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Pro-Arrhythmogenic Effects of Heterogeneous Tissue Curvature - A Suggestion for Role of Left Atrial Appendage in Atrial Fibrillation

Authors
 Jun-Seop Song  ;  Jaehyeok Kim  ;  Byounghyun Lim  ;  Young-Seon Lee  ;  Minki Hwang  ;  Boyoung Joung  ;  Eun Bo Shim  ;  Hui-Nam Pak 
Citation
 Circulation Journal, Vol.83(1) : 32-40, 2018 
Journal Title
 Circulation Journal 
ISSN
 1346-9843 
Issue Date
2018
Keywords
Atrial fibrillation ; Curvature ; Left atrial appendage ; Modeling
Abstract
BACKGROUND: The arrhythmogenic role of complex atrial morphology has not yet been clearly elucidated. We hypothesized that bumpy tissue geometry can induce action potential duration (APD) dispersion and wavebreak in atrial fibrillation (AF). Methods and Results: We simulated a 2D-bumpy atrial model by varying the degree of bumpiness, and 3D-left atrial (LA) models integrated by LA computed tomographic (CT) images taken from 14 patients with persistent AF. We also analyzed wave-dynamic parameters with bipolar electrograms during AF and compared them with LA-CT geometry in 30 patients with persistent AF. In the 2D-bumpy model, APD dispersion increased (P<0.001) and wavebreak occurred spontaneously when the surface bumpiness was greater, showing phase transition-like behavior (P<0.001). The bumpiness gradient 2D-model showed that spiral wave drifted in the direction of higher bumpiness, and phase singularity (PS) points were mostly located in areas with higher bumpiness. In the 3D-LA model, PS density was higher in the LA appendage (LAA) compared with other parts of the LA (P<0.05). In 30 persistent-AF patients, the surface bumpiness of LAA was 5.8-fold that of other LA parts (P<0.001), and exceeded critical bumpiness to induce wavebreak. Wave dynamics complexity parameters were consistently dominant in the LAA (P<0.001). CONCLUSIONS: Bumpy tissue geometry promoted APD dispersion, wavebreak, and spiral wave drift in in-silico human atrial tissue, and corresponded to clinical electroanatomical maps.
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DOI
10.1253/circj.CJ-18-0615
Appears in Collections:
1. College of Medicine (의과대학) > Dept. of Internal Medicine (내과학교실) > 1. Journal Papers
1. College of Medicine (의과대학) > BioMedical Science Institute (의생명과학부) > 1. Journal Papers
Yonsei Authors
박희남(Pak, Hui Nam) ORCID logo https://orcid.org/0000-0002-3256-3620
임병현(Lim, Byounghyun)
정보영(Joung, Bo Young) ORCID logo https://orcid.org/0000-0001-9036-7225
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URI
https://ir.ymlib.yonsei.ac.kr/handle/22282913/167137
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