Left atrial wall stress distribution and its relationship to electrophysiologic remodeling in persistent atrial fibrillation

3.00
Hdl Handle:
http://hdl.handle.net/10545/313858
Title:
Left atrial wall stress distribution and its relationship to electrophysiologic remodeling in persistent atrial fibrillation
Authors:
Hunter, R. J.; Liu, Y.; Lu, Y.; Wang, Wen; Schilling, R. J.
Abstract:
Background—Atrial stretch causes remodeling that predisposes to atrial fibrillation. We tested the hypothesis that peaks in left atrial (LA) wall stress are associated with focal remodeling. Methods and Results—Nineteen patients underwent LA mapping before catheter ablation for persistent atrial fibrillation. Finite Element Analysis was used to predict wall stress distribution based on LA geometry from CT. The relationship was assessed between wall stress and (1) electrogram voltage and (2) complex fractionated atrial electrograms (CFAE), using CFAE mean (the mean interval between deflections). Wall stress varied widely within atria and between subjects (median, 36 kPa; interquartile range, 26–51 kP). Peaks in wall stress (≥90th percentile) were common at the pulmonary vein (PV) ostia (93%), the appendage ridge (100%), the high posterior wall (84%), and the anterior wall and septal regions (42–84%). Electrogram voltage showed an inverse relationship across quartiles for wall stress (19% difference across quartiles, P=0.016). There was no effect on CFAE mean across quartiles of wall stress. Receiver operating characteristic analysis showed high wall stress was associated with low voltage (ie, <0.5 mV) and electrical scar (ie, <0.05 mV; both P<0.0001) and with absence of CFAE (ie, CFAE mean <120 ms; P<0.0001). However, peaks in wall stress and CFAE were found at 88% of PV ostia. Conclusions—Peaks in wall stress were associated with areas of low voltage, suggestive of focal remodeling. Although peaks in wall stress were not associated with LA CFAE, the PV ostia may respond differently.
Affiliation:
University of Derby
Citation:
Left atrial wall stress distribution and its relationship to electrophysiologic remodeling in persistent atrial fibrillation 2012, 5 (2):351 Circulation: Arrhythmia and Electrophysiology
Journal:
Circulation: Arrhythmia and Electrophysiology
Issue Date:
Jan-2012
URI:
http://hdl.handle.net/10545/313858
DOI:
10.1161/CIRCEP.111.965541
Additional Links:
http://circep.ahajournals.org/content/5/2/351
Type:
Article
Language:
en
ISSN:
1941-3149; 1941-3084
Appears in Collections:
Mechanical/Manufacturing Engineering & Industrial Design Research Group

Full metadata record

DC FieldValue Language
dc.contributor.authorHunter, R. J.en
dc.contributor.authorLiu, Y.en
dc.contributor.authorLu, Y.en
dc.contributor.authorWang, Wenen
dc.contributor.authorSchilling, R. J.en
dc.date.accessioned2014-03-10T16:13:48Z-
dc.date.available2014-03-10T16:13:48Z-
dc.date.issued2012-01-
dc.identifier.citationLeft atrial wall stress distribution and its relationship to electrophysiologic remodeling in persistent atrial fibrillation 2012, 5 (2):351 Circulation: Arrhythmia and Electrophysiologyen
dc.identifier.issn1941-3149-
dc.identifier.issn1941-3084-
dc.identifier.doi10.1161/CIRCEP.111.965541-
dc.identifier.urihttp://hdl.handle.net/10545/313858-
dc.description.abstractBackground—Atrial stretch causes remodeling that predisposes to atrial fibrillation. We tested the hypothesis that peaks in left atrial (LA) wall stress are associated with focal remodeling. Methods and Results—Nineteen patients underwent LA mapping before catheter ablation for persistent atrial fibrillation. Finite Element Analysis was used to predict wall stress distribution based on LA geometry from CT. The relationship was assessed between wall stress and (1) electrogram voltage and (2) complex fractionated atrial electrograms (CFAE), using CFAE mean (the mean interval between deflections). Wall stress varied widely within atria and between subjects (median, 36 kPa; interquartile range, 26–51 kP). Peaks in wall stress (≥90th percentile) were common at the pulmonary vein (PV) ostia (93%), the appendage ridge (100%), the high posterior wall (84%), and the anterior wall and septal regions (42–84%). Electrogram voltage showed an inverse relationship across quartiles for wall stress (19% difference across quartiles, P=0.016). There was no effect on CFAE mean across quartiles of wall stress. Receiver operating characteristic analysis showed high wall stress was associated with low voltage (ie, <0.5 mV) and electrical scar (ie, <0.05 mV; both P<0.0001) and with absence of CFAE (ie, CFAE mean <120 ms; P<0.0001). However, peaks in wall stress and CFAE were found at 88% of PV ostia. Conclusions—Peaks in wall stress were associated with areas of low voltage, suggestive of focal remodeling. Although peaks in wall stress were not associated with LA CFAE, the PV ostia may respond differently.en
dc.language.isoenen
dc.relation.urlhttp://circep.ahajournals.org/content/5/2/351en
dc.rightsArchived with thanks to Circulation: Arrhythmia and Electrophysiologyen
dc.subjectAtrial fibrillationen
dc.subjectComputional modelingen
dc.subjectWall stresssen
dc.subjectComplex fractionated atrial electrogramen
dc.titleLeft atrial wall stress distribution and its relationship to electrophysiologic remodeling in persistent atrial fibrillationen
dc.typeArticleen
dc.contributor.departmentUniversity of Derbyen
dc.identifier.journalCirculation: Arrhythmia and Electrophysiologyen
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