Mattias Duytschaever, Robin Van den Abeele, Niels Carlier, Arthur Santos Bezerra, Bjorn Verstraeten, Sebastiaan Lootens, Karel Desplenter, Arstanbek Okenov, Timur Nezlobinsky, Dipen Shah, Annika Haas, Armin Luik, Jordi Martens, Milad El Haddad, Maarten De Smet, Benjamin De Becker, Clara Francois, Jean-Benoit Le Polain de Waroux, Rene Tavernier, Sebastien Knecht, Sander Hendrickx, Nele Vandersickel
{"title":"Atrial Topology for a Unified Understanding of Typical and Atypical Flutter.","authors":"Mattias Duytschaever, Robin Van den Abeele, Niels Carlier, Arthur Santos Bezerra, Bjorn Verstraeten, Sebastiaan Lootens, Karel Desplenter, Arstanbek Okenov, Timur Nezlobinsky, Dipen Shah, Annika Haas, Armin Luik, Jordi Martens, Milad El Haddad, Maarten De Smet, Benjamin De Becker, Clara Francois, Jean-Benoit Le Polain de Waroux, Rene Tavernier, Sebastien Knecht, Sander Hendrickx, Nele Vandersickel","doi":"10.1161/CIRCEP.124.013102","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>Macroreentry stands as the predominant mechanism of typical and atypical flutter. Despite advances in mapping, many aspects of macroreentrant atrial tachycardia remain unsolved. In this translational study, we applied principles of topology to understand the activation patterns, entrainment characteristics, and ablation responses in a large clinical macroreentrant atrial tachycardia database.</p><p><strong>Methods: </strong>Because the atrium can be topologically seen as a closed sphere with holes, we used a computational fixed spherical mesh model with a finite number of holes to induce and analyze macroreentrant atrial tachycardia. The ensuing insights were used to interpret high-density activation maps, postpacing interval-tachycardia cycle length values (difference between postpacing interval and tachycardia cycle length), and ablation response in 131 cases of typical and atypical flutter (n=106 left atrium, n=25 right atrium).</p><p><strong>Results: </strong>Modeling of macroreentrant atrial tachycardia revealed that reentry on closed surfaces consistently manifests itself as paired rotation and that an odd number of critical boundaries is mathematically impossible. Together with mathematical confirmation by the index theorem, this led to a unifying construct that could explain the number of loops, difference between postpacing interval and tachycardia cycle length values, and ablation outcomes (termination, no change, or prolongation in tachycardia cycle length) in all 131 cases.</p><p><strong>Conclusions: </strong>Combining topology with the index theorem offers a novel and cohesive framework for understanding and managing typical and atypical flutter.</p>","PeriodicalId":10319,"journal":{"name":"Circulation. Arrhythmia and electrophysiology","volume":null,"pages":null},"PeriodicalIF":9.1000,"publicationDate":"2024-11-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Circulation. Arrhythmia and electrophysiology","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1161/CIRCEP.124.013102","RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"CARDIAC & CARDIOVASCULAR SYSTEMS","Score":null,"Total":0}
引用次数: 0
Abstract
Background: Macroreentry stands as the predominant mechanism of typical and atypical flutter. Despite advances in mapping, many aspects of macroreentrant atrial tachycardia remain unsolved. In this translational study, we applied principles of topology to understand the activation patterns, entrainment characteristics, and ablation responses in a large clinical macroreentrant atrial tachycardia database.
Methods: Because the atrium can be topologically seen as a closed sphere with holes, we used a computational fixed spherical mesh model with a finite number of holes to induce and analyze macroreentrant atrial tachycardia. The ensuing insights were used to interpret high-density activation maps, postpacing interval-tachycardia cycle length values (difference between postpacing interval and tachycardia cycle length), and ablation response in 131 cases of typical and atypical flutter (n=106 left atrium, n=25 right atrium).
Results: Modeling of macroreentrant atrial tachycardia revealed that reentry on closed surfaces consistently manifests itself as paired rotation and that an odd number of critical boundaries is mathematically impossible. Together with mathematical confirmation by the index theorem, this led to a unifying construct that could explain the number of loops, difference between postpacing interval and tachycardia cycle length values, and ablation outcomes (termination, no change, or prolongation in tachycardia cycle length) in all 131 cases.
Conclusions: Combining topology with the index theorem offers a novel and cohesive framework for understanding and managing typical and atypical flutter.
期刊介绍:
Circulation: Arrhythmia and Electrophysiology is a journal dedicated to the study and application of clinical cardiac electrophysiology. It covers a wide range of topics including the diagnosis and treatment of cardiac arrhythmias, as well as research in this field. The journal accepts various types of studies, including observational research, clinical trials, epidemiological studies, and advancements in translational research.