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Effect of catheter ablation on the hemodynamics of the left atrium

Hemodynamics of ablation

  • Published:
Journal of Interventional Cardiac Electrophysiology Aims and scope Submit manuscript

Abstract

Background

This study aims to evaluate the impact of catheter ablation for atrial fibrillation (AF) on left atrial (LA) flow dynamics and geometrical changes.

Methods

This exploratory study included computational flow simulations from 10 patients who underwent catheter ablation for AF. Complete cardiac cycle dataset was simulated before and after ablation using computational fluid dynamics. The study main endpoints were the changes in LA volume, LA velocity, LA wall shear stress (WSS), circulation (Γ), vorticity, pulmonary vein (PV) ostia area, and LA vortices before and after ablation.

Results

There was an average decrease in LA volume (11.58 ± 15.17%) and PV ostia area (16.6 ± 21.41%) after ablation. A non-uniform trend of velocity and WSS changes were observed after ablation. Compared with pre-ablation, 4 patients exhibited lower velocities, WSS distributions, and a decreased Γ (> 8.5%), while 6 developed higher velocities and WSS distributions. These geometrical changes dictated different flow mixing in the LA and distinct vortex patterns, characterized by different spinning velocities, vorticities, and rotational directions. Regions with q-criterion > 0 were found to be dominant in the LA, indicating prevalent rotational vortex structures.

Conclusion

Catheter ablation for AF induced different geometrical changes on the LA and the PVs, therefore influencing flow mixing and vortex patterns in the LA, in addition to overall velocity and WSS distribution. Further exploration of the impact of catheter ablation on intracardiac flow dynamics is warranted to discern patterns that may correlate with clinical outcomes.

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Abbreviations

LA:

Left atrium

PV:

Pulmonary veins

AF:

Atrial fibrillation

WSS:

Wall shear stress

CFD:

Computational fluid dynamics

LAA:

Left atrial appendage

Γ:

Circulation

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Authors and Affiliations

  1. Biomedical Engineering Department, Michigan Technological University, Houghton, MI, USA

    Brennan J. Vogl & Hoda Hatoum

  2. Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, USA

    Ahmed El Shaer, Martin Van Zyl, Ammar M. Killu & Mohamad Alkhouli

  3. Department of Biomedical Engineering, Health Research Institute, Center of Biocomputing and Digital Health and Institute of Computing and Cybernetics, Michigan Technological University, 1400 Townsend Dr, Houghton, MI, 49931, USA

    Hoda Hatoum

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  1. Brennan J. Vogl
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Correspondence to Hoda Hatoum.

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Supplementary Information

Below is the link to the electronic supplementary material.

Supplementary file1 Summary of patients’ ablation characteristics (DOCX 16 KB)

10840_2022_1191_MOESM2_ESM.docx

Supplementary file2 Summary of patients' characteristics includingbody mass index (BMI), hypertension (HT), and diabetes mellitus (DM). Patientswith a BMI of 30 or greater are considered obese (DOCX 13 KB)

10840_2022_1191_MOESM3_ESM.docx

Supplementary file3 Variation in averagedvelocity at a selected location in the LA with mesh resolution refinement for asample representative patient. Seven meshes were evaluated with element edgelengths ranging from 0.8 to 2.0 mm (DOCX 13 KB)

10840_2022_1191_MOESM4_ESM.docx

Supplementary file4 Comparison of velocity in the PVs at the D waveand that obtained from the CFD simulations. PV denotes pulmonary veins (DOCX 13 KB)

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Vogl, B.J., Shaer, A.E., Van Zyl, M. et al. Effect of catheter ablation on the hemodynamics of the left atrium. J Interv Card Electrophysiol 65, 83–96 (2022). https://doi.org/10.1007/s10840-022-01191-3

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  • DOI: https://doi.org/10.1007/s10840-022-01191-3

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