Personalized computational modeling of atrial fibrosis to guide catheter ablation of atrial fibrillation

Abstract

Methods, system, and media for identifying one or more ablation locations in an atrial tissue region in an atrial fibrillation (AF) patient with atrial fibrosis are disclosed. Three-dimensional imaging data representing the atria of the patient may be received. A patient-specific model of the atria may be generated from the three-dimensional imaging data. Simulation of the AF on the patient-specific model may be conducted to identify AF-perpetrating regions. One or more ablation locations in the atria may be identified from the AF-perpetrating regions.

We claim: 
     
         1 . A method for identifying one or more ablation locations in an atrial tissue region in an atrial fibrillation (AF) patient with atrial fibrosis, the method comprising:
 receiving three-dimensional imaging data representing the atria of the patient;   generating a patient-specific model of the atria from the three-dimensional imaging data;   conducting simulation of AF using the patient-specific atrial model to identify AF-perpetrating regions; and   identifying from the AF-perpetrating regions one or more ablation locations in the atria.   
     
     
         2 . The method of  claim 1 , wherein the AF-perpetrating regions comprise regions of tissue that contain the organizing centers of persistent electrical rotors during simulation. 
     
     
         3 . The method of  claim 2 , wherein persistent electrical rotors are re-circulating electrical waves in cardiac tissue 
     
     
         4 . The method of  claim 1 , wherein identifying from the AF-perpetrating regions one or more ablation locations in the atria further comprises:
 simulating ablation of lesions within and around the AF-perpetrating regions to determine the size and shape of the lesion necessary to render the atria non-inducible to AF.   
     
     
         5 . The method of  claim 1 , wherein conducting simulation on the patient-specific model to identify AF-perpetrating regions further comprises:
 determining whether pacing stimuli will degrade into reentrant activity.   
     
     
         6 . The method of  claim 1 , wherein fibrotic lesions are modeled with electrophysiological properties that are distinct from non-fibrotic regions. 
     
     
         7 . The method of  claim 1 , wherein induction of AF is simulated using a dynamic pacing from different locations. 
     
     
         8 . The method of  claim 1 , wherein conducting simulation on the patient-specific atrial model to identify AF-perpetrating regions further comprises:
 determining fibrotic lesions that lead to the breakup of pacing-induced wavefronts and degeneration of the wavefronts into reentrant waves that form AF rotors; and   determining spatial location of the resulting AF rotors.   
     
     
         9 . The method of  claim 1 , wherein the patient-specific atrial model includes modeling of fibrosis as at least one of ion channel function remodeling, collagen deposition, gap junction remodeling, fibroblast proliferation and phenotype switching into myofibroblasts, or any combination thereof. 
     
     
         10 . The method of  claim 1 , wherein said three-dimensional imaging data is at least one of magnetic resonance imaging (MRI), computed tomography (CT), positron emission tomography (PET), ultrasound, or nuclear tracer three-dimensional imaging data. 
     
     
         11 . The method of  claim 1 , further comprising:
 receiving additional patient-specific data that includes at least one of biopsy data, electrocardiogram data, recorded data from an implantable device, or invasive electrical mapping data,   wherein the simulation uses the additional patient-specific data.   
     
     
         12 . The method of  claim 1 , wherein conducting simulation on the patient-specific atrial model to identify AF-perpetrating regions further comprises:
 constructing a geometric model of the atria, said geometric model including normal tissue regions and remodeled tissue regions determined for said patient using the three-dimensional imaging data.   
     
     
         13 . The method of  claim 12  further comprising:
 estimating atrial fiber orientations in said geometric model. 
 
     
     
         14 . The method of  claim 12 , wherein the geometric model of the tissue region includes at least a geometric model of right and left atria of the patient's heart, and
 wherein said remodeled tissue regions are segmented into a plurality of different regions based on said three-dimensional imaging data, said plurality of different regions including imaging data consistent with fibrotic regions, scar tissue regions, normal tissues regions, and transition zones between normal and fibrotic or scar tissue regions.   
     
     
         15 . The method of  claim 1 , wherein conducting simulation on the patient-specific atrial model to identify AF-perpetrating regions includes simulating electrophysiological activity of at least the right and left atria of the patient's heart. 
     
     
         16 . A non-transitory computer-readable medium comprising computer-executable code for identifying one or more ablation locations in an atrial tissue region in an atrial fibrillation (AF) patient with atrial fibrosis, said computer-executable code comprising instructions that, when executed by the computer, causes the computer to:
 receive three-dimensional imaging data representing the atria of the patient;   generate a patient-specific atrial model of AF from the three-dimensional imaging data;   conduct a simulation of AF using the patient-specific atrial model to identify AF-perpetrating regions; and   identify from the AF-perpetrating regions one or more ablation locations in the atria.   
     
     
         17 . The non-transitory computer-readable medium of  claim 16 , wherein the AF-perpetrating regions comprise regions of atrial tissue that contain the organizing centers of electrical rotors during simulation. 
     
     
         18 . The non-transitory computer-readable medium of  claim 17 , wherein persistent electrical rotors are re-circulating electrical waves in cardiac tissue. 
     
     
         19 . The non-transitory computer-readable medium of  claim 16 , further comprising computer-executable code that, when executed by the computer, causes the computer to:
 simulate ablation of lesions within and around the AF-perpetrating regions to determine the size and shape of the lesions necessary to render the atria non-inducible to AF.   
     
     
         20 . The non-transitory computer-readable medium of  claim 16  further comprising computer-executable code that, when executed by the computer, causes the computer to:
 determine whether pacing stimuli will degrade into reentrant activity. 
 
     
     
         21 . The non-transitory computer-readable medium of  claim 16 , wherein fibrotic lesions are modeled with electrophysiological properties that are distinct from non-fibrotic regions. 
     
     
         22 . The non-transitory computer-readable medium of  claim 16 , wherein induction of AF is simulated using a dynamic pacing from different locations. 
     
     
         23 . The non-transitory computer-readable medium of  claim 16  further comprising computer-executable code that, when executed by the computer, causes the computer to:
 determine fibrotic lesions that lead to the breakup of pacing-induced wavefronts and degeneration of the wavefronts into reentrant waves that form AF rotors; and 
 determine spatial location of the resulting AF rotors. 
 
     
     
         24 . The non-transitory computer-readable medium of  claim 16 , wherein the patient-specific atrial model includes modeling of fibrosis as at least one of ion channel function remodeling, collagen deposition, gap junction remodeling, fibroblast proliferation and phenotype switching into myofibroblasts, or any combination thereof. 
     
     
         25 . The non-transitory computer-readable medium of  claim 16 , wherein said three-dimensional imaging data is at least one of magnetic resonance imaging (MRI), computed tomography (CT), positron emission tomography (PET), ultrasound, or nuclear tracer three-dimensional imaging data. 
     
     
         26 . The non-transitory computer-readable medium of  claim 16  further comprising computer-executable code that, when executed by the computer, causes the computer to:
 receive additional patient-specific data that includes at least one of biopsy data, electrocardiogram data, recorded data from an implantable device, or invasive electrical mapping data, 
 wherein the simulation uses the additional patient-specific data. 
 
     
     
         27 . The non-transitory computer-readable medium of  claim 16  further comprising computer-executable code that, when executed by the computer, causes the computer to:
 construct a geometric model of the atria, said geometric model including normal tissue regions and remodeled tissue regions determined for said patient using the three-dimensional imaging data. 
 
     
     
         28 . The non-transitory computer-readable medium of  claim 27  further comprising computer-executable code that, when executed by the computer, causes the computer to:
 estimate atrial fiber orientations in said geometric model. 
 
     
     
         29 . The non-transitory computer-readable medium of  claim 27 , wherein the geometric model of the tissue region includes at least a geometric model of right and left atria of the patient's heart, and
 wherein said remodeled tissue regions are segmented into a plurality of different regions based on said three-dimensional imaging data, said plurality of different regions including imaging data consistent with fibrotic regions, scar tissue regions, normal tissues regions, and transition zones between normal and fibrotic or scar tissue regions.   
     
     
         30 . The non-transitory computer-readable medium of  claim 16 , wherein conducting simulation on the patient-specific atrial model to identify AF-perpetrating regions includes simulating electrophysiological activity of at least the right and left atria of the patient's heart. 
     
     
         31 . A system for identifying one or more ablation locations in an atrial tissue region in an atrial fibrillation (AF) patient with atrial fibrosis, the system comprising a processor configured to:
 receive three-dimensional imaging data representing the atria of the patient;   generate a patient-specific model of the atria from the three-dimensional imaging data;   conduct simulation of AF using the patient-specific atrial model to identify AF-perpetrating regions; and   identify from the AF-perpetrating regions one or more ablation locations in the atria.   
     
     
         32 . The system of  claim 31 , wherein the AF-perpetrating regions comprise regions of tissue that contain the organizing centers of persistent electrical rotors during simulation. 
     
     
         33 . The system of  claim 32 , wherein persistent electrical rotors are re-circulating electrical waves in cardiac tissue. 
     
     
         34 . The system of  claim 31 , wherein the processor is further configured to:
 simulate ablation of lesions within and around the AF-perpetrating regions to determine the size and shape of the lesion necessary to render the atria non-inducible to AF.   
     
     
         35 . The system of  claim 31 , wherein the processor is further configured to:
 determine whether pacing stimuli will degrade into reentrant activity.   
     
     
         36 . The system of  claim 31 , wherein fibrotic lesions are modeled with electrophysiological properties that are distinct from non-fibrotic regions. 
     
     
         37 . The system of  claim 31 , wherein induction of AF is simulated using a dynamic pacing from different locations. 
     
     
         38 . The system of  claim 31  wherein the processor is further configured to:
 determine fibrotic lesions that lead to the breakup of pacing-induced wavefronts and degeneration of the wavefronts into reentrant waves that form AF rotors; and 
 determine spatial location of the resulting AF rotors. 
 
     
     
         39 . The system of  claim 31 , wherein the patient-specific atrial model includes modeling of fibrosis as at least one of ion channel function remodeling, collagen deposition, gap junction remodeling, fibroblast proliferation and phenotype switching into myofibroblasts, or any combination thereof. 
     
     
         40 . The system of  claim 31 , wherein said three-dimensional imaging data is at least one of magnetic resonance imaging (MRI), computed tomography (CT), positron emission tomography (PET), ultrasound, or nuclear tracer three-dimensional imaging data. 
     
     
         41 . The system of  claim 31 , wherein the processor is further configured to:
 receive additional patient-specific data that includes at least one of biopsy data, electrocardiogram data, recorded data from an implantable device, or invasive electrical mapping data,   wherein the simulation uses the additional patient-specific data.   
     
     
         42 . The system of  claim 31 , wherein the processor is further configured to:
 construct a geometric model of the atria, said geometric model including normal tissue regions and remodeled tissue regions determined for said patient using the three-dimensional imaging data.   
     
     
         43 . The system of  claim 42 , wherein the processor is further configured to:
 estimate atrial fiber orientations in said geometric model.   
     
     
         44 . The system of  claim 42 , wherein the geometric model of the tissue region includes at least a geometric model of right and left atria of the patient's heart, and
 wherein said remodeled tissue regions are segmented into a plurality of different regions based on said three-dimensional imaging data, said plurality of different regions including imaging data consistent with fibrotic regions, scar tissue regions, normal tissues regions, and transition zones between normal and fibrotic or scar tissue regions.   
     
     
         45 . The system of  claim 31 , wherein conducting simulation on the patient-specific atrial model to identify AF-perpetrating regions includes simulating electrophysiological activity of at least the right and left atria of the patient's heart.