Ablation of multiwavelet re-entry guided by circuit-density and distribution: maximizing the probability of circuit annihilation

Circ Arrhythm Electrophysiol. 2013 Dec;6(6):1229-35. doi: 10.1161/CIRCEP.113.000759. Epub 2013 Sep 15.


Background: A key mechanism responsible for atrial fibrillation is multiwavelet re-entry (MWR). We have previously demonstrated improved efficiency of ablation when lesions were placed in regions of high circuit-density. In this study, we undertook a quantitative assessment of the relative effect of ablation on the probability of MWR termination and the inducibility of MWR, as a function of lesion length and circuit-density overlap.

Methods and results: We used a computational model to simulate MWR in tissues with (and without) localized regions of decreased action potential duration and increased intercellular resistance. We measured baseline circuit-density and distribution. We then assessed the effect of various ablation lesion sets on the inducibility and duration of MWR as a function of ablation lesion length and overlap with circuit-density. Higher circuit-density reproducibly localized to regions of shorter wavelength. Ablation lines with high circuit-density overlap showed maximum decreases in duration of MWR at lengths equal to the distance from the tissue boundary to the far side of the high circuit-density region (high-overlap, -43.5% [confidence interval, -22.0% to -65.1%] versus low-overlap, -4.4% [confidence interval, 7.3% to -16.0%]). Further ablation (beyond the length required to cross the high circuit-density region) provided minimal further reductions in duration and increased inducibility.

Conclusions: Ablation at sites of high circuit-density most efficiently decreased re-entrant duration while minimally increasing inducibility. Ablation lines delivered at sites of low circuit-density minimally decreased duration yet increased inducibility of MWR.

Keywords: arrhythmias, cardiac; atrial fibrillation; catheter ablation; electrophysiology.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Action Potentials / physiology
  • Algorithms
  • Atrial Fibrillation / physiopathology*
  • Atrial Fibrillation / surgery*
  • Catheter Ablation*
  • Electrophysiologic Techniques, Cardiac
  • Heart Atria / physiopathology
  • Heart Conduction System / physiopathology*
  • Humans
  • Myocytes, Cardiac / physiology
  • Treatment Outcome