virag ◽

Vincent Jacquemet ◽

Jean-Marc Vesin ◽

Lukas Kappenberger

Keyword(s):

Atrial Fibrillation ◽

Rapid Pacing ◽

Local Capture

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Influence of atrial substrate on local capture induced by rapid pacing of atrial fibrillation

EP Europace ◽

10.1093/europace/euu003 ◽

2014 ◽

Vol 16 (5) ◽

pp. 766-773 ◽

Cited By ~ 5

Author(s):

A. Rusu ◽

V. Jacquemet ◽

J.-M. Vesin ◽

N. Virag

Keyword(s):

Atrial Fibrillation ◽

Rapid Pacing ◽

Local Capture

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The impact of initial electromechanical remodeling of left atrium on the outcome of radiofrequency ablation in patients with different types of atrial fibrillation

Annaly aritmologii ◽

10.15275/annaritmol.2014.2.6 ◽

2014 ◽

Vol 11 (2) ◽

pp. 118-129

Author(s):

L.A. Bockeria ◽

A.G. Filatov ◽

A.S. Kovalev

Keyword(s):

Atrial Fibrillation ◽

Radiofrequency Ablation ◽

Left Atrium ◽

Different Types ◽

The Impact

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Quota Women Are Threatening to Men

Swiss Journal of Psychology ◽

10.1024/1421-0185/a000195 ◽

2017 ◽

Vol 76 (3) ◽

pp. 107-116 ◽

Cited By ~ 4

Author(s):

Klea Faniko ◽

Till Burckhardt ◽

Oriane Sarrasin ◽

Fabio Lorenzi-Cioldi ◽

Siri Øyslebø Sørensen ◽

...

Keyword(s):

Decision Making ◽

Organizational Performance ◽

Gender Stereotypes ◽

Perceived Threat ◽

Preferential Treatment ◽

Public Sector Employees ◽

Different Types ◽

Low Levels ◽

Women In Decision Making ◽

The Impact

Abstract. Two studies carried out among Albanian public-sector employees examined the impact of different types of affirmative action policies (AAPs) on (counter)stereotypical perceptions of women in decision-making positions. Study 1 (N = 178) revealed that participants – especially women – perceived women in decision-making positions as more masculine (i.e., agentic) than feminine (i.e., communal). Study 2 (N = 239) showed that different types of AA had different effects on the attribution of gender stereotypes to AAP beneficiaries: Women benefiting from a quota policy were perceived as being more communal than agentic, while those benefiting from weak preferential treatment were perceived as being more agentic than communal. Furthermore, we examined how the belief that AAPs threaten men’s access to decision-making positions influenced the attribution of these traits to AAP beneficiaries. The results showed that men who reported high levels of perceived threat, as compared to men who reported low levels of perceived threat, attributed more communal than agentic traits to the beneficiaries of quotas. These findings suggest that AAPs may have created a backlash against its beneficiaries by emphasizing gender-stereotypical or counterstereotypical traits. Thus, the framing of AAPs, for instance, as a matter of enhancing organizational performance, in the process of policy making and implementation, may be a crucial tool to countering potential backlash.

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Faculty Opinions recommendation of Results from a single-blind, randomized study comparing the impact of different ablation approaches on long-term procedure outcome in coexistent atrial fibrillation and flutter (APPROVAL).

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.717999159.793477751 ◽

2013 ◽

Author(s):

Paolo Della Bella ◽

Pasquale Vergara

Keyword(s):

Atrial Fibrillation ◽

Randomized Study ◽

Atrial Fibrillation And Flutter ◽

The Impact ◽

Single Blind

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Faculty Opinions recommendation of The impact of adjunctive complex fractionated atrial electrogram ablation and linear lesions on outcomes in persistent atrial fibrillation: a meta-analysis.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.725932128.793537245 ◽

2017 ◽

Author(s):

Brian Olshansky

Keyword(s):

Atrial Fibrillation ◽

Meta Analysis ◽

Persistent Atrial Fibrillation ◽

Linear Lesions ◽

Atrial Electrogram ◽

The Impact ◽

Complex Fractionated Atrial Electrogram

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Artificial Intelligence as a Business Partner in Cardiovascular Precision Medicine: an Emerging Approach for Disease Detection and Treatment Optimization

Current Medicinal Chemistry ◽

10.2174/0929867328666201218122633 ◽

2020 ◽

Vol 28 ◽

Author(s):

Valeria Visco ◽

Germano Junior Ferruzzi ◽

Federico Nicastro ◽

Nicola Virtuoso ◽

Albino Carrizzo ◽

...

Keyword(s):

Artificial Intelligence ◽

Heart Failure ◽

Atrial Fibrillation ◽

Precision Medicine ◽

Clinical Decision Making ◽

Disease Detection ◽

Physician Patient Relationship ◽

Invasive Approach ◽

Tailored Treatment ◽

The Impact

Background: In the real world, medical practice is changing hand in hand with the development of new Artificial Intelligence (AI) systems and problems from different areas have been successfully solved using AI algorithms. Specifically, the use of AI techniques in setting up or building precision medicine is significant in terms of the accuracy of disease discovery and tailored treatment. Moreover, with the use of technology, clinical personnel can deliver a very much efficient healthcare service. Objective: This article reviews AI state-of-the-art in cardiovascular disease management, focusing on diagnostic and therapeutic improvements. Methods: To that end, we conducted a detailed PubMed search on AI application from distinct areas of cardiology: heart failure, arterial hypertension, atrial fibrillation, syncope and cardiovascular rehabilitation. Particularly, to assess the impact of these technologies in clinical decision-making, this research considers technical and medical aspects. Results: On one hand, some devices in heart failure, atrial fibrillation and cardiac rehabilitation represent an inexpensive, not invasive or not very invasive approach to long-term surveillance and management in these areas. On the other hand, the availability of large datasets (big data) is a useful tool to predict the development and outcome of many cardiovascular diseases. In summary, with this new guided therapy, the physician can supply prompt, individualised, and tailored treatment and the patients feel safe as they are continuously monitored, with a significant psychological effect. Conclusion: Soon, tailored patient care via telemonitoring can improve the clinical practice because AI-based systems support cardiologists in daily medical activities, improving disease detection and treatment. However, the physician-patient relationship remains a pivotal step.

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