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H2020Individual fellowship2015–2017

AFIBROTIC · Atrial Fibrillation, Fibrosis and Rotors: New Insights from Imaging and Computational Modeling

Horizon 2020 — Marie Skłodowska-Curie Actions

Duration
2015-10-01 → 2017-09-30
EU contribution
€168,277
Participants
1
Scheme
MSCA-IF-EF-ST

Lines connect the coordinator with its partners.

Results in brief

Atrial Fibrillation, Fibrosis and Rotors: New Insights from Imaging and Computational Modeling

Atrial fibrillation (AF) is the most common form of arrhythmia worldwide. In the EU, the prevalence of AF (2%) has doubled since the last decade and it is estimated that number of AF patients by 2030 will be 14–17 million. AF is associated with substantial morbidity and mortality. In particular, patients with AF have a five-fold higher risk of stroke. Management of AF and AF-related complications has a high burden on the social security systems (~10b€ in 2004). Despite the high clinical and societal priority, clinical management of AF is still suboptimal. AF is typically treated by pulmonary veins (PV’s) isolation by catheter ablation. However, success rates of PV isolation in non-paroxysmal patients (i.e., roughly the two thirds of AF patients) are as low as 28% for a single procedure. Indeed, non-paroxysmal AF is sustained by complex electrical sources, such as rotors focal sources and multiple wavelets, which persist after PV isolation. Hereto, ablation schemes that address such electrical features (e.g. rotor-driven ablation) have gained popularity. Yet, the initial enthusiasm is mitigated by growing skepticism due to the difficulty in replicating such protocols in multicenter studies. Overall, ablation of non-paroxysmal AF remains an unstandardized procedure with low success rates (42%). Moreover, stroke risk is treated either pharmaceutically (by anticoagulant drugs) or procedurally (by left clamping the left atrial appendage). Yet, stroke risk stratification indices, such as the CHADS score, are based on extremely generic parameters (e.g., age, hypertension, diabetes mellitus) and their predictive power remains low. The overall objective of AFIBROTIC was therefore to study the key mechanisms of atrial fibrillation, in particular connected to electrical conduction and blood flow dynamics, by using patient-specific computational modelling. Computational modelling provides a unique framework to study the response of a biological system to given solicitations (boundary conditions) in a fully controlled reproducible and non-invasive way. Ultimately, the developed technology aims to leads toward personalized optimal therapy delivery for the atrial fibrillation patient.

Data: CORDIS, © European Union

Project objective

Atrial fibrillation (AF) is the most common type of arrhythmia and causes substantial morbidity and mortality. AF is principally treated with catheter ablation. Unfortunately, the mechanisms that initiate and sustain the arrhythmia are still incompletely understood and, as such, ablation remains a highly operator-dependent procedure with low success rates. Two recent studies promise to lead to better ablation outcomes, showing that a) the amount of atrial fibrosis directly correlates with the non-responsiveness to ablation and that b) AF is maintained by electrical rotors and targeting their suppression improves the success rates. Nonetheless, the lack of a rigorous mechanistic framework of AF pathophysiology deprives those studies of solid fundaments so that their effective value is still debated.This project aims therefore to provide such a framework by exploiting advanced biomedical engineering concepts. The focus will be on explaining and connecting recent experimental findings about fibrosis and rotors. The relationship will be first analyzed in vivo from AF patient data acquired with state-of-the-art instrumentation in the field of interventional electrophysiology. Measured data will be then integrated within a multi-scale personalized computational model of the fibrillating atrium that will determine, on a patient-specific basis, the mechanistic connection between fibrosis and reentries. Furthermore, the tool will provide an in silico environment for personalized ablation planning. Key in the project will be the synergy between complementary state-of-the-art expertise in the fields of medical imaging and computational modeling provided by applicant and host institutions. All partners will strongly benefit from the implied two way knowledge transfer, in terms of career advancement (the applicant) and enlarged network/grant proposal opportunities. The study will foster more focused clinical research aiming at better treatment for the AF patients.

Original text from CORDIS.

Participants

  • ALMA MATER STUDIORUM - UNIVERSITA DI BOLOGNA · BolognaCoordinatorItaly

Links

Data: CORDIS, © European Union