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2017 ; 12
(7
): e0179459
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Ablation as targeted perturbation to rewire communication network of persistent
atrial fibrillation
#MMPMID28678805
Tao S
; Way SF
; Garland J
; Chrispin J
; Ciuffo LA
; Balouch MA
; Nazarian S
; Spragg DD
; Marine JE
; Berger RD
; Calkins H
; Ashikaga H
PLoS One
2017[]; 12
(7
): e0179459
PMID28678805
show ga
Persistent atrial fibrillation (AF) can be viewed as disintegrated patterns of
information transmission by action potential across the communication network
consisting of nodes linked by functional connectivity. To test the hypothesis
that ablation of persistent AF is associated with improvement in both local and
global connectivity within the communication networks, we analyzed
multi-electrode basket catheter electrograms of 22 consecutive patients (63.5 ±
9.7 years, 78% male) during persistent AF before and after the focal impulse and
rotor modulation-guided ablation. Eight patients (36%) developed recurrence
within 6 months after ablation. We defined communication networks of AF by nodes
(cardiac tissue adjacent to each electrode) and edges (mutual information between
pairs of nodes). To evaluate patient-specific parameters of communication,
thresholds of mutual information were applied to preserve 10% to 30% of the
strongest edges. There was no significant difference in network parameters
between both atria at baseline. Ablation effectively rewired the communication
network of persistent AF to improve the overall connectivity. In addition,
successful ablation improved local connectivity by increasing the average
clustering coefficient, and also improved global connectivity by decreasing the
characteristic path length. As a result, successful ablation improved the
efficiency and robustness of the communication network by increasing the
small-world index. These changes were not observed in patients with AF
recurrence. Furthermore, a significant increase in the small-world index after
ablation was associated with synchronization of the rhythm by acute AF
termination. In conclusion, successful ablation rewires communication networks
during persistent AF, making it more robust, efficient, and easier to
synchronize. Quantitative analysis of communication networks provides not only a
mechanistic insight that AF may be sustained by spatially localized sources and
global connectivity, but also patient-specific metrics that could serve as a
valid endpoint for therapeutic interventions.
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