Full Text:   <2471>

Summary:  <1743>

CLC number: R540.4

On-line Access: 2024-08-27

Received: 2023-10-17

Revision Accepted: 2024-05-08

Crosschecked: 2019-03-02

Cited: 0

Clicked: 4894

Citations:  Bibtex RefMan EndNote GB/T7714

 ORCID:

Ling Xia

https://orcid.org/0000-0002-1937-9693

-   Go to

Article info.
Open peer comments

Journal of Zhejiang University SCIENCE B 2019 Vol.20 No.4 P.300-309

http://doi.org/10.1631/jzus.B1800420


Simulation of inter atrial block based on a human atrial model


Author(s):  Yuan Gao, Ying-lan Gong, Ling Xia, Ding-chang Zheng

Affiliation(s):  Key Laboratory for Biomedical Engineering of Ministry of Education, Department of Biomedical Engineering, Zhejiang University, Hangzhou 310027, China; more

Corresponding email(s):   xialing@zju.edu.cn

Key Words:  Inter atrial block, Electrocardiogram, Simulation, Heart model


Yuan Gao, Ying-lan Gong, Ling Xia, Ding-chang Zheng. Simulation of inter atrial block based on a human atrial model[J]. Journal of Zhejiang University Science B, 2019, 20(4): 300-309.

@article{title="Simulation of inter atrial block based on a human atrial model",
author="Yuan Gao, Ying-lan Gong, Ling Xia, Ding-chang Zheng",
journal="Journal of Zhejiang University Science B",
volume="20",
number="4",
pages="300-309",
year="2019",
publisher="Zhejiang University Press & Springer",
doi="10.1631/jzus.B1800420"
}

%0 Journal Article
%T Simulation of inter atrial block based on a human atrial model
%A Yuan Gao
%A Ying-lan Gong
%A Ling Xia
%A Ding-chang Zheng
%J Journal of Zhejiang University SCIENCE B
%V 20
%N 4
%P 300-309
%@ 1673-1581
%D 2019
%I Zhejiang University Press & Springer
%DOI 10.1631/jzus.B1800420

TY - JOUR
T1 - Simulation of inter atrial block based on a human atrial model
A1 - Yuan Gao
A1 - Ying-lan Gong
A1 - Ling Xia
A1 - Ding-chang Zheng
J0 - Journal of Zhejiang University Science B
VL - 20
IS - 4
SP - 300
EP - 309
%@ 1673-1581
Y1 - 2019
PB - Zhejiang University Press & Springer
ER -
DOI - 10.1631/jzus.B1800420


Abstract: 
inter atrial block (IAB) is a prevailing cardiac conduction abnormality that is under-recognized in clinical practice. IAB has strong association with atrial arrhythmia, left atrial enlargement, and electromechanical discordance, increasing the risk of atrial fibrillation (AF) and myocardial ischemia. IAB was generally believed to be caused by impaired conduction along the Bachmann bundle (BB). However, there are three other conduction pathways, including the fibers posteriorly in the vicinity of the right pulmonary veins (VRPV), transseptal fibers in the fossa ovalis (FO), and muscular bundles on the inferior atrial surface near the coronary sinus (CS). We hypothesized that the importance of BB on IAB might have been overestimated. To test this hypothesis, various combinations of conduction pathway blocks were simulated based on a realistic human atrial model to investigate their effects on the index of clinical diagnosis standard of IAB using a simulated 12-lead electrocardiogram (ECG). Firstly, the results showed that the BB block alone could not generate typical P wave morphology of IAB, and that the combination of BB and VRPV pathway block played important roles in the occurrence of IAB. Secondly, although single FO and CS pathways play subordinate roles in inter atrial conduction, their combination with BB and VRPV block could also produce severe IAB. In summary, this simulation study has demonstrated that the combinations of different inter atrial conduction pathways, rather than BB alone, resulted in ECG morphology of IAB. Attention needs to be paid to this in future pathophysiological and clinical studies of IAB.

基于人体心房模型的房间阻滞仿真

目的:探究不同心房间传导通道阻滞的组合对形成房间阻滞的影响及体表心电图变化,探究房间阻滞的产生机理.
创新点:通过仿真证明了单一Bachmann束阻滞并不能产生典型的房间阻滞P波时长和波形,并结合电兴奋传导时序,解释了房间阻滞的产生机理.
方法:通过64位螺旋电子计算机断层扫描(CT)扫描人体心房,构建心房解剖模型.阻断不同的心房间传导通道,以单域方程仿真出心房电兴奋传导时序,采用边界元法计算各时刻人体体表电位,进而计算出P波波形.
结论:要使P波时长和形态均满足临床诊断房间阻滞的条件,必须同时阻断Bachmann束和右肺静脉后部的穿间隔纤维(VRPV)通道,这为进一步了解房间阻滞的发病机制及未来临床研究提供了指导.

关键词:房间阻滞;心电图;仿真;心脏建模

Darkslateblue:Affiliate; Royal Blue:Author; Turquoise:Article

Reference

[1]Abe Y, Fukunami M, Yamada T, et al., 1997. Prediction of transition to chronic atrial fibrillation in patients with paroxysmal atrial fibrillation by signal-averaged electrocardiography: a prospective study. Circulation, 96(8):2612-2616.

[2]Ackerman MI, 1991. Viewpoint: the visible human project. J Biocommun, 18(2):14.

[3]Alexander B, MacHaalany J, Lam B, et al., 2017. Comparison of the extent of coronary artery disease in patients with versus without interatrial block and implications for new-onset atrial fibrillation. Am J Cardiol, 119(8):1162-1165.

[4]Ariyarajah V, Spodick DH, 2006. The Bachmann Bundle and interatrial conduction. Cardiol Rev, 14(4):194-199.

[5]Ariyarajah V, Apiyasawat S, Najjar H, et al., 2007a. Frequency of interatrial block in patients with sinus rhythm hospitalized for stroke and comparison to those without interatrial block. Am J Cardiol, 99(1):49-52.

[6]Ariyarajah V, Kranis M, Apiyasawat S, et al., 2007b. Potential factors that affect electrocardiographic progression of interatrial block. Ann Noninvasive Electrocardiol, 12(1):21-26.

[7]Bachmann G, 1916. The inter-auricular time interval. Am J Physiol Legacy Content, 41(3):309-320.

[8]Bayés de Luna A, Platonov P, Cosio FG, et al., 2012. Interatrial blocks. A separate entity from left atrial enlargement: a consensus report. J Electrocardiol, 45(5):445-451.

[9]Bayés de Luna A, Martínez-Sellés M, Bayés-Genís A, et al., 2017. Surface ECG interatrial block-guided treatment for stroke prevention: rationale for an attractive hypothesis. BMC Cardiovasc Disord, 17:211.

[10]Burri H, Bennani I, Domenichini G, et al., 2011. Biatrial pacing improves atrial haemodynamics and atrioventricular timing compared with pacing from the right atrial appendage. EP Europace, 13(9):1262-1267.

[11]Chhabra L, Devadoss R, Chaubey VK, et al., 2014. Interatrial block in the modern era. Curr Cardiol Rev, 10(3):181-189.

[12]Courtemanche M, Ramirez RJ, Nattel S, 1998. Ionic mechanisms underlying human atrial action potential properties: insights from a mathematical model. Am J Physiol, 275(1):H301-H321.

[13]Deng DD, Jiao PF, Ye XS, et al., 2012a. An image-based model of the whole human heart with detailed anatomical structure and fiber orientation. Comput Math Methods Med, 2012:891070.

[14]Deng DD, Gong YL, Shou GF, et al., 2012b. Simulation of biatrial conduction via different pathways during sinus rhythm with a detailed human atrial model. J Zhejiang Univ-Sci B (Biomed & Biotechnol), 13(9):676-694.

[15]Enriquez A, Sarrias A, Villuendas R, et al., 2015. New-onset atrial fibrillation after cavotricuspid isthmus ablation: identification of advanced interatrial block is key. EP Europace, 17(8):1289-1293.

[16]Fernández-Fernández FJ, 2017. Atrial fibrillation: interatrial block may be an underdiagnosed and easily recognizable risk factor. Mayo Clin Proc, 92(4):681-682.

[17]Gao Y, Xia L, Gong YL, et al., 2018. Electrocardiogram (ECG) patterns of left anterior fascicular block and conduction impairment in ventricular myocardium: a whole-heart model-based simulation study. J Zhejiang Univ-Sci B (Biomed & Biotechnol), 19(1):49-56.

[18]Gialafos E, Psaltopoulou T, Papaioannou TG, et al., 2007. Prevalence of interatrial block in young healthy men <35 years of age. Am J Cardiol, 100(6):995-997.

[19]Gong YL, Gao Y, Lu ZH, et al., 2015. Preliminary simulation study of atrial fibrillation treatment procedure based on a detailed human atrial model. J Clin Trial Cardiol, 2(4):1-9.

[20]https://doi.org/10.15226/2374-6882/2/4/00130

[21]He JL, Tse G, Korantzopoulos P, et al., 2017. P-wave indices and risk of ischemic stroke: a systematic review and meta-analysis. Stroke, 48(8):2066-2072.

[22]Kitkungvan D, Spodick DH, 2009. Interatrial block: is it time for more attention? J Electrocardiol, 42(6):687-692.

[23]Kligfield P, Gettes LS, Bailey JJ, et al., 2007. Recommendations for the standardization and interpretation of the electrocardiogram: Part I: the electrocardiogram and its technology: a scientific statement from the American Heart Association Electrocardiography and Arrhythmias Committee, Council on Clinical Cardiology; the American College of Cardiology Foundation; and the Heart Rhythm Society. J Am Coll Cardiol, 49(10):1109-1127.

[24]Lau CP, Tachapong N, Wang CC, et al., 2013. Prospective randomized study to assess the efficacy of site and rate of atrial pacing on long-term progression of atrial fibrillation in sick sinus syndrome: septal pacing for atrial fibrillation suppression evaluation (SAFE) study. Circulation, 128(7):687-693.

[25]Martínez-Sellés M, Massó-van Roessel A, Álvarez-García J, et al., 2016. Interatrial block and atrial arrhythmias in centenarians: prevalence, associations, and clinical implications. Heart Rhythm, 13(3):645-651.

[26]Martínez-Sellés M, Baranchuk A, Elosua R, et al., 2017. Rationale and design of the BAYES (Interatrial Block and Yearly Events) registry. Clin Cardiol, 40(4):196-199.

[27]Massó-van Roessel A, Escobar-Robledo LA, Dégano IR, et al., 2017. Analysis of the association between electrocardiographic P-wave characteristics and atrial fibrillation in the REGICOR study. Rev Esp Cardiol (Engl Ed), 70(10):841-847.

[28]O'Neal WT, Zhang ZM, Loehr LR, et al., 2016. Electrocardiographic advanced interatrial block and atrial fibrillation risk in the general population. Am J Cardiol, 117(11):1755-1759.

[29]Rubaj A, Rucinski P, Kutarski A, et al., 2013. Cardiac hemodynamics and proinflammatory cytokines during biatrial and right atrial appendage pacing in patients with interatrial block. J Interv Card Electrophysiol, 37(2):147-154.

[30]Shou GF, Xia L, Jiang MF, et al., 2007. Forward and inverse solutions of electrocardiography problem using an adaptive BEM method. Proc 4th Int Conf on Functional Imaging and Modeling of the Heart, p.290-299.

[31]Spodick DH, Ariyarajah V, 2009. Interatrial block: the pandemic remains poorly perceived. Pacing Clin Electrophysiol, 32(5):667-672.

[32]Tapanainen JM, Jurkko RF, Holmqvist F, et al., 2009. Interatrial right-to-left conduction in patients with paroxysmal atrial fibrillation. J Interv Card Electrophysiol, 25(2):117-122.

[33]Tekkesin AI, Çinier G, Cakilli Y, et al., 2017. Interatrial block predicts atrial high rate episodes detected by cardiac implantable electronic devices. J Electrocardiol, 50(2):234-237.

[34]Tse G, Lai ETH, Yeo JM, et al., 2016. Electrophysiological mechanisms of Bayés syndrome: insights from clinical and mouse studies. Front Physiol, 7:188.

[35]Tse G, Wong CW, Gong MQ, et al., 2017. Predictive value of inter-atrial block for new onset or recurrent atrial fibrillation: a systematic review and meta-analysis. Int J Cardiol, 250:152-156.

[36]Verlato R, Botto GL, Massa R, et al., 2011. Efficacy of low interatrial septum and right atrial appendage pacing for prevention of permanent atrial fibrillation in patients with sinus node disease: results from the electrophysiology-guided pacing site selection (EPASS) study. Circ Arrhythm Electrophysiol, 4(6):844-850.

[37]Waldo AL, Bush HL Jr, Gelband H, et al., 1971. Effects on the canine P wave of discrete lesions in the specialized atrial tracts. Circ Res, 29(5):452-467.

[38]Wu JT, Wang SL, Chu YJ, et al., 2017. CHADS2 and CHA2DS2-VASc scores predict the risk of ischemic stroke outcome in patients with interatrial block without atrial fibrillation. J Atheroscler Thromb, 24(2):176-184.

[39]Xia L, Huo M, Wei Q, et al., 2006. Electrodynamic heart model construction and ECG simulation. Methods Inf Med, 45(5):564-573.

[40]Zhang Y, Xia L, Gong YL, et al., 2007. Parallel solution in simulation of cardiac excitation anisotropic propagation. Proc 4th Int Conf on Functional Imaging and Modeling of the Heart, p.170-179.

Open peer comments: Debate/Discuss/Question/Opinion

<1>

Please provide your name, email address and a comment





Journal of Zhejiang University-SCIENCE, 38 Zheda Road, Hangzhou 310027, China
Tel: +86-571-87952783; E-mail: cjzhang@zju.edu.cn
Copyright © 2000 - 2024 Journal of Zhejiang University-SCIENCE