Abstract
AbstractIn both clinical and computational studies, different pacing protocols are used to induce arrhythmia and non-inducibility is often considered as the endpoint of treatment. The need for a standardized methodology is urgent since the choice of the protocol used to induce arrhythmia could lead to contrasting results, e.g., in assessing atrial fibrillation (AF) vulnerabilty. Therefore, we propose a novel method – pacing at the end of the effective refractory period (PEERP) – and compare it to state-of-the-art protocols such as phase singularity distribution (PSD) and rapid pacing (RP) in a computational study. All methods were tested by pacing from 227 evenly distributed endocardial points in a bi-atrial geometry. 6 different atrial models were implemented: 4 cases without specific AF-induced remodelling but with decreasing global conduction velocity and 2 persistent AF cases with an increasing amount of fibrosis resembling different substrate remodeling stages. Compared with PSD and RP, PEERP induced a larger variety of arrhythmia complexity requiring, on average, only 2.7 extra-stimuli and 3 s of simulation time to initiate reentry. Moreover, PEERP and PSD were the protocols which unveiled a larger number of areas vulnerable to sustain stable long living reentries compared to RP. Finally, PEERP can foster standardization and reproducibility, since, in contrast to the other protocols, it is a parameter-free method. Furthermore, we discuss its clinical applicability. We conclude that the choice of the inducing protocol has an influence on both initiation and maintenance of AF and we propose and provide PEERP as a reproducible method to assess arrhythmia vulnerability.
Publisher
Cold Spring Harbor Laboratory
Cited by
3 articles.
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