Topology guided ablation for atrial tachycardia
Overview
-
Topology
- Deformation
- Index theorem
-
Simulations
- Patterns
- Virtual treatment
- Clinical validation
- Conclusion
- Future research
Clinical: the atrial tachycardia
Atrial tachycardia (AT):
atria, regular, fast
Mechanism: anatomical reentry
Treatment: ablation procedure (burning tissue)
Standard practice:
- electro-anatomical map
- identify the reentrant boundary
- ablate to the closest non-conductive structure
Problem:
a slower AT can arise after ablation
Topology in cardiac arrhythmia
- Field of mathematics
- Deformation
- Preservation of properties
LPV
MV
RPV
LPV
MV
RPV
Topology: the index theorem
- Calculation of index / topological charge
- 0 for no rotation
- +1 for counter-clockwise rotation
- -1 for clockwise rotation
-
Sum of all TC = 0
- Path independence
- Closed surface
- Consider tachycardia:
- Only anatomical reentry
- Pairs of counter rotating patterns
Simulations
Complete rotation
Near-complete rotation
Parallel activation
TC = +1
TC = -1
TC = 0
Simulations
Simulations: ablation
Simulations: entrainment mapping
Clinical validation
- Clinical proof of concept: 24 cases
- 131 High Quality clinical cases
- Upcoming multi-center clinical study
Dr. M. Duytschaever
Dr. A. Luik
Dr. S. Knecht
A. Haas
Clinical validation: RPV reentry
Conclusion
1. Rotational patterns in atrial tachycardia exist in counter-rotating pairs.
2. Only ablation between the rotation pairs will terminate the tachycardia. Any other ablation will either cause no notable change or slow down the tachycardia.
Future research
-
Atrial tachycardia
- Multicenter clinical study
-
Bi-atrial tachycardia
- More complex topology
- Voids
-
Atrial fibrillation
- Functional reentry
- Mathematical boundaries (singularities)
-
Ventricular tachycardia
- Thickness
- 2D manifolds
Thank you!
Questions?
Cinc Robin
By Nele Vandersickel
