Effects of Electrical and Structural Remodeling on Atrial Fibrillation Maintenance A Simulation Study 英文参考文献.docVIP

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Effects of Electrical and Structural Remodeling on Atrial Fibrillation Maintenance A Simulation Study 英文参考文献.doc

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Effects of Electrical and Structural Remodeling on Atrial Fibrillation Maintenance A Simulation Study 英文参考文献

EffectsofElectricalandStructuralRemodelingonAtrial FibrillationMaintenance:ASimulationStudy TrineKrogh-Madsen1,2,GeoffreyW.Abbott3¤,DavidJ.Christini1,2* 1GreenbergDivisionofCardiology,DepartmentofMedicine,WeillCornellMedicalCollege,NewYork,NewYork,UnitedStatesofAmerica,2InstituteforComputational Biomedicine,WeillCornellMedicalCollege,NewYork,NewYork,UnitedStatesofAmerica,3DepartmentofPharmacology,WeillCornellMedicalCollege,NewYork,New York,UnitedStatesofAmerica Abstract Atrialfibrillation,acommoncardiacarrhythmia,oftenprogressesunfavourably:inpatientswithlong-termatrialfibrillation, fibrillatoryepisodesaretypicallyofincreaseddurationandfrequencyofoccurrencerelativetohealthycontrols.Thisisdue toelectrical,structural,andcontractileremodelingprocesses.Weinvestigatedmechanismsofhowelectricalandstructural remodeling contribute to perpetuation of simulated atrial fibrillation, using a mathematical model of the human atrial actionpotentialincorporatedintoananatomicallyrealisticthree-dimensionalstructuralmodelofthehumanatria.Electrical and structural remodeling both shortened the atrial wavelength - electrical remodeling primarily through a decrease in actionpotentialduration,whilestructuralremodelingprimarilyslowedconduction.Thedecreaseinwavelengthcorrelates with an increase in the average duration of atrial fibrillation/flutter episodes. The dependence of reentry duration on wavelength was the same for electrical vs. structural remodeling. However, the dynamics during atrial reentry varied between electrical, structural, and combined electrical and structural remodeling in several ways, including: (i) with structural remodeling there were more occurrences of fragmented wavefronts and hence more filaments than during electrical remodeling; (ii) dominant waves anchored around different anatomical obstacles in electrical vs. structural remodeling;(iii)dominantwaveswereoftennotanchoredincombinedelectricalandstructuralremodeling.Weconclude that,insimulatedatrialfibrillation,