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:

  1. electro-anatomical map
  2. identify the reentrant boundary
  3. 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?