抄録
Background: We have recently demonstrated in computer simulations that electrotonic interactions between atrial myocytes and heterogeneously-distributed fibroblasts result in the genesis of complex fractionated atrial electrograms (CFAEs) during chronic atrial fibrillation (AF). However, previous research has not provided sufficient evidence that ablation targeting such fibroblast-derived CFAEs can terminate AF. Methods: To clarify this issue, we repeated simulations of CFAE-targeted ablation in the model of human chronic AF under heart failure, and we analyzed details of the excitation propagation until the AF was terminated by the application of CFAE-targeted ablation. Results: (1) Sustained spiral wave reentry, as a model of chronic AF, was found to terminate earlier as the number of ablation sites increased. (2) CFAE-targeted ablation site transiently pinned the spiral wave, preventing wave breakup by blocking the shortcut of the reentry. (3) The spiral wave drifted between ablation sites, and after a short time the spiral wave was pushed out of the CFAE area, resulting in AF termination. (4) For more effective CFAE-targeted ablation, avoiding collagen accumulation area and keeping an appropriate distance between ablation sites were required. Conclusion: Our findings might contribute to better understanding of the mechanisms of CFAE-targeted AF ablation.
