Integrating State-of-the-Art Computational Modeling with Clinical Practice: The Promise of Numerical Methods

  • David E. Krummen
  • Gainyu Oshodi
  • Sanjiv M. Narayan


The use of numerical methods in clinical medicine has grown exponentially over the past decade. This is particularly true in clinical cardiac electrophysiology (EP), which is focused on the diagnosis, prevention and treatment of heart rhythm abnormalities. Part of the reason for this is the suitability of cardiac rhythm pathology to numerical modeling. At the tissue level, the mechanisms of electrical propagation within the heart are relatively deterministic both in health and during arrhythmias [31]. As a result, for many applications, there is remarkable correlation between prediction and measurement [30]. Another reason is the availability of detailed anatomical and physiologic imaging data in cardiology, including: echocardiography (transthoracic, transesophageal, and intracardiac), computed tomography (CT), magnetic resonance imaging (MRI), nuclear medicine, and positron emission tomography.


Atrial Fibrillation Heart Rate Variability Ventricular Fibrillation Cardiac Resynchronization Therapy Brugada Syndrome 
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  1. 1.
    Arentz T, Weber R, Burkle G, Herrera C, Blum T, Stockinger J, Minners J, Neumann FJ, and Kalusche D. Small or large isolation areas around the pulmonary veins for the treatment of atrial fibrillation? Results from a prospective randomized study. Circulation 115: 3057–3063, 2007.PubMedCrossRefGoogle Scholar
  2. 2.
    Badhwar N, Kalman JM, Sparks PB, Kistler PM, Attari M, Berger M, Lee RJ, Sra J, and Scheinman MM. Atrial tachycardia arising from the coronary sinus musculature: electrophysiological characteristics and long-term outcomes of radiofrequency ablation. J Am Coll Cardiol 46: 1921–1930, 2005.PubMedCrossRefGoogle Scholar
  3. 3.
    Bello D, Kipper S, Valderrabano M, and Shivkumar K. Catheter ablation of ventricular tachycardia guided by contrast-enhanced cardiac computed tomography. Heart Rhythm 1: 490–492, 2004.PubMedCrossRefGoogle Scholar
  4. 4.
    Bertaglia E, Brandolino G, Zoppo F, Zerbo F, and Pascotto P. Integration of 3-D left atrial magnetic resonance images into a real-time electroanatomic mapping system: validation of a registration method. Pacing Clin Electrophysiol 31: 273–282, 2008.PubMedCrossRefGoogle Scholar
  5. 5.
    Beshai JF, Grimm RA, Nagueh SF, Baker JH, 2nd, Beau SL, Greenberg SM, Pires LA, and Tchou PJ. Cardiac-resynchronization therapy in heart failure with narrow QRS complexes. N Engl J Med 357: 2461–2471, 2007.PubMedCrossRefGoogle Scholar
  6. 6.
    Bogun F, Bender B, Li YG, and Hohnloser SH. Ablation of atypical atrial flutter guided by the use of concealed entrainment in patients without prior cardiac surgery. J Cardiovasc Electrophysiol 11: 136–145, 2000.PubMedCrossRefGoogle Scholar
  7. 7.
    Bogun FM, Desjardins B, Good E, Gupta S, Crawford T, Oral H, Ebinger M, Pelosi F, Chugh A, Jongnarangsin K, and Morady F. Delayed-enhanced magnetic resonance imaging in nonischemic cardiomyopathy: utility for identifying the ventricular arrhythmia substrate. J Am Coll Cardiol 53: 1138–1145, 2009.PubMedCrossRefGoogle Scholar
  8. 8.
    Bonakdar HR, Jorat MV, Fazelifar AF, Alizadeh A, Givtaj N, Sameie N, Sadeghpour A, and Haghjoo M. Prediction of response to cardiac resynchronization therapy using simple electrocardiographic and echocardiographic tools. Europace 11: 1330–1337, 2009.PubMedCrossRefGoogle Scholar
  9. 9.
    Brignole M, Oddone D, Maggi R, Lupi G, Bollini R, Corallo S, Robotti S, Solano A, Donateo P, and Croci F. Resynchronization of the left ventricular contraction by tailored programming of right and left ventricular pacing. Europace 10: 489–495, 2008.PubMedCrossRefGoogle Scholar
  10. 10.
    Cano O, Hutchinson M, Lin D, Garcia F, Zado E, Bala R, Riley M, Cooper J, Dixit S, Gerstenfeld E, Callans D, and Marchlinski FE. Electroanatomic substrate and ablation outcome for suspected epicardial ventricular tachycardia in left ventricular nonischemic cardiomyopathy. J Am Coll Cardiol 54: 799–808, 2009.PubMedCrossRefGoogle Scholar
  11. 11.
    Cobb LA, Fahrenbruch CE, Olsufka M, and Copass MK. Changing incidence of out-of-­hospital ventricular fibrillation, 1980–2000. Jama 288: 3008–3013, 2002.PubMedCrossRefGoogle Scholar
  12. 12.
    Corrado D, Basso C, Leoni L, Tokajuk B, Bauce B, Frigo G, Tarantini G, Napodano M, Turrini P, Ramondo A, Daliento L, Nava A, Buja G, Iliceto S, and Thiene G. 3-D electroanatomic voltage mapping increases accuracy of diagnosing arrhythmogenic right ventricular cardiomyopathy/dysplasia. Circulation 111: 3042–3050, 2005.PubMedCrossRefGoogle Scholar
  13. 13.
    Costantini O, Hohnloser SH, Kirk MM, Lerman BB, Baker JH, 2nd, Sethuraman B, Dettmer MM, and Rosenbaum DS. The ABCD (Alternans Before Cardioverter Defibrillator) trial: strategies using T-wave alternans to improve efficiency of sudden cardiac death prevention. J Am Coll Cardiol 53: 471–479, 2009.PubMedCrossRefGoogle Scholar
  14. 14.
    Desjardins B, Crawford T, Good E, Oral H, Chugh A, Pelosi F, Morady F, and Bogun F. Infarct architecture and characteristics on delayed enhanced magnetic resonance imaging and electroanatomic mapping in patients with postinfarction ventricular arrhythmia. Heart Rhythm 6: 644–651, 2009.PubMedCrossRefGoogle Scholar
  15. 15.
    Eckstein J, Verheule S, de Groot NM, Allessie M, and Schotten U. Mechanisms of perpetuation of atrial fibrillation in chronically dilated atria. Prog Biophys Mol Biol 97: 435–451, 2008.PubMedCrossRefGoogle Scholar
  16. 16.
    Epstein AE, Dimarco JP, Ellenbogen KA, Estes NA, 3rd, Freedman RA, Gettes LS, Gillinov AM, Gregoratos G, Hammill SC, Hayes DL, Hlatky MA, Newby LK, Page RL, Schoenfeld MH, Silka MJ, Stevenson LW, and Sweeney MO. ACC/AHA/HRS 2008 guidelines for device-based therapy of cardiac rhythm abnormalities: executive summary. Heart Rhythm 5: 934–955, 2008.PubMedCrossRefGoogle Scholar
  17. 17.
    Fahmy TS, Wazni OM, Jaber WA, Walimbe V, Di Biase L, Elayi CS, DiFilippo FP, Young RB, Patel D, Riedlbauchova L, Corrado A, Burkhardt JD, Schweikert RA, Arruda M, and Natale A. Integration of positron emission tomography/computed tomography with electroanatomical mapping: a novel approach for ablation of scar-related ventricular tachycardia. Heart Rhythm 5: 1538–1545, 2008.PubMedCrossRefGoogle Scholar
  18. 18.
    Fan R, Cano O, Ho SY, Bala R, Callans DJ, Dixit S, Garcia F, Gerstenfeld EP, Hutchinson M, Lin D, Riley M, and Marchlinski FE. Characterization of the phrenic nerve course within the epicardial substrate of patients with nonischemic cardiomyopathy and ventricular tachycardia. Heart Rhythm 6: 59–64, 2009.PubMedCrossRefGoogle Scholar
  19. 19.
    Forleo GB, Pappalardo A, Avella A, Visigalli L, Dello Russo A, and Tondo C. Real-time integration of intracardiac echocardiography and 3D electroanatomical mapping to guide catheter ablation of isthmus-dependent atrial flutter in a patient with complete situs inversus and interruption of the inferior vena cava with azygos continuation. J Interv Card Electrophysiol 2009.Google Scholar
  20. 20.
    Ghanem RN. Noninvasive electrocardiographic imaging of arrhythmogenesis: insights from modeling and human studies. J Electrocardiol 40: S169–S173, 2007.PubMedCrossRefGoogle Scholar
  21. 21.
    Gold MR, Bloomfield DM, Anderson KP, El-Sherif NE, Wilber DJ, Groh WJ, Estes NA, 3rd, Kaufman ES, Greenberg ML, and Rosenbaum DS. A comparison of T-wave alternans, signal averaged electrocardiography and programmed ventricular stimulation for arrhythmia risk stratification. J Am Coll Cardiol 36: 2247–2253, 2000.PubMedCrossRefGoogle Scholar
  22. 22.
    Gussak I, Antzelevitch C, Bjerregaard P, Towbin JA, and Chaitman BR. The Brugada ­syndrome: clinical, electrophysiologic and genetic aspects. J Am Coll Cardiol 33: 5–15, 1999.PubMedCrossRefGoogle Scholar
  23. 23.
    Haissaguerre M, Jais P, Shah DC, Takahashi A, Hocini M, Quiniou G, Garrigue S, Le Mouroux A, Le Metayer P, and Clementy J. Spontaneous initiation of atrial fibrillation by ectopic beats originating in the pulmonary veins. N Engl J Med 339: 659–666, 1998.PubMedCrossRefGoogle Scholar
  24. 24.
    Haissaguerre M, Extramiana F, Hocini M, Cauchemez B, Jais P, Cabrera JA, Farre J, Leenhardt A, Sanders P, Scavee C, Hsu LF, Weerasooriya R, Shah DC, Frank R, Maury P, Delay M, Garrigue S, and Clementy J. Mapping and ablation of ventricular fibrillation associated with long-QT and Brugada syndromes. Circulation 108: 925–928, 2003.PubMedCrossRefGoogle Scholar
  25. 25.
    Haissaguerre M, Lim KT, Jacquemet V, Rotter M, Dang L, Hocini M, Matsuo S, Knecht S, Jais P, and Virag N. Atrial fibrillatory cycle length: computer simulation and potential clinical importance. Europace 9 (Suppl 6): vi64–70, 2007.PubMedCrossRefGoogle Scholar
  26. 26.
    Heist EK, Chevalier J, Holmvang G, Singh JP, Ellinor PT, Milan DJ, D’Avila A, Mela T, Ruskin JN, and Mansour M. Factors affecting error in integration of electroanatomic mapping with CT and MR imaging during catheter ablation of atrial fibrillation. J Interv Card Electrophysiol 17: 21–27, 2006.PubMedCrossRefGoogle Scholar
  27. 27.
    Hsu EW and Henriquez CS. Myocardial fiber orientation mapping using reduced encoding diffusion tensor imaging. J Cardiovasc Magn Reson 3: 339–347, 2001.PubMedCrossRefGoogle Scholar
  28. 28.
    Huang Z, Patel C, Li W, Xie Q, Wu R, Zhang L, Tang R, Wan X, Ma Y, Zhen W, Gao L, and Yan GX. Role of signal-averaged electrocardiograms in arrhythmic risk stratification of patients with Brugada syndrome: a prospective study. Heart Rhythm 6: 1156–1162, 2009.PubMedCrossRefGoogle Scholar
  29. 29.
    Jalife J, Berenfeld O, and Mansour M. Mother rotors and fibrillatory conduction: a mechanism of atrial fibrillation. Cardiovasc Res 54: 204–216, 2002.PubMedCrossRefGoogle Scholar
  30. 30.
    Kerckhoffs RC, Faris OP, Bovendeerd PH, Prinzen FW, Smits K, McVeigh ER, and Arts T. Electromechanics of paced left ventricle simulated by straightforward mathematical model: comparison with experiments. Am J Physiol Heart Circ Physiol 289: H1889–H1897, 2005.PubMedCrossRefGoogle Scholar
  31. 31.
    Kerckhoffs RC, Narayan SM, Omens JH, Mulligan LJ, and McCulloch AD. Computational modeling for bedside application. Heart Fail Clin 4: 371–378, 2008.PubMedCrossRefGoogle Scholar
  32. 32.
    Kirn B, Jansen A, Bracke F, van Gelder B, Arts T, and Prinzen FW. Mechanical discoordination rather than dyssynchrony predicts reverse remodeling upon cardiac resynchronization. Am J Physiol Heart Circ Physiol 295: H640–H646, 2008.PubMedCrossRefGoogle Scholar
  33. 33.
    Kistler PM, Rajappan K, Jahngir M, Earley MJ, Harris S, Abrams D, Gupta D, Liew R, Ellis S, Sporton SC, and Schilling RJ. The impact of CT image integration into an electroanatomic mapping system on clinical outcomes of catheter ablation of atrial fibrillation. J Cardiovasc Electrophysiol 17: 1093–1101, 2006.PubMedCrossRefGoogle Scholar
  34. 34.
    Kleijn SA, van Dijk J, de Cock CC, Allaart CP, van Rossum AC, and Kamp O. Assessment of intraventricular mechanical dyssynchrony and prediction of response to cardiac resynchronization therapy: comparison between tissue Doppler imaging and real-time 3-D echocardiography. J Am Soc Echocardiogr 22: 1047–1054, 2009.PubMedCrossRefGoogle Scholar
  35. 35.
    Knecht S, Sacher F, Wright M, Hocini M, Nogami A, Arentz T, Petit B, Franck R, De Chillou C, Lamaison D, Farre J, Lavergne T, Verbeet T, Nault I, Matsuo S, Leroux L, Weerasooriya R, Cauchemez B, Lellouche N, Derval N, Narayan SM, Jais P, Clementy J, and Haissaguerre M. Long-term follow-up of idiopathic ventricular fibrillation ablation: a multicenter study. J Am Coll Cardiol 54: 522–528, 2009.PubMedCrossRefGoogle Scholar
  36. 36.
    Konings KT, Smeets JL, Penn OC, Wellens HJ, and Allessie MA. Configuration of unipolar atrial electrograms during electrically induced atrial fibrillation in humans. Circulation95: 1231–1241, 1997.PubMedCrossRefGoogle Scholar
  37. 37.
    Korinek J, Kjaergaard J, Sengupta PP, Yoshifuku S, McMahon EM, Cha SS, Khandheria BK, and Belohlavek M. High spatial resolution speckle tracking improves accuracy of 2-dimensional strain measurements: an update on a new method in functional echocardiography. J Am Soc Echocardiogr 20: 165–170, 2007.PubMedCrossRefGoogle Scholar
  38. 38.
    Koutelou M, Katsikis A, Flevari P, Theodorakis G, Livanis E, Georgiadis M, Voudris V, and Kremastinos D. Predictive value of cardiac autonomic indexes and MIBG washout in ICD recipients with mild to moderate heart failure. Ann Nucl Med 23: 677–684, 2009.PubMedCrossRefGoogle Scholar
  39. 39.
    Krummen DE, Peng KA, Bullinga JR, and Narayan SM. Centrifugal gradients of rate and organization in human atrial fibrillation. Pacing Clin Electrophysiol 32: 1366–1378, 2009.PubMedCrossRefGoogle Scholar
  40. 40.
    Lakireddy V, Bub G, Baweja P, Syed A, Boutjdir M, and El-Sherif N. The kinetics of spontaneous calcium oscillations and arrhythmogenesis in the in vivo heart during ischemia/reperfusion. Heart Rhythm 3: 58–66, 2006.PubMedCrossRefGoogle Scholar
  41. 41.
    Latcu DG, Ricard P, Zarqane N, Yaici K, Rinaldi JP, Maluski A, and Saoudi N. Robotic magnetic navigation for ablation of human arrhythmias: initial experience. Arch Cardiovasc Dis 102: 419–425, 2009.PubMedCrossRefGoogle Scholar
  42. 42.
    Lemery R, Birnie D, Tang AS, Green M, and Gollob M. Feasibility study of endocardial ­mapping of ganglionated plexuses during catheter ablation of atrial fibrillation. Heart Rhythm 3: 387–396, 2006.PubMedCrossRefGoogle Scholar
  43. 43.
    Lemola K, Desjardins B, Sneider M, Case I, Chugh A, Good E, Han J, Tamirisa K, Tsemo A, Reich S, Tschopp D, Igic P, Elmouchi D, Bogun F, Pelosi F, Jr., Kazerooni E, Morady F, and Oral H. Effect of left atrial circumferential ablation for atrial fibrillation on left atrial transport function. Heart Rhythm 2: 923–928, 2005.PubMedCrossRefGoogle Scholar
  44. 44.
    Lickfett L, Dickfeld T, Kato R, Tandri H, Vasamreddy CR, Berger R, Bluemke D, Luderitz B, Halperin H, and Calkins H. Changes of pulmonary vein orifice size and location throughout the cardiac cycle: dynamic analysis using magnetic resonance cine imaging. J Cardiovasc Electrophysiol 16: 582–588, 2005.PubMedCrossRefGoogle Scholar
  45. 45.
    Martinek M, Nesser HJ, Aichinger J, Boehm G, and Purerfellner H. Accuracy of integration of multislice computed tomography imaging into 3-D electroanatomic mapping for real-time guided radiofrequency ablation of left atrial fibrillation-influence of heart rhythm and radiofrequency lesions. J Interv Card Electrophysiol 17: 85–92, 2006.PubMedCrossRefGoogle Scholar
  46. 46.
    McGann CJ, Kholmovski EG, Oakes RS, Blauer JJ, Daccarett M, Segerson N, Airey KJ, Akoum N, Fish E, Badger TJ, DiBella EV, Parker D, MacLeod RS, and Marrouche NF. New magnetic resonance imaging-based method for defining the extent of left atrial wall injury after the ablation of atrial fibrillation. J Am Coll Cardiol 52: 1263–1271, 2008.PubMedCrossRefGoogle Scholar
  47. 47.
    Moss AJ, Zareba W, Hall WJ, Klein H, Wilber DJ, Cannom DS, Daubert JP, Higgins SL, Brown MW, and Andrews ML. Prophylactic implantation of a defibrillator in patients with myocardial infarction and reduced ejection fraction. N Engl J Med 346: 877–883, 2002.PubMedCrossRefGoogle Scholar
  48. 48.
    Nademanee K, McKenzie J, Kosar E, Schwab M, Sunsaneewitayakul B, Vasavakul T, Khunnawat C, and Ngarmukos T. A new approach for catheter ablation of atrial fibrillation: mapping of the electrophysiologic substrate. J Am Coll Cardiol 43: 2044–2053, 2004.PubMedCrossRefGoogle Scholar
  49. 49.
    Nakagawa E, Takagi M, Tatsumi H, and Yoshiyama M. Successful radiofrequency catheter ablation for electrical storm of ventricular fibrillation in a patient with Brugada syndrome. Circ J 72: 1025–1029, 2008.PubMedCrossRefGoogle Scholar
  50. 50.
    Noseworthy PA, Malchano ZJ, Ahmed J, Holmvang G, Ruskin JN, and Reddy VY. The impact of respiration on left atrial and pulmonary venous anatomy: implications for image-guided intervention. Heart Rhythm 2: 1173–1178, 2005.PubMedCrossRefGoogle Scholar
  51. 51.
    Oral H, Knight BP, Tada H, Ozaydin M, Chugh A, Hassan S, Scharf C, Lai SW, Greenstein R, Pelosi F, Jr., Strickberger SA, and Morady F. Pulmonary vein isolation for paroxysmal and persistent atrial fibrillation. Circulation 105: 1077–1081, 2002.PubMedCrossRefGoogle Scholar
  52. 52.
    Passman R, Subacius H, Ruo B, Schaechter A, Howard A, Sears SF, and Kadish A. Implantable cardioverter defibrillators and quality of life: results from the defibrillators in nonischemic cardiomyopathy treatment evaluation study. Arch Intern Med 167: 2226–2232, 2007.PubMedCrossRefGoogle Scholar
  53. 53.
    Patel AM, d’Avila A, Neuzil P, Kim SJ, Mela T, Singh JP, Ruskin JN, and Reddy VY. Atrial tachycardia after ablation of persistent atrial fibrillation: identification of the critical isthmus with a combination of multielectrode activation mapping and targeted entrainment mapping. Circ Arrhythm Electrophysiol 1: 14–22, 2008.PubMedCrossRefGoogle Scholar
  54. 54.
    Peichl P, Cihak R, Kozeluhova M, Wichterle D, Vancura V, and Kautzner J. Catheter ablation of arrhythmic storm triggered by monomorphic ectopic beats in patients with coronary artery disease. J Interv Card Electrophysiol 27(1):51–59, 2010.PubMedCrossRefGoogle Scholar
  55. 55.
    Po SS, Scherlag BJ, Yamanashi WS, Edwards J, Zhou J, Wu R, Geng N, Lazzara R, and Jackman WM. Experimental model for paroxysmal atrial fibrillation arising at the pulmonary vein-atrial junctions. Heart Rhythm 3: 201–208, 2006.PubMedCrossRefGoogle Scholar
  56. 56.
    Poole JE, Johnson GW, Hellkamp AS, Anderson J, Callans DJ, Raitt MH, Reddy RK, Marchlinski FE, Yee R, Guarnieri T, Talajic M, Wilber DJ, Fishbein DP, Packer DL, Mark DB, Lee KL, and Bardy GH. Prognostic importance of defibrillator shocks in patients with heart failure. N Engl J Med 359: 1009–1017, 2008.PubMedCrossRefGoogle Scholar
  57. 57.
    Rausch P, Manfai B, Varady E, and Simor T. Radiofrequency catheter ablation of left ventricular outflow tract tachycardia with the assistance of the CartoSound system. Europace 11: 1248–1249, 2009.PubMedCrossRefGoogle Scholar
  58. 58.
    Reddy VY, Reynolds MR, Neuzil P, Richardson AW, Taborsky M, Jongnarangsin K, Kralovec S, Sediva L, Ruskin JN, and Josephson ME. Prophylactic catheter ablation for the prevention of defibrillator therapy. N Engl J Med 357: 2657–2665, 2007.PubMedCrossRefGoogle Scholar
  59. 59.
    Reddy VY, Neuzil P, Malchano ZJ, Vijaykumar R, Cury R, Abbara S, Weichet J, McPherson CD, and Ruskin JN. View-synchronized robotic image-guided therapy for atrial fibrillation ablation: experimental validation and clinical feasibility. Circulation 115: 2705–2714, 2007.PubMedCrossRefGoogle Scholar
  60. 60.
    Ren JF, Marchlinski FE, and Callans DJ. Left atrial thrombus associated with ablation for atrial fibrillation: identification with intracardiac echocardiography. J Am Coll Cardiol 43: 1861–1867, 2004.PubMedCrossRefGoogle Scholar
  61. 61.
    Ren JF, Lin D, Marchlinski FE, Callans DJ, and Patel V. Esophageal imaging andstrategies for avoiding injury during left atrial ablation for atrial fibrillation. Heart Rhythm3: 1156–1161, 2006.PubMedCrossRefGoogle Scholar
  62. 62.
    Ripley KL, Gage AA, Olsen DB, Van Vleet JF, Lau CP, and Tse HF. Time course of ­esophageal lesions after catheter ablation with cryothermal and radiofrequency ablation: implication for atrio-esophageal fistula formation after catheter ablation for atrial fibrillation. J Cardiovasc Electrophysiol 18: 642–646, 2007.PubMedCrossRefGoogle Scholar
  63. 63.
    Rivero-Ayerza M, Jessurun E, Ramcharitar S, van Belle Y, Serruys PW, and Jordaens L. Magnetically guided left ventricular lead implantation based on a virtual 3-D reconstructed image of the coronary sinus. Europace 10: 1042–1047, 2008.PubMedCrossRefGoogle Scholar
  64. 64.
    Rosendahl L, Ahlander BM, Bjorklund PG, Blomstrand P, Brudin L, and Engvall JE. Image quality and myocardial scar size determined with magnetic resonance imaging in patients with permanent atrial fibrillation: a comparison of two imaging protocols. Clin Physiol Funct Imaging 30(2):122–129, 2010.PubMedCrossRefGoogle Scholar
  65. 65.
    Saksena S, Simon AM, Mathew P, and Nagarakanti R. Intracardiac echocardiography-guided cardiac resynchronization therapy: technique and clinical application. Pacing Clin Electrophysiol 32: 1030–1039, 2009.PubMedCrossRefGoogle Scholar
  66. 66.
    Saliba W, Reddy VY, Wazni O, Cummings JE, Burkhardt JD, Haissaguerre M, Kautzner J, Peichl P, Neuzil P, Schibgilla V, Noelker G, Brachmann J, Di Biase L, Barrett C, Jais P, and Natale A. Atrial fibrillation ablation using a robotic catheter remote control system: initial human experience and long-term follow-up results. J Am Coll Cardiol 51: 2407–2411, 2008.PubMedCrossRefGoogle Scholar
  67. 67.
    Santucci PA, Varma N, Cytron J, Akar JG, Wilber DJ, Al Chekakie MO, and Brysiewicz N. Electroanatomic mapping of postpacing intervals clarifies the complete active circuit and ­variants in atrial flutter. Heart Rhythm 6: 1586–1595, 2009.PubMedCrossRefGoogle Scholar
  68. 68.
    Saoudi N, Cosio F, Waldo A, Chen SA, Iesaka Y, Lesh M, Saksena S, Salerno J, and Schoels W. Classification of atrial flutter and regular atrial tachycardia according to electrophysiologic mechanism and anatomic bases: a statement from a joint expert group from the Working Group of Arrhythmias of the European Society of Cardiology and the North American Society of Pacing and Electrophysiology. J Cardiovasc Electrophysiol 12: 852–866, 2001.PubMedCrossRefGoogle Scholar
  69. 69.
    Sarrazin JF, Labounty T, Kuhne M, Crawford T, Armstrong WF, Desjardins B, Good E, Jongnarangsin K, Chugh A, Oral H, Pelosi F, Morady F, and Bogun F. Impact of radiofrequency ablation of frequent post-infarction premature ventricular complexes on left ventricular ejection fraction. Heart Rhythm 6: 1543–1549, 2009.PubMedCrossRefGoogle Scholar
  70. 70.
    Savard P, Rouleau JL, Ferguson J, Poitras N, Morel P, Davies RF, Stewart DJ, Talajic M, Gardner M, Dupuis R, Lauzon C, Sussex B, Potvin L, and Warnica W. Risk stratification after myocardial infarction using signal-averaged electrocardiographic criteria adjusted for sex, age, and myocardial infarction location. Circulation 96: 202–213, 1997.PubMedCrossRefGoogle Scholar
  71. 71.
    Schmidt A, Azevedo CF, Cheng A, Gupta SN, Bluemke DA, Foo TK, Gerstenblith G, Weiss RG, Marban E, Tomaselli GF, Lima JA, and Wu KC. Infarct tissue heterogeneity by magnetic resonance imaging identifies enhanced cardiac arrhythmia susceptibility in patients with left ventricular dysfunction. Circulation 115: 2006–2014, 2007.PubMedCrossRefGoogle Scholar
  72. 72.
    Schwartzman D and Zhong H. On the Use of CartoSound for Left Atrial Navigation. J Cardiovasc Electrophysiol 2009.Google Scholar
  73. 73.
    Sen-Chowdhry S, Prasad SK, Syrris P, Wage R, Ward D, Merrifield R, Smith GC, Firmin DN, Pennell DJ, and McKenna WJ. Cardiovascular magnetic resonance in arrhythmogenic right ventricular cardiomyopathy revisited: comparison with task force criteria and genotype. J Am Coll Cardiol 48: 2132–2140, 2006.PubMedCrossRefGoogle Scholar
  74. 74.
    Seo Y, Ishizu T, Sakamaki F, Yamamoto M, Machino T, Yamasaki H, Kawamura R, Yoshida K, Sekiguchi Y, Kawano S, Tada H, Watanabe S, and Aonuma K. Mechanical dyssynchrony assessed by speckle tracking imaging as a reliable predictor of acute and chronic response to cardiac resynchronization therapy. J Am Soc Echocardiogr 22: 839–846, 2009.PubMedCrossRefGoogle Scholar
  75. 75.
    Shen X, Aronow WS, Nair CK, Holmberg MJ, Hee T, Maciejewski S, and Esterbrooks DJ. Are the extent, location, and score of segmental wall motion abnormalities related to cardiac resynchronization therapy response? Echocardiography 26: 1136–1145, 2009.PubMedCrossRefGoogle Scholar
  76. 76.
    Sporton SC, Earley MJ, Nathan AW, and Schilling RJ. Electroanatomic versus fluoroscopic mapping for catheter ablation procedures: a prospective randomized study. J Cardiovasc Electrophysiol 15: 310–315, 2004.PubMedCrossRefGoogle Scholar
  77. 77.
    Sztajzel J. Heart rate variability: a noninvasive electrocardiographic method to measure the autonomic nervous system. Swiss Med Wkly 134: 514–522, 2004.PubMedGoogle Scholar
  78. 78.
    Thiagalingam A, Wallace EM, Boyd AC, Eipper VE, Campbell CR, Byth K, Ross DL, and Kovoor P. Noncontact mapping of the left ventricle: insights from validation with transmural contact mapping. Pacing Clin Electrophysiol 27: 570–578, 2004.PubMedCrossRefGoogle Scholar
  79. 79.
    Tops LF, de Groot NM, Bax JJ, and Schalij MJ. Fusion of electroanatomical activation maps and multislice computed tomography to guide ablation of a focal atrial tachycardia in a fontan patient. J Cardiovasc Electrophysiol 17: 431–434, 2006.PubMedCrossRefGoogle Scholar
  80. 80.
    Towbin JA, Li H, Taggart RT, Lehmann MH, Schwartz PJ, Satler CA, Ayyagari R, Robinson JL, Moss A, and Hejtmancik JF. Evidence of genetic heterogeneity in Romano-Ward long QT syndrome. Analysis of 23 families. Circulation 90: 2635–2644, 1994.PubMedCrossRefGoogle Scholar
  81. 81.
    Verma A, Marrouche NF, Schweikert RA, Saliba W, Wazni O, Cummings J, Abdul-Karim A, Bhargava M, Burkhardt JD, Kilicaslan F, Martin DO, and Natale A. Relationship between successful ablation sites and the scar border zone defined by substrate mapping for ventricular tachycardia post-myocardial infarction. J Cardiovasc Electrophysiol 16: 465–471, 2005.PubMedCrossRefGoogle Scholar
  82. 82.
    Volkmer M, Ouyang F, Deger F, Ernst S, Goya M, Bansch D, Berodt K, Kuck KH, and Antz M. Substrate mapping vs. tachycardia mapping using CARTO in patients with coronary artery disease and ventricular tachycardia: impact on outcome of catheter ablation. Europace8: 968–976, 2006.PubMedCrossRefGoogle Scholar
  83. 83.
    Wazni OM, Barrett C, Martin DO, Shaheen M, Tarakji K, Baranowski B, Hussein A, Callahan T, Dresing T, Bhargava M, Kanj M, Tchou P, Natale A, and Saliba W. Experience with the Hansen robotic system for atrial fibrillation ablation-lessons learned and techniques modified: Hansen in the real world. J Cardiovasc Electrophysiol 20(11): 1193–1196, 2009.PubMedCrossRefGoogle Scholar
  84. 84.
    Xia H, Zhao X, Bains J, and Wortham DC. Influence of channel blockers on cardiac alternans. Conf Proc IEEE Eng Med Biol Soc 1: 2823–2826, 2009.Google Scholar
  85. 85.
    Yagi T, Pu J, Chandra P, Hara M, Danilo P, Jr., Rosen MR, and Boyden PA. Density and function of inward currents in right atrial cells from chronically fibrillating canine atria. Cardiovasc Res 54: 405–415, 2002.PubMedCrossRefGoogle Scholar
  86. 86.
    Zeppenfeld K, Tops LF, Bax JJ, and Schalij MJ. Images in cardiovascular medicine. Epicardial radiofrequency catheter ablation of ventricular tachycardia in the vicinity of coronary arteries is facilitated by fusion of 3-D electroanatomical mapping with multislice computed tomography. Circulation 114: e51–e52, 2006.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2010

Authors and Affiliations

  • David E. Krummen
    • 1
  • Gainyu Oshodi
  • Sanjiv M. Narayan
  1. 1.University of California San Diego and VA San Diego Healthcare SystemSan DiegoUSA

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